Hymes Jeffrey, Bickimer Tammy, Jackson James H, Bookhart Brahim K, Mody Samir H, Tak Piech Catherine
Nephrology Associates, Nashville, TN, USA.
Curr Med Res Opin. 2007 Aug;23(8):1931-7. doi: 10.1185/030079907X210705.
To compare real-world dosing patterns, drug costs, and hematologic outcome in anemic chronic kidney disease (CKD) patients, not receiving dialysis, who switched from darbepoetin alfa (DARB) to epoetin alfa (EPO) in a community practice setting.
This retrospective observational chart review from a US nephrology clinic included 153 anemic CKD patients > or = 18 years of age who did not receive dialysis during the study period, switched from DARB to EPO between 8/2003 and 8/2005, and received > or = 2 doses of both agents. Paired t-test and McNemar's chi-square were performed comparing pre-switch and post-switch outcomes.
Mean interval between doses increased from 24.3 +/- 11.1 days with DARB to 28.8 +/- 19.8 days with EPO (p = 0.001). Weighted mean pre-switch weekly dose for DARB was 25 mug, while weighted mean post-switch weekly dose for EPO was 7090 Units, resulting in a dose ratio (Units EPO:microg DARB) of 287:1. These doses resulted in mean weekly costs of $110 (DARB) and $86 (EPO). Mean hemoglobin (Hb) levels increased over time from 10.8 g/dL at 6 months pre-switch to 11.1 g/dL 6 months after EPO initiation (p = 0.0132). Mean Hb levels were > 11 g/dL, but below 12 g/dL, while patients received EPO.
Patients switching from DARB to EPO had a greater mean interval between doses, lower drug costs, and consistently maintained recommended Hb levels over time.
The reverse direction (EPO to DARB) was not investigated. Although treatment outcomes were not assessed in a randomized, controlled setting, the study's observational nature provided actual evidence in a real-world setting.
比较在社区实践环境中，未接受透析的贫血慢性肾脏病（CKD）患者从达比加群酯（DARB）转换为促红细胞生成素（EPO）后的实际给药模式、药物成本和血液学结果。
这项来自美国肾脏病诊所的回顾性观察图表审查纳入了153例年龄≥18岁的贫血CKD患者，这些患者在研究期间未接受透析，于2003年8月至2005年8月期间从DARB转换为EPO，且两种药物均接受了≥2剂。采用配对t检验和McNemar卡方检验比较转换前和转换后的结果。
给药间隔的平均时间从使用DARB时的24.3±11.1天增加到使用EPO时的28.8±19.8天（p = 0.001）。转换前DARB的加权平均每周剂量为25μg，而转换后EPO的加权平均每周剂量为7090单位，剂量比（EPO单位：μg DARB）为287:1。这些剂量导致每周平均成本分别为110美元（DARB）和86美元（EPO）。平均血红蛋白（Hb）水平随时间从转换前6个月的10.8 g/dL增加到开始使用EPO后6个月的11.1 g/dL（p = 0.0132）。患者接受EPO治疗期间，平均Hb水平>11 g/dL但低于12 g/dL。
从DARB转换为EPO的患者给药间隔平均时间更长，药物成本更低，且随着时间推移持续维持推荐的Hb水平。
未研究相反方向（从EPO转换为DARB）。尽管未在随机对照环境中评估治疗结果，但该研究的观察性质提供了真实世界环境中的实际证据。
