Comparison of Efficacy and Safety of Epoetin Alfa and Epoetin Beta in Continuous Ambulatory Peritoneal Dialysis Anemic Patients

Abstract

. Anemia is a very common complication in patients with chronic kidney disease (CKD) and its
main etiology is due to the decrease in renal production of erythropoietin (EPO). The two most commonly
used Erythropoietin-stimulating agents (ESAs) in Malaysian public hospitals are Epoetin alfa (Eprex®) and
Epoetin beta (Recormon®). This study aims to compare the efficacy and safety of Eprex® and Recormon® in
continuous ambulatory peritoneal dialysis (CAPD) anemia patients. This is a retrospective study included
72 CAPD patients in Hospital Serdang receiving Eprex® (n = 36) and Recormon® (n = 36) to maintain target
Hb at 11-12 g/dL. Hb, Hct, ferritin and blood pressure (BP) levels at baseline and upon achieving target
Hb were measured for each patient. The weekly EPO Index (defined as weekly epoetin dose/mean monthly
Hct) and Erythropoietin Resistance Index (ERI) (defined as weekly weight-adjusted epoetin dose/Hb level)
were derived for each patient at baseline, at target and at the end of 6th month follow-up, to evaluate ESA
dose-response. There was no significant difference between the two preparations in terms of mean target Hb
(p = 0.805) and Hct (p = 0.720) levels achieved. EPO index similarly decreased from baseline values in both
groups. Analysis showed no significant difference on EPO index and ERI in both Eprex® and Recormon®
group. However, percentage of patients improved from moderate stage of anemia was higher in Recormon®
(55.6%) as compared to Eprex® (39.7%) group. Sub-analysis showed female gender and lower albumin were
correlated with higher ESA treatment resistance. This may explain the higher ESA index and ERI in Recormon® group, which showed higher percentage of female gender patients. There was no statistically significant
correlation between ERI with baseline ferritin level (r = -0.065, p = 0.586). Both the mean change BP, and
SBP at the end of 6th month follow-up were not significantly different between two groups. It was concluded
that both efficacy and safety profile were not significantly different between Eprex® and Recormon® group