Hemoglobin Response and Influence on Left Ventricular Hypertrophy after 24-Week Treatment of a Biosimilar Epoetin-Alfa in Hemodialysis Patients with Anemia
Prasert Thanakitcharu MD*, Napha Siriwiwatanakul MD**
Affiliation : * Division of Nephrology, Department of Medicine, Rajavithi Hospital, Bangkok ** Division of Cardiology, Department of Medicine, Rajavithi Hospital, Bangkok
Background : Anemia is common in end-stage renal disease (ESRD) patients and an important determinant
for left ventricular hypertrophy (LVH) in dialysis patients. There are increasing numbers of biosimilar epoetin-
alfa entering Thailand.
Objective : To conduct a prospective trial to evaluate the efficacy and safety of a biosimilar epoetin-alfa
(epoetin) (EspogenTM) in ESRD patients receiving chronic hemodialysis complicated by anemia and to address
its impact on the left ventricular mass index (LVMI) and volume index (LVVI) in these patients.
Materials and Methods : Twenty-two hemodialysis (HD) subjects were recruited from Rajavithi and Huachiew
Hospitals. Inclusion criteria were chronic HD, hemoglobin (Hb) < 10 g/dL without preceding treatment
(epoetin or transfusion) for 1 month. Echocardiographic baselines were obtained. Epoetin-alfa was initially
given 4,000 IU subcutaneously twice a week and titrated biweekly to keep the Hb range of 11 to 12 g/dL
(titration period 12 weeks). Treatment continued until the end of 24 weeks. Records were made for conven-
tional blood tests, blood pressure, amount of drugs needed to control blood pressure, and adverse events.
Echocardiogram was repeated (on observer blinding) at the completion of the present study.
Results : After 24-week of epoetin therapy, the predialysis Hb level increased significantly from 8.0 + 1.3 g/dL
to 11.0 + 1.1 g/dL (p < 0.001). The mean dose of epoetin at the present study entry was 143.6 + 87.8 IU/kg/
week. At the present study entry, LVH was present in 86.4% of the patients. At the completion of the present
study, a decrease in LVMI was observed in 50% of the patients; however, the mean LVMI change was not
significantly different. Notably, there were minimal but significant changes in LVEDD (52.8 + 7.0 vs. 50.1 + 6.9
mm, p < 0.05), LVVI (86.2 + 25.2 vs. 75.5 + 19.5 mL/m2, p < 0.05) and when subjects were partitioned into
tertiles of baseline LVMI, the LVVI change was confined to the highest tertile (103.7 + 25.2 vs. 79.6 + 21.9 mL/
m2, p < 0.05). The aortic root diameter also significantly decreased despite some increase in blood pressures
but without significant change in number of antihypertensive agents. No serious adverse event was observed
during the present study period.
Conclusion : The efficacy of anemia treatment and safety of the biosimilar epoetin-alfa was demonstrated in
hemodialysis patients. Significant regression of LVVI and some reduction in LVMI were shown in this 24-week
prospective trial.
Keywords : Erythropoietin, Epoetin, Anemia, Hemodialysis, End-stage renal disease, Left ventricular mass index, Left ventricular volume index
