Appropriate Use of Inpatient Erythropoiesis Stimulating Agents

Background: Anemia is a significant global public health issue, and is associated with lethargy, weakness, tiredness, and shortness of breath. Erythropoiesis stimulating agents (ESAs) are recombinant/synthetic erythropoietin and can increase hemoglobin (Hb) levels. There are increased risks of cardiovascular events and death associated with the use of ESAs when raising Hb levels above 12 g/dL. Methods: The objective was to assure safety and appropriate use of ESA. We performed a baseline assessment via a retrospective chart review, including patients who recently received an inpatient dose of an ESA within Mount Sinai Hospital (MSH) from November 1, 2015 (after MSH ESA guideline revision) to August 1, 2023. All adult patients who received an ESA (originator or biosimilar products) during hospitalization were included. Data collection was in reverse chronology, and the most recent dose administered to each unique patient was collected. Results: If an ESA dose was dispensed when the Hb was less than the upper limit of the target Hb for the specific indication, this was considered appropriate use. Based on data from June 15 to August 1, 2023 (~47 days of inpatient utilization), for the primary outcome, 169 out of 171 doses (98.8%) met the predefined criteria for appropriateness. One dose was dispensed when the Hb was 11.1 g/dL to a patient on renal replacement therapy, and one dose was dispensed when the Hb was 13.8 g/dL to a surgical patient who refused blood transfusions. Among secondary outcomes of interest, there was a difference in blood transfusions administered in critical versus non-critical care settings. Conclusion: Inpatient use of ESA at MSH was appropriate when looking at Hb targets. There are currently no formal order sets, service-line restrictions, or additional chairperson approvals needed at MSH. Despite this, there remained significant adherence to prevailing Hb targets, reflecting provider and pharmacy teams' knowledge and awareness of contemporary best practices.