Comparison of Efficacy and Safety of Epoetin Alfa and Epoetin Beta in Continuous Ambulatory Peritoneal Dialysis Anemic Patients

Anemia is a very common complication in patients with chronic kidney disease (CKD) and its main etiology is due to the decrease in renal production of erythropoietin (EPO). The two most commonly used Erythropoietin-stimulating agents (ESAs) in Malaysian public hospitals are Epoetin alfa (Eprex®) and Epoetin beta (Recormon®). This study aims to compare the efficacy and safety of Eprex® and Recormon® in continuous ambulatory peritoneal dialysis (CAPD) anemia patients. This is a retrospective study included 72 CAPD patients in Hospital Serdang receiving Eprex® (n = 36) and Recormon® (n = 36) to maintain target Hb at 11-12 g/dL. Hb, Hct, ferritin and blood pressure (BP) levels at baseline and upon achieving target Hb were measured for each patient. The weekly EPO Index (defined as weekly epoetin dose/mean monthly Hct) and Erythropoietin Resistance Index (ERI) (defined as weekly weight-adjusted epoetin dose/Hb level) were derived for each patient at baseline, at target and at the end of 6^th month follow-up, to evaluate ESA dose-response. There was no significant difference between the two preparations in terms of mean target Hb (p = 0.805) and Hct (p = 0.720) levels achieved. EPO index similarly decreased from baseline values in both groups. Analysis showed no significant difference on EPO index and ERI in both Eprex® and Recormon® group. However, percentage of patients improved from moderate stage of anemia was higher in Recormon® (55.6%) as compared to Eprex® (39.7%) group. Sub-analysis showed female gender and lower albumin were correlated with higher ESA treatment resistance. This may explain the higher ESA index and ERI in Recor-mon® group, which showed higher percentage of female gender patients. There was no statistically significant correlation between ERI with baseline ferritin level (r =-0.065, p = 0.586). Both the mean change BP, and SBP at the end of 6th month follow-up were not significantly different between two groups. It was concluded that both efficacy and safety profile were not significantly different between Eprex® and Recormon® group.