How to get the best out of r-HuEPO

Recombinant human erythropoietin (r-HuEPO) therapy is expensive, and it is therefore important to optimize its use to satisfy the health economist as well as the prescriber. Five main issues can be considered in helping to achieve this goal: (i) Route and site of administration. Much evidence suggests that subcutaneous (s.c.) administration of r-HuEPO is more cost-effective than intravenous (i.v.) administration, i.e. lower s.c. doses may be used to achieve the same effect. There are, however, some studies which suggest that there is little to choose between the two routes. One pharmacokinetic study in normal volunteers found that s.c. injection of r-HuEPO into the thigh resulted in greater peak values and greater bioavailability than s.c. injection into the arm or abdomen. (ii) Frequency of injection. There are now reports of dialysis patients being variously treated with once-weekly, twice-weekly, thrice-weekly, and once-daily s.c. administration of r-HuEPO. Despite some comparative studies, the optimum dosing frequency for s.c. r-HuEPO remains unclear. (iii) Iron status. Failure of an adequate supply of iron to the erythron is probably the most common and most easily treated cause of sub-optimal response to r-HuEPO. Effective and regular monitoring of iron status by measurement of serum ferritin, transferrin saturation, and per cent hypochromic red cells is critical to the management of the patient receiving r-HuEPO, and there is increasing evidence that liberal use of i.v. iron may enhance the response to this treatment. (iv) Other factors affecting response to r-HuEPO.(ABSTRACT TRUNCATED AT 250 WORDS)