Yamasaki Satoshi, Horiuchi Takahiko
Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0840, Japan.
Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan.
Hematol Rep. 2023 Mar 6;15(1):180-187. doi: 10.3390/hematolrep15010019.
Although daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, and dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, have been approved for the treatment of renal anemia in Japan, their efficacy and safety for patients aged 80 years or older with low-risk myelodysplastic syndrome (MDS)-related anemia have not been demonstrated. Our case series comprised two men and one woman aged >80 years with low-risk MDS-related anemia and diabetic mellitus (DM)-related chronic kidney disease who were dependent on red blood cell transfusions and in whom erythropoiesis-stimulating agents had been insufficient. All three patients received daprodustat and additional dapagliflozin achieved red blood cell transfusion independence and were followed up for >6 months. Daily oral daprodustat was well tolerated. There were no fatalities or progression to acute myeloid leukemia during the >6-month follow-up after daprodustat initiation. On the basis of these outcomes, we consider 24 mg of daprodustat combined with 10 mg of dapagliflozin daily an effective form of treatment for low-risk MDS-related anemia. Further studies are required to clarify the synergistic effects of daprodustat and dapagliflozin, which correct chronic kidney disease-related anemia by promoting endogenous erythropoietin production and normalizing iron metabolism to manage low-risk MDS in the long term.
尽管低氧诱导因子脯氨酰羟化酶抑制剂达普司他和钠-葡萄糖协同转运蛋白2抑制剂达格列净已在日本获批用于治疗肾性贫血，但其对80岁及以上低危骨髓增生异常综合征（MDS）相关贫血患者的疗效和安全性尚未得到证实。我们的病例系列包括两名男性和一名女性，年龄均大于80岁，患有低危MDS相关贫血和糖尿病（DM）相关慢性肾脏病，依赖红细胞输血且促红细胞生成剂治疗效果不佳。所有三名患者均接受了达普司他治疗，加用达格列净后实现了红细胞输血独立，并进行了超过6个月的随访。每日口服达普司他耐受性良好。在开始使用达普司他后的6个月随访期间，没有发生死亡或进展为急性髓系白血病的情况。基于这些结果，我们认为每日24毫克达普司他联合10毫克达格列净是治疗低危MDS相关贫血的有效治疗方式。需要进一步研究以阐明达普司他和达格列净的协同作用，它们通过促进内源性促红细胞生成素的产生和使铁代谢正常化来纠正慢性肾脏病相关贫血，从而长期管理低危MDS。
