Eficiencia de la administración mensual subcutánea de metoxi-polietilenglicol epoetina β (Mircera®) en pacientes estables en hemodiálisis previamente tratados con eritropoyetinaEficiencia de la administración sc mensual de MIRCERA en pacientes en HD

Abstract

Objective

To analyze the effectiveness and efficiency of monthly treatment with subcutaneous CERA (Mircera^®) in terms of maintaining previous levels of hemoglobin (Hb) and dose equivalence in patients on hemodialysis (HD) compared with previous treatment with weekly subcutaneous erythropoietin.

Methodology

We conducted a 6-month prospective study that included 30 HD patients with a stable dose of subcutaneous erythropoietin for the previous 3 months, replaced by an equivalent dose of monthly subcutaneous CERA administered according to the official data sheet. Hb, ferritin and the transferrin saturation index (TSI) were measured monthly and the dose of CERA was adjusted to maintain Hb between 11 and 13 g/dl.

Results

Of the 30 patients who began the study, 13 were withdrawn because of death, transplantation or a process that might interfere with the Hb level. Of the 17 patients who completed the 6-month study, 12 (70.6%) had stable Hb levels with minor variations of ± 1 g/dl. Mean levels of Hb, ferritin and TSI also remained stable and no differences were found between levels at baseline and 6 months later (Hb 11.6 ± 0.6 vs. 11.5 ± 0.9 g/dl). However, an increase in the average dose of CERA was required from 160.3 ± 40.6 at baseline to 200.0 ± 95.2 mg/month after 6 months (ns). The mean change in dose was an increment of 27.9 ± 5.9%. The average monthly cost per patient increased from 174.3 ± 85.4 € (erythropoietin) to 290.1 ± 69.0 € (baseline CERA) and finally to 361.6 ± 169.3 € (6-month CERA).

Conclusion

Replacement of subcutaneous erythropoietin by subcutaneous CERA maintained Hb within baseline levels but with an increased dose and cost. However, because of the small sample size, our results were not statistically significant.