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darbepoetin-alfa (Aranesp)

Tradename: Aranesp. (a longer acting erythropoietin) Indications: 1) anemia secondary to chronic renal failure 2) anemia in patients with heart failure? (see anemia & heart failure) Contraindications: - uncontrolled hypertension - not for use in patients receiving myelosuppressive therapy when the expected outcome is cure [5] - cancer-related anemia: may improve quality of life & diminish need for transfusion at the expense of increased mortality [6] - darbepoetin alpha provides little benefit & might cause harm in patients with type 2 diabetes, chronic kidney disease, & anemia; no clear hemoglobin target is safe [7] - hospitalized patients without symptoms of anemia or end organ damage [9] Dosage: - Weekly injection - check serum iron, TIBC, ferritin before initiating erythropoiesis-stimulating agent - maintain transferrin saturation > 30% & serum ferritin > 500 ng/mL - do not check serum erythropoietin [9] Adverse effects: 1) neutralizing antibodies against erythropoietin resulting in red cell aplasia with or without other cytopenias [3] 2) excess thrombosis & increased mortality when hemoglobin targeted to 13.4 g/dL [4]; no clear hemoglobin target is safe [7] 3) see epoetin-alfa Notes: Manufacturer: Amgen

Interactions

drug adverse effects of erythropoiesis-stimulating agents monitor with erythropoietins

Related

epoetin-alfa (Epogen, Procrit, Eprex)

General

erythropoiesis-stimulating agent recombinant protein; chimer erythropoietin (EPO)

References

  1. Prescriber's Letter 8(11):61 2001
  2. Department of Veterans Affairs, VA National Formulary
  3. FDA Medwatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#aranesp2 http://www.fda.gov/medwatch/safety/2006/safety06.htm#erythropoiesis
  4. Prescriber's Letter 14(1): 2007 Erythropoiesis Stimulating Agents (Aranesp, Epogen, and Procrit): Caution not to Exceed Recommended Hemoglobin Targets Detail-Document#: 230105 (subscription needed) http://www.prescribersletter.com
  5. FDA MedWatch http://www.fda.gov/medwatch/safety/2008/safety08.htm#ESA2
  6. Tonelli M et al. Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: A meta-analysis. CMAJ 2009 May 26; 180:E62. http://dx.doi.org/10.1503/cmaj.090470 PMID: 19407261
  7. Pfeffer MA et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009 Oct 30 PMID: 19880844 http://dx.doi.org/10.1056/NEJMoa0907845 http://content.nejm.org/cgi/content/abstract/NEJMoa0907845v1
  8. Prescriber's Letter 17(4): 2010 ESA APPRISE Oncology Program for Cancer Patients Using Procrit, Epogen, or Aranesp COMMENTARY: ESA APPRISE Oncology Program for Cancer Patients Using Procrit, Epogen, or Aranesp CHART: Drugs with Special Prescribing and Dispensing Requirements Detail-Document#: 260422 (subscription needed) http://www.prescribersletter.com
  9. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, American College of Physicians, Philadelphia 2015, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  10. Palmer SC, Saglimbene V, Craig JC et al Darbepoetin for the anaemia of chronic kidney disease. Cochrane Database Syst Rev. 2014 Mar 31;(3):CD009297. Review. PMID: 24683046