Biology Reference
In-Depth Information
patients with ACD are sufficiently anemic to potentially require red cell trans-
fusions [3, 4]. The usual approach to ACD has been to direct treatment to the
underlying disorder, since the degree of anemia generally reflects the activity
of the associated disease. Since the anemia is generally not sufficiently severe
to merit specific therapy,this remains the best general recommendation. For
individuals who would potentially benefit from a higher hematocrit, however,
the use of rHuEPO has proved highly effective.
rHuEPO in ACD
The use of rHuEPO in ACD was first reported as an abstract in December 1987
and as a full paper in 1989 [74]. Two patients with anemia and rheumatoid
arthritis were treated with rHuEPO 100 to 300 U/kg intravenously three times
a week for four to five months with correction of the hematocrit into the nor-
mal range. Comparable results were obtained with similar doses of intravenous
rHuEPO in two larger studies (six and thirteen patients, respectively) involv-
ing patients with rheumatoid arthritis [75, 76].
About the same time, data began to emerge from the nephrology literature
indicating that rHuEPO administered subcutaneously was of comparable or
greater efficacy than rHuEPO administered intravenously [77]. In addition to
offering a greater degree of convenience, this route of administration offered
the possibility of self-administration, an issue of great importance in ACD.
Table 1 summarizes several studies using subcutaneous rHuEPO in ACD.
Although subcutaneous rHuEPO is clearly effective in ACD, the size of the
response and the dose required to achieve it in these studies differs consider-
ably. In the study of patients in intensive care units [83], the comparatively
small response in the context of large doses of rHuEPO likely reflects the short
Table 1. Use of subcutaneous recombinant human (rHuEPO) in anemia of chronic disease (ACD)
Ref
Setting
n
rHuEPO/wk
Doses/wk
Mean Hgb Duration
(g/dL)
[78]
Rheumatoid arthritis
11
250 U/kg
2.7
6 weeks
[79]
Rheumatoid arthritis
34
720 U/kg
3
1.3
6 weeks
[80]
Rheumatoid arthritis
36
300 U/kg
2
1.2
12 weeks
[81]
Rheumatoid arthritis
30
300 U/kg
3
2.5
12 weeks
[82]
Crohn's disease
450 U/kg
3
2.9
12 weeks
4
4.9%
b
[83]
ICU
80
1500 U/kg × 1;
5; then 3
2-6 weeks
then 900 U/kg
[84]
Congestive heart failure
26
5227
a
1.9
a
4-15 months
1
hgb, hemoglobin; ICU, intensive care unit.
a
mean dose. The dose was adjusted to achieve a target hemoglobin of 12 g/dL.
b
expressed as hematocrit in this study.
