Novel Agents for Anaemia Management in Chronic Kidney Disease
European Nephrology 2010;4:37–41
“Twenty years ago, the management of anaemia in chronic kidney disease was revolutionised by the introduction of recombinant human EPO, which was licensed in Europe in 1990. This was subsequently followed by two longer-acting erythropoietin analogues, the first of which was darbepoetin alfa, which allowed once-weekly or even once-every-two-weeks dosing. More recently, another EPO-related molecule was manufactured called CERA, which had an even longer half-life and could be administered up to once monthly. Other molecules are in development or are becoming licensed in Europe, including biosimilar and ‘copy’ epoetin products. Hematide is a synthetic peptide-based erythropoietin mimetic that, interestingly, has no structural homology with EPO, yet is still able to activate the EPO receptor and stimulate erythropoiesis. Research continues for orally active anti-anaemic therapies, and several strategies are under investigation. Two new intravenous iron products have also been licensed (ferumoxytol in the US, and FCM in Europe). In conclusion, the development of effective therapies to treat anaemia has been a highly active field, both scientifically and commercially, over the last two decades.”
Anaemia management was transformed 20 years ago by the manufacture and widespread availability of recombinant human EPO. Ever since it was recognised that red cell production was controlled by the hormone EPO, and that this hormone was produced de novo in the kidney in response to hypoxia, there was a clear rationale for administering EPO replacement therapy. When this dream became reality in the late 1980s, the true impact of the treatment was realised. Dialysis patients who were heavily transfusion-dependent, and who without regular blood transfusions could barely achieve haemoglobin levels above 6 or 7g/dl, were rendered transfusion-independent, with haemoglobin concentrations of around 11–12g/dl. This was truly one of the major breakthroughs in nephrology, if not in the whole of medicine, in the last two or three decades.
This article will discuss the way this therapeutic field has evolved over the last 20 years, with particular reference to the current and future development of ESAs and IV iron therapy.