EVALUASI PENGGUNAAN OBAT ANEMIA PADA PASIEN PENYAKIT GINJAL KRONIK DENGAN HEMODIALISA DI RSU ARI CANTI PADA TAHUN 2020

Penyakit ginjal kronik (PGK) menjadi perkara nyata dalam dunia medis dengan peningkatan prevalensi secara terus-menerus. Tindakan medis yang dilakukan pada pasien PGK ialah hemodialisis, tindakan ini dilakukan untuk mengganti fungsi ginjal dalam menyaring dan mengeluarkan racun uremik dalam tubuh. Hemodialisis dapat menimbulkan beberapa dampak yaitu kram otot, hiperkalemia, hipotensi atau hipertensi dan anemia. Anemia yang dialami pasien PGK sebagian besar diakibatkan oleh defisiensi erythropoietin. Penilaian kesesuaian pemberian terapi anemia pada pasien PGK dengan standar yang berlaku menjadi penting untuk mencapai efek terapi yang optimal. Tujuan dari penelitian ini untuk menilai penggunaan obat anemia pada pasien PGK yang sedang menjalani hemodialisis di RSU Ari Canti pada periode Januari-Desember 2020. Penelitian ini termasuk penelitian deskriptif dengan data diambil menggunakan teknik restrospektif yang melibatkan 80 sampel data rekam medis, yang dipilih secara purposive sampling. Pada penelitian ini menunjukan hasil pola pemakaian obat anemia pada pasien PGK yang sedang melakukan hemodialisis mendapat pengobatan tunggal (73,75%) dan pengobatan kombinansi (26,25%). Obat yang dipakai ialah erythropoietin alfa, iron dan asam folat. Penilaian penggunaan obat anemia pada pasien PGK yang melakukan hemodialisis atas dasar ketepatan pasien (100%), ketepatan indikasi (100%), ketepatan obat (97,5%), ketepatan dosis (100%), ketepatan interval waktu pemberian (100%) dan waspada efek samping (100%). Kesimpulannya penilaian penggunaan obat anemia pada pasien PGK yang sedang melakukan hemodialisis di RSU Ari Canti pada tahun 2020 telah memenuhi kriteria ketepatan pasien, ketepatan indikasi, ketepatan dosis, ketepatan obat, ketepatan interval waktu minum obat dan kewaspadaan terhadap efek samping.

Therapeutic efficacy of erythropoietin alfa and erythropoietin beta in hemodialysis; a randomized controlled trial

Introduction: Anemia, as a common complication of end-stage renal disease (ESRD), usually develops due to erythropoietin deficiency. Recombinant human erythropoietins (rHEPOs) are indicated for the correction of renal anemia. Objectives: We aimed to evaluate the efficacy of a new brand of erythropoietin named CinnaPoietin (erythropoietin beta) on hemoglobin levels. Patients and Methods: This is a randomized double-blinded controlled trial. Ninety-six ESRD patients on hemodialysis recruited in the study, whose hemoglobin levels was less than 10 g/dL. They allocated to two groups. PDPoetin (erythropoietin alfa) 50-100 U/kg three times per week intravenously administrated to the control group and CinnaPoietin with exactly same regimen as like PDPoetin group administrated for the rest of the participants. The study duration was 3 months. We measured plasma hemoglobin monthly for 3 months. Results: We found, hemoglobin was increased across the time and it was statistically significant (P<0.001), while there was no statistically significant differences between the groups (P=0.712). Conclusion: According to the result of the present study there is no statistical significant difference between these two brands of exogenous rHEPO in the case of increasing the hemoglobin concentration.

Randomized Phase III Trial of Sequential Adjuvant Chemoradiotherapy With or Without Erythropoietin Alfa in Patients With High-Risk Cervical Cancer: Results of the NOGGO-AGO Intergroup Study

