May help PrometicActual Erythropoiesis-stimulating agents (ESAs) like Aranesp, Procrit and Epogen ... INCREASE RISK OF DEATH in CA patients !!! See this summary published this morning (from JAMA ) :
Erythropoiesis-stimulating agents increase risk of VTE/death in CA patients
Clinical question
Are erythropoiesis-stimulating agents useful in the treatment of cancer-associated anemia?
Bottom line
Erythropoiesis-stimulating agents (ESAs) used in the treatment of anemia in patients with cancer are associated with a significantly increased risk of venous thromboembolism (VTE) and mortality. (LOE = 1a)
Reference
Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetiin administration for the treatment of cancer-associated anemia. JAMA 2008;299(8):914-924.
Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetiin administration for the treatment of cancer-associated anemia. JAMA 2008;299(8):914-924.
Study design: Meta-analysis (randomized controlled trials)
Funding: Foundation
Allocation: N/A
Setting: Various (meta-analysis)
Synopsis
ESAs, including erythropoietin (Procrit, Epogen) and darbepoetin (Aranesp), are frequently used in the treatment of cancer-associated anemia. These investigators thoroughly searched multiple databases including MEDLINE, EMBASE, and the Cochrane Collaboration, and contacted national conference presenters, ESA manufacturers, and clinical investigators for relevant studies. Only randomized trials comparing ESAs with placebo or standard care in the management of anemia in patients with cancer were included in the analysis. Three independent investigators reviewed and evaluated the individual trials for inclusion and methodologic quality; disagreements were resolved by consensus. Overall, mortality was evaluated for 13,611 patients in 51 clinical trials and VTE was evaluated for 8172 patients in 38 separate trials. Cancer patients receiving ESA therapy for anemia had a significantly increased risk of mortality compared with those receiving placebo or standard treatment (hazard ratio = 1.10; 95% CI, 1.01-1.20). Similarly, ESA-treated patients were also at a significantly increased risk of VTE (number needed to treat to harm = 35; 23-64). There was no significant heterogeneity (ie, the results were similar) among the 51 trials.