Effectiveness of Darbepoetin Alfa Versus Epoetin Alfa in Patients with Chemotherapy-Induced Anemia Treated in Clinical Practice

Abstract

Primary Purpose. The objective of this retrospective observational cohort study was to compare the effectiveness of darbepoetin alfa with that of epoetin alfa in patients with chemotherapy-induced anemia using data from noncontemporaneous chart audits conducted at a community-based oncology practice.Materials and Methods. For the first chart audit, data were collected from consecutive patients with nonmyeloid malignancies with diagnoses of chemotherapyinduced anemia and hemoglobin levels ≤10.5 g/dl who were receiving concurrent chemotherapy and had at least 5 weeks of visits from July-September 2000. After therapeutic substitution of darbepoetin alfa for epoetin alfa for all patients with chemotherapy-induced anemia, data were collected from consecutive darbepoetin alfatreated patients with diagnoses of chemotherapy-induced anemia and at least 8 weeks of visits from June-October (darbepoetin alfa was approved in July 2002).Results. Most (86%) of the 212 epoetin alfa-treated patients had received an initial dose of 40,000 U once weekly, and most (85%) of the 196 darbepoetin alfatreated patients had received a fixed dose of either 100 µg once weekly (49%) or 200 µg every 2 weeks (36%). At 8 weeks, the mean change in hemoglobin level was 1.1 g/dl for the darbepoetin alfa patient group and 1.0 g/dl for the epoetin alfa patient group.Discussion. Utilization, dose escalation rates, and clinical outcomes were considered comparable for the darbepoetin alfa and epoetin alfa patient groups.Conclusions. Darbepoetin alfa, 100 µg once weekly or 200 µg every 2 weeks, appears to be as effective as epoetin alfa, 40,000 U once weekly, for the treatment of chemotherapy-induced anemia in the clinical practice setting. The Oncologist 2004;9: 451-458

Pharmacodynamic model for chemotherapy-induced anemia in rats

“…Several clinical studies [4][5][6] have been conducted to gain insight into optimizing the dose and schedule of hematopoietic supports to improve management of chemotherapy-related anemia. In addition, the importance of baseline hemoglobin values at the start of erythropoietic therapy and the timing of erythropoietic treatment relative to application of chemotherapy have been recognized [1,7,8].…”

Neuroprotective Effect of Darbepoetin Alfa, a Novel Recombinant Erythropoietic Protein, in Focal Cerebral Ischemia in Rats

“…9 Darbepoetin alfa is now being used extensively to treat anemia associated with chronic renal insufficiency and chemotherapy. 10,11 Because darbepoetin alfa activates the EPO receptor, we hypothesized that it should also confer neuroprotection in stroke.…”

Therapeutic interchange of darbepoetin alfa for epoetin alfa in a multiinstitution health care system

“…Studies and clinical practice guidelines have shown that darbepoetin alfa can effectively ameliorate anemia in oncology patients when administered at intervals ranging from once a week to once every three weeks. [1][2][3][4][5]8,[11][12][13] This creates the potential for a flexible dosage regimen that can be aligned with a patient's cancer chemotherapy schedule, enabling both erythropoietic therapy and chemotherapy to be administered during the same visit. This, in turn, increases the time available for seeing other patients, potentially generating further income for the hospital or clinic.…”

“…The dosage equivalence between epoetin alfa (40,000 units weekly) and darbepoetin alfa (200 μg every two weeks or 100 μg weekly) for the oncology patients was determined with data gathered from published clinical trials, MUE data, and national guidelines. [1][2][3][4][5]8 In the nephrology setting, the dosage conversion recommended in the darbepoetin alfa package insert was used. 9 Support from administration.…”