Optimizing epoetin therapy in end-stage renal disease: the case for subcutaneous administration

The effectiveness of various recombinant human erythropoietin (epoetin) administration routes and dosage schedules in patients on dialysis was studied. The mean dose required to achieve and maintain a hematocrit level between 33% and 40% is 225 U/kg/wk when administered intravenously (i.v.) in three divided doses. A once-weekly i.v. schedule requires a dose of 429 U/kg/wk to maintain the same target hematocrit. In contrast, the required epoetin dose is reduced by an average of 25% to 50% when administered via the subcutaneous (SC) route. Analysis of data from 25 dialysis centers shows that SC epoetin administration resulted in higher normalized responses than i.v. administration. The hematocrit response in patients at these centers was proportional to the weekly dose, with a greater slope in those centers using predominantly SC as compared with i.v. dosing. Cost analysis indicates that the use of SC dosing two or three times weekly at an average total weekly dose of 120 U/kg is effective for the treatment of anemia in most patients on dialysis.