Zheng Qiyan, Wang Yahui, Yang Huisheng, Sun Luying, Fu Xinwen, Wei Ruojun, Liu Yu Ning, Liu Wei Jing
Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China.
Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.
Front Pharmacol. 2021 Jan 12;11:573645. doi: 10.3389/fphar.2020.573645. eCollection 2020.
Daprodustat is a novel oral agent in treating anemia of chronic kidney disease (CKD), and several clinical trials have been conducted to compare daprodustat with recombinant human erythropoietin (rhEPO) or placebo. Our systematic review aimed to investigate the efficacy and safety of daprodustat for anemia treatment in both dialysis-dependent (DD) and non-dialysis-dependent (NDD) patients. Six databases were searched for randomized controlled trials (RCTs) reporting daprodustat vs. rhEPO or placebo for anemia patients in CKD. The outcome indicators were focused on hemoglobin (Hb), ferritin, transferrin saturation (TSAT), total iron-binding capacity (TIBC), vascular endothelial growth factor (VEGF), and serious adverse events (SAEs). Eight eligible studies with 1,516 participants were included. For both NDD and DD patients, changes in Hb levels from baseline were significantly higher in daprodustat group than that in the placebo (mean difference (MD) = 1.73, [95% confidence interval (CI), 0.34 to 3.12], = 0.01; MD = 1.88, [95% CI, 0.68 to 3.09], = 0.002; respectively), and there was no significant difference between daprodustat and rhEPO group (MD = 0.05, [95% CI, -0.49 to 0.59], = 0.86; MD = 0.12, [95% CI, -0.28 to 0.52], = 0.55; respectively). The indexes of iron metabolism were improved significantly in the daprodustat group compared to placebo- or rhEPO-treated patients, while there was no similar change in terms of TSAT for DD patients. Furthermore, no trend of increasing plasma VEGF was observed in daprodustat-treated subjects. As for safety, there was no significant difference in the incidence of SAEs between daprodustat and placebo treatment, while the incidence of SAEs in the daprodustat group was significantly lower than that in the rhEPO group. Daprodustat was efficacious and well tolerated for anemia in both NDD and DD patients in the short term based on current RCTs. And daprodustat may become an effective alternative for treatment of anemia with CKD. Since the application of daprodustat is still under exploration, future researches should consider the limitations of our study to evaluate the value of daprodustat.
达泊西汀是一种治疗慢性肾脏病(CKD)贫血的新型口服药物,已经进行了多项临床试验来比较达泊西汀与重组人促红细胞生成素(rhEPO)或安慰剂的效果。我们的系统评价旨在研究达泊西汀在透析依赖(DD)和非透析依赖(NDD)患者中治疗贫血的疗效和安全性。检索了六个数据库,以查找报告达泊西汀与rhEPO或安慰剂治疗CKD贫血患者的随机对照试验(RCT)。结局指标集中在血红蛋白(Hb)、铁蛋白、转铁蛋白饱和度(TSAT)、总铁结合力(TIBC)、血管内皮生长因子(VEGF)和严重不良事件(SAE)。纳入了八项符合条件的研究,共1516名参与者。对于NDD和DD患者,达泊西汀组Hb水平相对于基线的变化均显著高于安慰剂组(平均差值(MD)=1.73,[95%置信区间(CI),0.34至3.12],P=0.01;MD=1.88,[95%CI,0.68至3.09],P=0.002;),且达泊西汀组与rhEPO组之间无显著差异(MD=0.05,[95%CI,-0.49至0.59],P=0.86;MD=0.12,[95%CI,-0.28至0.52],P=0.55;)。与安慰剂或rhEPO治疗的患者相比,达泊西汀组铁代谢指标有显著改善,而DD患者的TSAT无类似变化。此外,在接受达泊西汀治疗的受试者中未观察到血浆VEGF升高的趋势。在安全性方面,达泊西汀与安慰剂治疗的SAE发生率无显著差异,而达泊西汀组的SAE发生率显著低于rhEPO组。基于目前的RCT,达泊西汀在短期内对NDD和DD患者的贫血均有效且耐受性良好。达泊西汀可能成为治疗CKD贫血的有效替代药物。由于达泊西汀的应用仍在探索中,未来的研究应考虑我们研究的局限性来评估达泊西汀的价值。