KDIGO report questions use of iron, raises concerns of inflammation with new anemia drugs
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Key takeaways:
- Trials show hypoxia-inducible factor prolyl hydroxylase inhibitors are non-inferior to other anemia drugs for patients with dialysis dependent CKD.
- Concerns about inflammation and iron therapy remain.
While clinical trials have shown hypoxia-inducible factor prolyl hydroxylase inhibitors to be non-inferior to other anemia drugs, questions remain about IV or oral iron supplementation and inflammation, according to a new report.
“The current data do not suggest that hypoxia-inducible factor prolyl hydroxylase inhibitors will reduce the need for iron supplementation, but all of the trials to date were not designed to answer this question,” Elaine Ku, MD, a co-chair of the Kidney Disease: Improving Global Outcomes Controversies Conference report on novel anemia therapies in chronic kidney disease, said in a press release. “Similarly, the hypothesis that hypoxia-inducible factor prolyl hydroxylase inhibitors may be more suitable in patients with chronic inflammation remains untested, which reinforces the need for further studies in this area.”
Ku said there is “still much to be learned” about the long-term safety and potential benefits of hypoxia-inducible factor prolyl hydroxylase inhibitors. The KDIGO report highlighted 10 areas for future investigation into hypoxia-inducible factor prolyl hydroxylase inhibitors, including:
- whether the drugs impact CKD progression;
- whether hemoglobin targets should vary depending on dialysis treatment when using the anemia drugs vs. erythropoiesis-stimulating agents;
- learning more about the need for iron supplementation and appropriate dosing strategy;
- assessing long-term safety in children, older adults and other specific populations;
- identifying novel biomarkers to monitor safety; and
- learning more about variability in the risk of major adverse cardiovascular events and thrombosis.
Conference co-chair David C. Wheeler, MD, said that hypoxia-inducible factor prolyl hydroxylase inhibitors are equally effective as erythropoiesis-stimulating agents regardless of whether patients are on dialysis. Although hypoxia-inducible factor prolyl hydroxylase inhibitors also reduce transfusion requirements, “lingering concerns” about long-term safety persist, he said in the release.
Reference:
KDIGO announces publication of novel anemia therapies Controversies Conference report. https://myemail.constantcontact.com/KDIGO-Announces-Publication-of-Novel-Anemia-Therapies-Controversies-Conference-Report.html?soid=1134196072483&aid=qDvhlfBzvOY. Published Sept. 20, 2023. Accessed Sept. 26, 2023.
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