A randomized,controlled trial comparing darbepoetin alfa correction/maintenance dosing with weekly dosing for treating chemotherapy-induced anemia

ABSTRACT

Objective: To evaluate if a darbepoetin alfa correction/maintenance dosing regimen is non-inferior to a weekly regimen with respect to red blood cell trans­fusion requirements in patients with chemotherapy-induced anemia (CIA).

Research design and methods: In this randomized, active-controlled, double-blind phase 3 trial, CIA patients were randomized 1?:?1 to receive darbepoetin alfa in either a correction/maintenance schedule (4.5?μg/kg weekly for 4 weeks followed by 4.5?μg/kg every 3 weeks (Q3W)) or a weekly schedule (2.25?μg/kg weekly). The primary endpoint was the transfusion incidence during weeks 1–16. Non-inferiority was to be concluded if the upper limit of the 95% confidence interval (CI) of the difference in transfusion incidence between treatment groups was below 12.5%. Hematologic responses and safety profiles were also compared.

Results: Transfusion incidence (95% CI) during weeks 1–16 was 37% (32–42) and 38% (32–43) in the weekly and correction/maintenance groups, respectively. The difference (95% CI) in transfusions was 0.4% (–7.0 to 7.8), demonstrating non-inferiority between treatment groups. Similar percentages in both groups achieved and maintained hemoglobin in a target range of 11–13?g/dL and had clinically meaningful FACT?F score improvements. The median (range) time to hemoglobin response was 10 (1–17) weeks and 12 (2–17) weeks in the weekly and correction/maintenance groups, respectively. Both groups had similar safety profiles.

Conclusions: A correction/maintenance schedule with its initial two-fold higher weekly dosing and subsequent Q3W dosing yielded outcomes similar to those observed with a weekly schedule. Although correction/maintenance dosing provided no incremental clinical benefit, Q3W dosing could provide benefits of convenience and facilitate patient compliance.