Do erythropoietic-stimulating agents relieve fatigue? A review of reviews

Interest in the efficacy and potential deleterious consequences of treatment with erythropoietic-stimulating agents (ESAs) is very high. Recently, the ESAs have come under intense scrutiny as several clinical trials have shown their use to be associated with an increased risk of thrombosis, and a concern for increased mortality risk in oncology. In this context, attention to the effect of ESAs upon fatigue and other aspects of quality of life has tended to be lost. To aid inclusion of this endpoint in the important consideration of risks and benefits of ESA therapy, we summarize the many reviews that have been conducted on this topic. The ten selected reviews were all conducted systematically or were otherwise comprehensive. While these reviews acknowledge an overall positive fatigue or quality-of-life effect, some were equivocal about the meaningfulness or magnitude of the benefit. The overall evidence from these reviews supports a fatigue and overall quality-of-life benefit from treatment with ESAs that is unlikely to be due to chance. This information should be included in the risk/benefit consideration of these controversial agents.