Subcutaneous versus intravenous administration of erythropoietin improves its efficiency for the treatment of anaemia in haemodialysis patients

Abstract

Recombinant human erythropoietin (rHuEpo) seems to be more efficient when given subcutaneously (SC) instead of intravenously (IV) for therapy of anaemia in haemodialysis patients. This was a cross-over study designed to assess the efficiency of rHuEpo when given SC rather than IV in a 1 year follow-up. Sixteen patients received IV rHuEpo for 6 months, then SC rHuEpo for 6 months. They were four males and 12 females with a mean age of 56 years (range 15-82). Haemoglobin concentration ([Hb]) was kept at 10 g/dl and transferrin saturation (TS) at more than 25%. Mean [Hb] was 9.7 +/- 1.0 g/dl with IV rHuEpo and 9.9 +/- 0.9 g/dl with SC rHuEpo (NS). Transferrin saturation was 27% before rHuEpo, 31% with IV rHuEpo and 34% with SC rHuEpo (NS vs IV rHuEpo). Serum ferritin was 691 +/- 113 ng/ml before rHuEpo, 652 +/- 94 ng/ml with IV rHuEpo and 997 +/- 132 ng/ml with SC rHuEpo (P < 0.05 vs IV rHuEpo). Intact parathyroid hormone was 354 +/- 83 pg/ml before rHuEpo, 201 +/- 63 pg/ml with IV rHuEpo and 122 +/- 33 pg/ml with SC rHuEpo (NS vs IV rHuEpo). Doses of IV rHuEpo were 156 +/- 24 U/kg/week and SC rHuEpo 74 +/- 13 U/kg/week (i.e. a saving of 53%; P < 0.001). We conclude that subcutaneous administration of rHuEpo is twice as efficient as IV rHuEpo in patients with good functional iron reserve.

Erythropoietin Accelerates the Regeneration of Ureteral Function in a Murine Model of Obstructive Uropathy

“…25 While intravenous administration results in higher plasma EPO, the subcutaneous route results in longer half-life, longer sustained plasma concentrations, which potentially enable the administration of lower concentrations, and potentially a lower risk of EPO induced hypertension. 26,27 Before proposing the implementation of EPO after ureteral obstruction the most efficient time line, most effective administration route and lowest EPO dose providing beneficial effects must be elucidated. That is the focus of current and future studies at our laboratory.…”

Subcutaneous Compared with Intravenous Epoetin in Patients Receiving Hemodialysis

“…Many, [12][13][14][15][16][17][18][19][20][21] but not all, [22][23][24][25][26][27] previous trials also concluded that the doses of epoetin required to maintain the hematocrit at a given level were lower with a subcutaneous route of administration, but most of those studies were nonrandomized crossover studies in which the patients were switched from the intravenous to the subcutaneous route of administration. This design does not take into consideration the possibility of crossover effects that would, owing to the long half-life of red cells, delay the decrease in hematocrit resulting from an inadequate dose.…”

Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology

“…Evidence from hemodialysis patients suggests that subcutaneous administration is 30%-50% more efficient than the intravenous route. 41,42 Recommendation. Continuing epoetin treatment beyond 6-8 weeks in the absence of response (eg, Ͻ 1-2 g/dL rise in hemoglobin level), assuming appropriate dose increase has been attempted in nonresponders, does not appear to be beneficial.…”