Resolution of epoetin‐induced pure red cell aplasia, successful re‐challenge with roxadustat

Wu, Yunjie; Cai, Xiaona; Ni, Jianing; Lin, Xiaomeng

doi:10.1111/ijlh.13325

Cited by 10 publications

(16 citation statements)

References 10 publications

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“…This current case was different to another patient that received roxadustat after using immunosuppressant agents. 6 In conclusion, careful evaluation of this current case suggests that repeat testing for anti-EPO antibodies is required when a patient is suspected of having developed resistance to EPO therapy. Roxadustat was useful in treating anti-EPO antibodymediated renal anaemia without the use of immunosuppressants in this current case.…”

Section: Discussionmentioning

confidence: 82%

“…7,8 Recently, roxadustat was found to be useful in treating anti-EPO antibody-mediated renal anaemia. 6 This current case report describes a female patient with chronic kidney disease that developed anti-EPO antibody-mediated renal anaemia subsequent to rHuEPO treatment, which was successfully treated with roxadustat.…”

Section: Introductionmentioning

confidence: 95%

“…5 Previous literature has reported that roxadustat, an inhibitor of hypoxia-inducible factor proline hydroxylases (HIF-PHI), has effects on anti-EPO antibodies. 6 As a novel oral agent, roxadustat first became available in China on 18 th December 2018 and it has now been successfully used in treating patients with renal anaemia. 7,8 Recently, roxadustat was found to be useful in treating anti-EPO antibody-mediated renal anaemia.…”

Section: Introductionmentioning

confidence: 99%

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Successful application of roxadustat in the treatment of patients with anti-erythropoietin antibody-mediated renal anaemia: a case report and literature review

et al. 2021

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Recombinant human erythropoietin (rHuEPO) has been used worldwide for treatment of renal anaemia due to its good curative effect. However, rHuEPO treatment is associated with a rare but severe complication because of the development of anti-EPO antibodies, which are difficult to treat. Currently, the main treatments for the anti-EPO antibodies include withdrawing the rHuEPO, providing blood transfusions and administrating steroid-based immunosuppressive agents. Although the above methods can alleviate anti-EPO-related anaemia, there are obvious side-effects such as decreased immunity and an increased risk of infection. Therefore, accurately identifying anti-EPO-related anaemia and effectively treating this complication is worth exploring. This current case report describes a 49-year-old female patient with chronic kidney disease that received rHuEPO subcutaneously and then developed anti-EPO antibody-mediated renal anaemia with her haemoglobin levels dropping to 37 g/l. The patient refused to be treated with steroids, so she received 120 mg roxadustat administered orally every 72 h and her Hb level increased to 110 g/l over a few months. This current case report demonstrates that roxadustat can be used to successfully treat anti-EPO antibody-mediated renal anaemia without the use of steroid-based immunosuppressants.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Successful application of roxadustat in the treatment of patients with anti-erythropoietin antibody-mediated renal anaemia: a case report and literature review

et al. 2021

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“…His hemoglobin started to stabilize and rose rapidly. Besides, anti‐EPO antibody remained negative after continued use of roxadustat 8 …”

Section: Discussionmentioning

confidence: 99%

“…Besides, anti-EPO antibody remained negative after continued use of roxadustat. 8 Roxadustat is an oral HIF prolyl hydroxylase inhibitor that enhanced HIF transcriptional activity by stabilizing HIFα subunits.…”

Section: Discussion and Con Clus I On Smentioning

confidence: 99%

Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Peng

2021

Seminars in Dialysis

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Anti-erythropoietin antibody-related pure red cell aplasia (anti-EPO PRCA) is a severe complication in patients who receive erythropoiesis-stimulating agents for nephrogenic anemia. The standard therapy is withdrawl of EPO and immunosuppression.Here, we present successful treatment of anti-EPO PRCA with roxadustat, a hypoxiainducible factor prolyl hydroxylase inhibitor. A 39-year-old woman with end-stage renal disease received recombinant human erythropoietin (rhEPO) subcutaneously.Unfortunately, she developed anti-EPO PRCA and her hemoglobin dropped continuously, whereas she rejected immunosuppressive therapy. The patient failed to achieve How to cite this article: Wu R, Peng Y. Roxadustat on anti-erythropoietin antibody-related pure red cell aplasia in the patient with end-stage renal disease. Semin Dial.

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Positive response of a hemodialysis patient with pure red cell aplasia on recombinant human erythropoietin therapy to cyclosporine and Roxadustat

Ma,

Pai,

Zhu

et al. 2024

CEN Case Rep

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Recombinant human erythropoietin (rHuEPO) is commonly used to treat anemia associated with chronic kidney disease (CKD). EPO-induced Pure Red Cell Aplasia (PRCA) is a rare condition of profound anemia with EPO treatment. Upon finding the development of EPO-induced PRCA, the treatment requires immediate withdrawal of EPO therapy and initiate new treatments with immunosuppression or renal transplantation. Anti-EPO antibody assay is not always positive in EPO-induced PRCA. Here, we report a case on the sudden development of PRCA in a hemodialysis patient receiving EPO and how we treated the condition successfully with cyclosporine and subsequently maintained the hemoglobin with Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI). Even though the anti-EPO antibody was negative by Enzyme Linked Immunosorbent Assay (ELISA) in our case, the clinical course, the markedly reduced reticulocyte count < 10,000/μL, the bone marrow (BM) biopsy revealing reduced erythroblasts, and its subsequent response to cyclosporine, were similar to EPO-induced PRCA. The clinical picture of EPO-induced PRCA, the limitation of the EPO-neutralizing antibody (Ab) assay, and treatment strategies were discussed.

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Resolution of epoetin‐induced pure red cell aplasia, successful re‐challenge with roxadustat

Cited by 10 publications

References 10 publications

Successful application of roxadustat in the treatment of patients with anti-erythropoietin antibody-mediated renal anaemia: a case report and literature review

Successful application of roxadustat in the treatment of patients with anti-erythropoietin antibody-mediated renal anaemia: a case report and literature review

Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Positive response of a hemodialysis patient with pure red cell aplasia on recombinant human erythropoietin therapy to cyclosporine and Roxadustat

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