Abstract: FR-PO0207
Darbepoetin vs. Other Agents in CKD Anemia: A Meta-Analysis
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Mohammed, Yaqub Nadeem, Western Michigan University, Kalamazoo, Michigan, United States
- Faique Hassan, Muhammad, King Edward Medical University, Lahore, Punjab, Pakistan
- Cheema, Shamikha, King Edward Medical University, Lahore, Punjab, Pakistan
- Henna, Fathimathul, Dubai Medical College for Girls, Dubai, United Arab Emirates
- Javid, Saman, Combined Military Hospital Kharian, Kharian, Punjab, Pakistan
- Islam, M. Rafiqul, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Dhaka Division, Bangladesh
- Habib, Insha Insha, Al Nafees Medical College and Hospital, Islamabad, Islamabad Capital Territory, Pakistan
- Usman, Muhammad, Dow University of Health Sciences, Karachi, Sindh, Pakistan
- Hameed Kurmasha, Yousif, University of Kufa College of Medicine, Najaf, Najaf Governorate, Iraq
- Faheem, Muhammad Shaheer Bin, Karachi Institute of Medical Sciences, Karachi, Sindh, Pakistan
- Khaliq, Momina, King Edward Medical University, Lahore, Punjab, Pakistan
- Samreen, Syeda Daniya, Wayne State University School of Medicine, Detroit, Michigan, United States
Background
In chronic kidney disease (CKD), anemia impacts 78.9% to 96.5% of patients. Darbepoetin is used to treat CKD-anemia. By contrasting darbepoetin alpha with other erythropoetin-stimulating agents (ESAs), its role can be better understood. To evaluate Darbepoetin alpha's safety and effectiveness in treating anemia of CKD, a network meta-analysis was conducted.
Methods
Following PRISMA-NMA guidelines, from inception to November 24, 2024, a comprehensive search was conducted in: PubMed, Embase, Scopus, and clinicaltrials.gov. We included RCTs evaluating ESAs or a placebo in adults with anemia of CKD. Risk of bias assessment and data extraction were carried out independently. BUGSnet in R was used to perform a Bayesian network meta-analysis utilizing random-effects models. Mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals were used to quantify the effects of the treatments.
Results
Molidustat showed the best cardiovascular and thrombotic safety despite lower efficacy, while methyl polyethylene glycol-epoetin beta showed the largest Hb increase in this network meta-analysis of 12 randomized trials involving over 4,000 CKD patients with anemia. With a safety profile comparable to darbepoetin and no discernible variations in mortality or cardiovascular events, daprodustat produced a moderate improvement in Hb. Roxadustat was associated with a higher incidence of gastrointestinal adverse events, particularly diarrhea.
Conclusion
Daprodustat and roxadustat indicated equivalent or higher efficacy when compared to darbepoetin in elevating hemoglobin levels in CKD-related anemia, with daprodustat demonstrating a good safety profile. While conventional ESAs remain beneficial, HIF-PHIs offer promising oral alternatives with possible benefits in cardiovascular safety and decreased hypertension risk.
Comparitive efficacy of ESAs
| Agent | Rank for Hgb Rise+ | Magnitude of Hb change vs Baseline* | Comments |
| Darbepoetin Alpha | - | Comparator | Std |
| Molidustat | 4 | Lowest efficacy | Safe CV profile |
| Roxadustat | 2-3 | Equivalent or Higher vs Darbepoetin | Higher GI AEs |
| Daprodustat | 2 | Moderate increase > darbepoetin | Similar mortality and CV event rates |
| Methyl-PEG-epoetin beta | 1 | Largest increase in Hgb among all | Long-acting |
+ Lower rank number = greater hgb-raising efficacy. * Comparison only, not an exact quantitative ranking.