Flexible dosing schemes for recombinant human erythropoietin--lessons from our daily practice

The availability of recombinant human erythropoietin (rh-Epo) has revolutionized the treatment of renal anaemia. Subcutaneous (s.c.) administration of rh-Epo offers significant advantages over the intravenous (i.v.) route, and numerous studies have demonstrated its efficacy and tolerability when administered two or three times weekly. Most of these studies showed a significant reduction in rh-Epo dosage requirements with s.c. administration compared with the i.v. route, offering clear benefits in terms of reduced costs. In addition, s.c. administration is more convenient and flexible than i.v. administration, and is recommended by European and US guidelines. Dosing frequency of rh-Epo is also an important issue in clinical practice, particularly when customizing therapy to meet individual patient needs. A few small-scale studies have shown comparable efficacy and tolerability of different s.c. dosing frequencies. Recently, a comprehensive randomized controlled trial has shown that once weekly s.c. epoetin beta effectively manages anaemia in haemodialysis patients, even in patients requiring a high dose. Once weekly dosing of s.c. epoetin beta adds greater flexibility and an improved capacity to tailor dosing frequency to patient needs. This reduces clinic time for patients who do not self-administer and, together with improved convenience of new formulations and delivery systems, has the potential to improve compliance and encourages self-administration.