Subcutaneous epoetin-alpha every one,two, and three weeks in renal anemia

BACKGROUND: The same epoetin dose administered subcutaneously (SC) once weekly instead of thrice or twice weekly to patients with renal anemia is reported to be equally effective. The aim of this study was to verify whether a target hemoglobin (Hb) could be maintained with SC epoetin administered at longer intervals - every one, two or three weeks. METHODS: This was a single-center, retrospective cohort study on 67 consecutive outpatients (35 adult caucasian males) with anemia secondary to chronic renal insufficiency, all in follow-up for at least 12 months, who maintained the target Hb of 11 to 13 g/dL for six months with one SC injection of 10,000 U epoetin-alpha every five days (14,000 U/wk), or every one (Epo/1, 10,000 U/wk), two (Epo/2, 5,000 U/wk) or three weeks (Epo/3, 3,333 U/wk) according to their Hb concentrations after the induction phase. RESULTS: The target Hb > or = 11 g/dL was maintained over six months of treatment with SC epoetin > 10,000 U/week in 4 patients (6.0%, 95% CI 1.5-14.6) and with SC epoetin < or = 10,000 U/week in 63 patients (94.0%, 95% CI 85.4-98.4). Among the latter, 16 (25.4 %, 95% CI 15.3-37.9) maintained the target with Epo/1, 25 (39.7 %, 95% CI 27.6 to 52.8) with Epo/2, and 22 (34.9 %, 95% CI 23.3 to 48.0) with the Epo/3 regimen. On average, they received 5,688 U/week (86.2 U/kg/week) and the expected number of injections was 30 per year. CONCLUSIONS: Epoetin 10,000 U SC every two or three weeks maintained the target Hb concentration of 11-13 g/dL over a six month period in 75% of patients. Prospective, randomized and controlled trials are needed to establish the validity of this simplified regimen.