Short‐acting erythropoiesis‐stimulating agents for anaemia in predialysis patients

摘要: Background The benefits of erythropoiesis-stimulating agents (ESA) for chronic kidney disease (CKD) patients have been previously demonstrated. However, the efficacy and safety short-acting epoetins administered at larger doses reduced frequency as well new biosimilars remains uncertain. Objectives This review aimed to evaluate harms different routes, frequencies (epoetin alpha, epoetin beta other epoetins) anaemia in adults children with CKD not receiving dialysis. Search methods We searched Cochrane Kidney Transplant Specialised Register 12 September 2016 through contact Information Specialist using search terms relevant this review. Studies contained are identified strategies specifically designed CENTRAL, MEDLINE, EMBASE; handsearching conference proceedings; searching International Clinical Trials (ICTRP) Search Portal ClinicalTrials.gov. Selection criteria We included randomised control trials (RCTs) comparing frequencies, types ESAs patients. Data collection analysis Two authors independently assessed study eligibility four risk bias extracted data. Results were expressed ratio (RR) or differences (RD) 95% confidence intervals (CI) dichotomous outcomes. For continuous outcomes mean difference (MD) was used. Statistical analyses performed random-effects model. Main results We 14 RCTs (2616 participants); nine studies multi-centre two involved children. The high most studies; only three demonstrated adequate random sequence generation low allocation concealment. Blinding participants personnel one study. outcome assessment judged 13 measures reported laboratory results therefore unlikely be influenced by blinding. Attrition eight while selective reporting six studies. Four interventions compared: alpha same total dose (six studies); (two intravenously versus subcutaneous administration (one study); (five studies). One compared both doses. Data from 7/14 could our meta-analyses. There no significant final haemoglobin (Hb) levels when dosing every weeks weekly (4 studies, 785 participants: MD -0.20 g/dL, CI -0.33 -0.07), (three 671 -0.16 -0.43 0.10) (four administration: study, 144 0.17 g/dL -0.19 0.53). Five evaluated interventions. theta found Hb (288 -0.02 -0.25 0.21). significantly higher pain scores beta. Two (165 participants) delta available since pharmaceutical company withdrew commercial reasons. fifth biosimilar HX575 stopped after subcutaneously developed anti-epoetin antibodies available. Adverse events poorly all did differ within comparisons. Mortality detailed adequately quality life data. Authors' conclusions Epoetin given extended weekly) is non-inferior more frequent maintaining adverse effects non-dialysed patients. However data methodological so that cannot excluded. Further large, designed, patient-centred required assess large shorter acting ESAs, including less frequently smaller on dialysis.