Survey shows limited uptake with new anemia drugs
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Key takeaways:
- Most nephrologists remain hesitant with prescribing hypoxia-inducible factor-prolyl hydroxylase inhibitors to treat anemia.
- Availability and dialysis center protocols may influence use of the drug class.
PHILADELPHIA — Results of a survey conducted in the U.S. and abroad showed that most nephrologists remain wary about prescribing hypoxia-inducible factor-prolyl hydroxylase inhibitors, according to a poster presentation at ASN Kidney Week.
The survey was distributed to 207 U.S. and 208 European nephrologists practicing in Germany, Italy, France, Spain and the United Kingdom with a knowledge base of hypoxia-inducible factor prolyl hydroxylase enzyme inhibitors (HIF-PHIs) as an alternative to using EPO to treat anemia in patients with kidney disease.
The drug daprodustat (Jesduvroq, GlaxoSmithKline) is the only HIF-PHI approved in the U.S. and is limited to patients with chronic kidney disease on dialysis. In the European Union (E.U.), roxadustat (Evrenzo, Astellas) has been approved to treat patients with both non-dialysis-dependent CKD and dialysis-dependent CKD, and vadadustat (Vafseo, Akebia Therapeutics) has been approved to treat patients with dialysis-dependent CKD only.
Responses to the survey were collected from February through April 2023. “Additional insights were captured via an independent, retrospective chart audit of 1,282 CKD non-dialysis patient records collected from 263 E.U.-based nephrologists [from] December 2021 through February 2022,” Meghan Weiss, senior insights director of nephrology at Spherix Global Insights, and colleagues wrote.
The results showed that “roxadustat has experienced slow uptake among E.U. nephrologists, with physicians reporting that 6% of their [hemodialysis (HD)] patients and 8% of their [peritoneal dialysis (PD)] patients are currently on therapy,” Weiss and colleagues reported, “and in the CKD non-dialysis setting, audited patient records reveal that roxadustat treatment rates are even lower at 3.5%, with increased use as patients progress in their CKD.”
While daprodustat is now available for treating anemia in patients on dialysis in the U.S., “52% of physicians report that they are likely to be more reserved and selective in their prescribing ... relying heavily on peers and [key opinion leaders] for guidance,” Weiss and colleagues wrote. “U.S. physicians also expect that availability and dialysis center protocols will be key drivers of adoption.”
The authors said 55% of E.U. nephrologists reported in their survey responses that the advantages of roxadustat outweigh the potential risks in dialysis patients. In the U.S., 44% of physicians believed the same for daprodustat. “Most nephrologists across regions (70% E.U., 55% U.S.) indicate they are anxious to gain clinical experience with the drugs,” the authors wrote.
Despite recognition of the benefits of HIF-PHIs in dialysis patients, “slow adoption of roxadustat in the E.U. and hesitancy among U.S.-based nephrologists to prescribe daprodustat may stifle treatment evolution in the anemia space, with ESAs likely to remain the standard of care in the dialysis setting,” the authors concluded.
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Weiss M, et al. TH-PO975. Presented at: ASN Kidney Week; Nov. 1-5, 2023; Philadelphia.
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