Appropriate Use of Inpatient Erythropoiesis Stimulating Agents

Area of Science:

• Hematology
• Pharmacology
• Public Health

Background:

• Anemia is a global health issue linked to fatigue and weakness.
• Erythropoiesis stimulating agents (ESAs) increase hemoglobin (Hb) but pose cardiovascular risks above 12 g/dL.
• ESA safety and appropriate use are critical public health concerns.

Observation:

• A retrospective chart review assessed inpatient ESA use at Mount Sinai Hospital (MSH) from November 2015 to August 2023.
• Data included adult patients receiving originator or biosimilar ESAs during hospitalization.
• The study focused on adherence to Hb targets to ensure safe ESA administration.

Findings:

• Nearly all (98.8%) inpatient ESA doses administered between June and August 2023 met appropriateness criteria based on Hb levels.
• Appropriate use was defined as dispensing ESA when Hb was below the target for the specific indication.
• Minor deviations included doses for a patient on renal replacement therapy and a surgical patient refusing transfusion.

Implications:

• Inpatient ESA administration at MSH demonstrates high adherence to Hb targets, despite the absence of formal restrictions.
• This suggests strong provider and pharmacy awareness of current best practices for ESA use.
• Findings support the safe and effective use of ESAs in inpatient settings when guidelines are followed.