Costly drugs used to address anemia in Chronic Kidney Disease (CKD) patients have been found to offer more risks than benefits. In a report on a study published this month in Annals of Internal Medicine, HealthDay said that contrary to previous thinking, drugs called erythropoietin-stimulating agents (ESAs) are not particularly effective in improving CKD patients’ quality of life.
But this class of medications, one intended benefit of which is to raise patients’ hemoglobin, the protein that carries oxygen in the blood, can in some instances – when the hemoglobin level is raised too much – increase patients’ risk of heart attacks, strokes and blood clots.
Drugs in this class include the injectables called Procrit, Epogen, and Aranesp.
Dr. Navdeep Tangri, an attending doctor at Seven Oaks General Hospital Renal Program in Winnipeg, Manitoba, Canada, was senior researcher on the study. He said its findings should “close the book on the idea that these drugs help with exhaustion and improve patients’ quality of life.”
Nevertheless, another expert said, in certain circumstances – where the patients are younger and more active, for example – some users of ESAs do feel somewhat better.
The U.S. Food and Drug Administration says the only reason ESAs should be prescribed is because they do seem to be effective in reducing the need in CKD patients for blood transfusions – a particular concern for individuals awaiting a kidney transplant because multiple transfusions can cause the immune system to generate antibodies with the potential to attack a donor kidney, said Dr. Jeffrey Berns, president of the National Kidney Foundation and a professor of medicine at the University of Pennsylvania.
In Berns’ view, HealthDay noted, it makes sense that these medications would not change day-to-day life for many people with chronic kidney disease, especially those on dialysis. Such patients are often older, have heart disease or other medical conditions, and are mostly sedentary.
“It’s not realistic to expect that you’ll improve their quality of life by raising their hemoglobin a little,” Berns said.
But, he added, younger patients who are still physically active and have full-time jobs or families to take care of may feel the difference when their hemoglobin is at 9 instead of 11.
For their study, Tangri and his colleagues pooled results of clinical trials that tested ESAs and aimed for either relatively higher or lower hemoglobin targets. On average, patients in the higher-target groups got their hemoglobin to between 10 and 14, while those with lower targets had levels between 7 and 12.
Overall, the researchers found, patients with higher hemoglobin reported no bigger gains in quality of life.
There was some evidence that among patients not on dialysis, higher hemoglobin led to bigger improvements in their physical functioning and energy levels. But, Tangri said, the average differences did not appear “clinically meaningful.”
He said the evidence does not support the idea that for certain patients, treatment should be “individualized” to reach a relatively higher hemoglobin level.
Berns disagreed — in part, he said, because the studies have included few younger, healthier patients.
“One of the challenges we have is that a study, or a meta-analysis of studies, tells us about the average for a group of patients,” Berns said. “That doesn’t necessarily tell me what to do with the patient in front of me.”