Meta-analysis of subcutaneous versus intravenous epoetin in maintenance treatment of anemia in hemodialysis patients
Meta-analysis of subcutaneous versus intravenous epoetin in maintenance treatment of anemia in hemodialysis patients
复制标题
DOI：
10.1053/ajkd.2002.34881
复制
发表时间：
2002-09-01
影响因子：
13.2
通讯作者：
Hornberger, J
中科院分区：
文献类型：
--
作者：
Besarab, A;Reyes, CM;Hornberger, J
背景临床和药代动力学研究表明，通过从静脉（IV）给药转换为皮下（SC）给药，使用减少的重组人促红细胞生成素（epoietin）剂量可以维持目标血红蛋白或红细胞压积水平。研究方法：我们对静脉注射与皮下注射给予依泊苷的比较研究进行了荟萃分析，以评估这些给药途径的相对成本。27项前瞻性临床研究（涉及916例患者）纳入分析。测定依泊苷IV和SC剂量之间的平均差异以及给药途径之间的药物成本平均差异。结果如下：皮下给药与静脉给药相比，患者的平均剂量减少为48 IU/kg/wk（P < 0.001），表明皮下给药平均每年可节省费用1，761美元+/-1，080美元（SD）/例患者。在平行和交叉设计研究中，SC和IV剂量之间的差异相似。一项回顾性美国调查显示，SC给药的剂量减少了26 IU/kg/wk（P < 0.001），转化为每例患者每年节省946美元。结论：本研究表明，与IV给药相比，SC给药可大幅降低依泊苷的成本。目前美国和欧洲指南的建议鼓励使用SC给药，不仅在有效性和安全性方面有合理的依据，而且也有合理的经济基础。(c)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background. Clinical and pharmacokinetic studies have shown that target hemoglobin or hematocrit levels can be maintained using a reduced recombinant human erythropoietin (epoetin) dosage by switching from intravenous (IV) to subcutaneous (SC) administration. Methods: We conducted a meta-analysis of comparative studies of epoetin administered IV versus SC to assess the relative costs of these administration routes. Twenty-seven prospective clinical studies involving 916 patients were included in the analysis. The average difference between IV and SC doses of epoetin and average difference in drug costs between administration routes were determined. Results: The average reduction in dose in patients treated with SC versus IV epoetin was 48 IU/kg/wk (P < 0.001), representing an average annual cost savings with SC administration of US $1,761 +/- $1,080 (SD) per patient. The difference between SC and IV doses was similar in both parallel- and crossover-design studies. A retrospective US survey showed a dose reduction of 26 IU/kg/wk (P < 0.001) with SC administration, translating to an annual savings of $946 per patient. Conclusion: This study indicates that the cost of epoetin is reduced substantially when administered SC in comparison to IV. Recommendations of current US and European guidelines, which encourage the use of SC administration, not only have a sound rationale in terms of efficacy and safety, but also have a sound economic basis. (c) 2002 by the National Kidney Foundation, Inc.