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聚乙二醇化重组人促红细胞生成素治疗腹膜透析慢性肾病患者的贫血

Peginesatide to Manage Anemia in Chronic Kidney Disease Patients on Peritoneal Dialysis.

作者信息

Zabaneh Raja, Roger Simon D, El-Shahawy Mohamed, Roppolo Michael, Runyan Grant, O'Neil Janet, Qiu Ping

机构信息

Northwest Louisiana Nephrology, Shreveport, Louisiana, USA

Department of Renal Medicine, Gosford Hospital, Gosford, New South Wales, Australia.

出版信息

Perit Dial Int. 2015 Jul-Aug;35(4):481-9. doi: 10.3747/pdi.2012.00224. Epub 2014 Mar 1.

Abstract

UNLABELLED

BACKGROUND

Peginesatide is a novel, synthetic, peptide-based pegylated erythropoiesis-stimulating agent that is designed specifically to stimulate the erythropoietin receptor. The purpose of the present study was to assess, for the first time, the efficacy and safety of peginesatide in chronic kidney disease (CKD) patients receiving peritoneal dialysis (PD) and previously on epoetin treatment. ♦

METHODS

In this open-label multicenter study, 59 PD patients with CKD were converted from epoetin (alfa or beta) to once-monthly peginesatide. Doses were titrated to maintain hemoglobin levels between 10 g/dL and 12 g/dL during the 25 weeks of the study. The primary endpoint was change from baseline in mean hemoglobin values during the evaluation period (weeks 20 - 25). ♦

RESULTS

The mean hemoglobin value during the evaluation period was 11.3 ± 1.07 g/dL, and the mean change from baseline was 0.10 ± 1.15 g/dL (95% confidence limits: -0.24, 0.44 g/dL). During the evaluation period, most patients maintained hemoglobin levels between 10 g/dL and 12 g/dL (63.0%) and within ±1.0 g/dL of baseline (60.9%). The median weekly epoetin dose at baseline was 96.0 U/kg, and the median starting peginesatide dose was 0.047 mg/kg. Forty-three patients (72.9%) completed the study. Six patients (10.2%) received red blood cell transfusions. The observed adverse event profile was consistent with underlying conditions in the PD patient population. The most common adverse event was peritonitis (20.3%), a complication commonly associated with PD. Four deaths occurred during the study (2 related to septic shock, and 1 each to myocardial ischemia and myasthenia gravis). ♦

CONCLUSIONS

In this study, once-monthly peginesatide maintained hemoglobin levels in PD patients after conversion from epoetin.

摘要

未标注

背景

聚乙二醇化促红细胞生成素是一种新型的、合成的、基于肽的聚乙二醇化促红细胞生成刺激剂,专门设计用于刺激促红细胞生成素受体。本研究的目的是首次评估聚乙二醇化促红细胞生成素在接受腹膜透析(PD)且先前接受过促红细胞生成素治疗的慢性肾脏病(CKD)患者中的疗效和安全性。♦

方法

在这项开放标签的多中心研究中,59例CKD的PD患者从促红细胞生成素(α或β)转换为每月一次的聚乙二醇化促红细胞生成素。在研究的25周内滴定剂量以维持血红蛋白水平在10 g/dL至12 g/dL之间。主要终点是评估期(第20 - 25周)内平均血红蛋白值相对于基线的变化。♦

结果

评估期内平均血红蛋白值为11.3±1.07 g/dL,相对于基线的平均变化为0.10±1.15 g/dL(95%置信区间:-0.24,0.44 g/dL)。在评估期内,大多数患者维持血红蛋白水平在10 g/dL至12 g/dL之间(63.0%),且在基线水平±1.0 g/dL范围内(60.9%)。基线时促红细胞生成素的中位每周剂量为96.0 U/kg,聚乙二醇化促红细胞生成素的中位起始剂量为0.047 mg/kg。43例患者(72.9%)完成了研究。6例患者(10.2%)接受了红细胞输血。观察到的不良事件谱与PD患者群体的基础疾病一致。最常见的不良事件是腹膜炎(20.3%),这是一种与PD常见相关的并发症。研究期间发生了4例死亡(2例与感染性休克有关,1例与心肌缺血有关,1例与重症肌无力有关)。♦

结论

在本研究中,每月一次的聚乙二醇化促红细胞生成素在从促红细胞生成素转换后维持了PD患者的血红蛋白水平。

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本文引用的文献

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A peptide-based erythropoietin-receptor agonist for pure red-cell aplasia.
N Engl J Med. 2009 Nov 5;361(19):1848-55. doi: 10.1056/NEJMoa074037.
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Clin Ther. 2009 Jun;31(6):1321-34. doi: 10.1016/j.clinthera.2009.06.013.
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Anemia management in patients on peritoneal dialysis: efficacy and safety of epoetin delta.
Haematologica. 2008 May;93(5):761-4. doi: 10.3324/haematol.10985. Epub 2008 Mar 26.
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