David P. Steensma, MD
In patients with cancer, are epoetin and darbepoetin effective and safe for management of anemia?
Articles selected evaluated erythropoietin analogues (EAs)—epoetin (alfa or beta) or darbepoetin alfa. Systematic reviews or meta-analyses limited to a single EA were excluded. Outcomes included blood transfusion, survival, and thrombosis.
MEDLINE and Cochrane Library (2002 to July 2007), Web site of the National Guideline Clearinghouse, US Food and Drug Administration (FDA) Oncologic Drugs Advisory Committee meetings (May 2004 and May 2007), and reference lists of primary studies were searched for English-language, randomized controlled trials (RCTs); systematic reviews; meta-analyses; and practice guidelines based on systematic reviews. Experts were also consulted. 5 systematic reviews based on RCTs were the primary source of evidence; the total number of reports that met the selection criteria was not stated.
Meta-analyses showed that epoetin and darbepoetin groups had fewer transfusions than controls but more thrombotic events; groups did not differ for survival (Table). Meta-analyses showed that epoetin and darbepoetin did not differ for thrombosis (relative risk [RR] reduction 14%, 95% CI −21 to 39) or blood transfusions (RR increase 10%, CI −7 to 29).
In patients with cancer, epoetin and darbepoetin reduce need for blood transfusions but increase risk for thrombosis. Epoetin and darbepoetin do not differ for transfusions or thrombosis.
Results of 4 systematic reviews evaluating epoetin and darbepoetin vs control for anemia in patients with cancer*
*NS = not significant; other abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article. 1 systematic review did not provide sufficient data to determine event rates and relative risks.
†From the largest of 3 reviews.
Steensma DP. Review: Epoetin and darbepoetin reduce need for blood transfusions but increase risk for thrombosis in patients with cancer. Ann Intern Med. ;148:JC4–7. doi: 10.7326/0003-4819-148-12-200806170-02007
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Published: Ann Intern Med. 2008;148(12):JC4-7.
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