Purpose This open-label, randomized phase III study was designed to investigate the effects of erythropoietin alfa (EPO) in addition to adjuvant chemotherapy and pelvic radiotherapy (CRT) in patients with stage IB to II cervical cancer who had undergone radical hysterectomy. Patients and Methods Two hundred fifty-seven patients were randomly assigned to four cycles of carboplatin/ifosfamide chemotherapy followed by external-beam pelvic radiotherapy (CRT group) or four cycles of carboplatin/ifosfamide chemotherapy and EPO followed by pelvic radiotherapy and EPO (CRT + EPO group). The primary end point was recurrence-free survival (RFS). Secondary end points included overall survival (OS), change in hemoglobin levels, and safety, including thromboembolic events. Results The estimated 5-year RFS rates were 78% for patients receiving CRT + EPO and 70% for patients receiving CRT. There was no statistically significant difference in RFS, although a trend favoring patients treated with CRT + EPO was observed (hazard ratio [HR], 0.66; 95% CI, 0.39 to 1.12; log-rank P = .06). Exploratory analyses suggest a benefit with CRT + EPO for patients with stage IB to IIA disease (HR, 0.39; 95% CI, 0.18 to 0.85; P = .014) or patients with complete resection (HR, 0.55; 95% CI, 0.31 to 0.98; P = .039). OS was similar in both groups (HR, 0.88; 95% CI, 0.51 to 1.50; log-rank P = .63). Patients treated with EPO maintained higher hemoglobin levels throughout CRT. No significant differences in safety profiles were observed between the two groups. Incidence of thrombovascular events was low (2%) and comparable between both groups. Conclusion This study confirms that EPO can be added safely to CRT in patients with cervical cancer, but it failed to demonstrate a significant benefit in RFS and OS.

Hepcidin Levels and Erythropoietin Alfa Resistance In Patients with Chemotherapy Induced Anemia (CIA)

Abstract 3216 Introduction: Hepcidin is a key regulator of iron metabolism and is a central mediator of anemia associated with inflammation. Hepcidin has previously been associated with resistance to ESAs in renal anemia and may also be a potential mediator of ESA resistance in chemotherapy-induced anemia (CIA). We therefore assessed hepcidin in a cohort of patients with CIA who received erythropoietin alfa (EPREX, Janssen-Cilag, Ltd.) as part of a post-approval safety study. Patients and Methods: All subjects were anemic (defined as baseline Hb ≤11 g/dL) and almost all patients had one of the following malignancies: breast, ovarian, gastric and pancreatic cancer, myeloma. Patients were receiving standard doses of EPREX for management of CIA. Patients with anemia secondary to iron deficiency (defined as transferrin saturation ≤ 20%) were excluded from study enrollment. Serum erythropoietin was not assessed as a condition of eligibility. Hemoglobin (Hb) response was defined as an increase of ≥ 1 g/dL through week 4. Baseline serum hepcidin levels were measured retrospectively using a hepcidin C-ELISA. The relationships between hepcidin, Hb, iron status (serum iron, ferritin, transferrin saturation), C-Reactive Protein (CRP) (a marker of inflammation and surrogate for IL-6 activity) and Hb response were evaluated. Results: Among 51 anemic patients with a median age of 56 (range 25–72), 42 were Hb responders. None of the patients studied received blood transfusions during the first 4 weeks of treatment. No significant difference in baseline hepcidin or CRP levels was found between the Hb responders and non-responders; hepcidin 129.43 ng/mL (9.5-722.4) versus 210.7 (9.9-399.6) and CRP 47.1 nmol/L (0-428.6) versus 46.0 (2.1-1145.7) respectively. All subjects who had a decrease in Hb through week 4 were tumor non-responders. Baseline hepcidin levels were inversely correlated with baseline Hb (p = 0.04) but did not predict for Hb response. Neither did baseline CRP nor iron status. Adjusting hepcidin for iron status did not improve predictive accuracy. No significant correlation was found between CRP change at week 4 and Hb response. A correlation was found between baseline hepcidin and week 4 CRP (p = 0.0004) but not with baseline CRP levels. Conclusions: Baseline hepcidin was not predictive of Hb response to ESA therapy. Hepcidin change may be a better predictor and warrants further evaluation. Lack of information on baseline erythropoietin levels is a significant limitation of this study. Correlation with additional markers (e.g., soluble transferrin receptor, inflammatory markers like IL-6) will also be important to fully determine the role of hepcidin as a predictor for EPO resistance in settings of chronic inflammation. Disclosures: Rijnbeek: Johnson & Johnson: Employment. Reddy:Johnson & Johnson: Employment. Li:Johnson & Johnson: Employment. Vercammen:Johnson & Johnson: Employment. Cornfeld:Johnson & Johnson: Employment.