A dosing algorithm for erythropoietin alpha in older adults with heart failure and a preserved ejection fraction
Cardiovascular Therapeutics, 04/30/2012
Altincatal A et al. – The currently employed dosing algorithm, which adjusts the administration of erythropoietin stimulating agent (ESA) based on the absolute hemoglobin and weekly change in hemoglobin increases hemoglobin concentrations (Hb) with relatively a low weekly dose of ESA without significant effects on blood pressure (BP).Methods
- In an ongoing randomized, placebo controlled, single blind clinical trial of ESA (epoetin alfa) in anemic patients with HF and a preserved ejection fraction (HFPEF), Hb was measured weekly as was BP, weight and concomitant medical therapy.
- A repeated measure mixed model evaluated determinants of weekly changes in Hb and BP.
- Among 45 subjects (78 ± 11 years, 67% women, EF = 57 ± 9%) with a total of 780 repeated weekly Hb measures, Hb significantly increased over time in those assigned to ESA (β= 0.933, P < 0.0001), compared to placebo.
- Dose (β=-0.108, P < 0.0001), patient weight (β=–0.016, P= 0.0037), diuretic use (β=–0.124, P= 0.0389), and time (β= 0.003, P= 0.0331), were all significantly associated with Hb change.
- Increased diuretic dose and weight change were significantly inversely associated with changes in Hb.
- ESA administration and dose were not significant determinants of absolute BP or changes in BP from baseline.