Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis
- PMID: 34739194
- DOI: 10.1056/NEJMoa2113379
Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis
Abstract
Background: Among patients with chronic kidney disease (CKD), the use of recombinant human erythropoietin and its derivatives for the treatment of anemia has been linked to a possibly increased risk of stroke, myocardial infarction, and other adverse events. Several trials have suggested that hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitors (PHIs) are as effective as erythropoiesis-stimulating agents (ESAs) in increasing hemoglobin levels.
Methods: In this randomized, open-label, phase 3 trial, we assigned patients with CKD who were undergoing dialysis and who had a hemoglobin level of 8.0 to 11.5 g per deciliter to receive an oral HIF-PHI (daprodustat) or an injectable ESA (epoetin alfa if they were receiving hemodialysis or darbepoetin alfa if they were receiving peritoneal dialysis). The two primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 (noninferiority margin, -0.75 g per deciliter) and the first occurrence of a major adverse cardiovascular event (a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke), with a noninferiority margin of 1.25.
Results: A total of 2964 patients underwent randomization. The mean (±SD) baseline hemoglobin level was 10.4±1.0 g per deciliter overall. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.28±0.02 g per deciliter in the daprodustat group and 0.10±0.02 g per deciliter in the ESA group (difference, 0.18 g per deciliter; 95% confidence interval [CI], 0.12 to 0.24), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 2.5 years, a major adverse cardiovascular event occurred in 374 of 1487 patients (25.2%) in the daprodustat group and in 394 of 1477 (26.7%) in the ESA group (hazard ratio, 0.93; 95% CI, 0.81 to 1.07), which also met the prespecified noninferiority margin for daprodustat. The percentages of patients with other adverse events were similar in the two groups.
Conclusions: Among patients with CKD undergoing dialysis, daprodustat was noninferior to ESAs regarding the change in the hemoglobin level from baseline and cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-D ClinicalTrials.gov number, NCT02879305.).
Copyright © 2021 Massachusetts Medical Society.
Comment in
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Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors for Anemia in CKD.N Engl J Med. 2021 Dec 16;385(25):2390-2391. doi: 10.1056/NEJMe2117100. Epub 2021 Nov 5. N Engl J Med. 2021. PMID: 34739195 No abstract available.
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Daprodustat for anaemia in CKD.Nat Rev Nephrol. 2022 Jan;18(1):3. doi: 10.1038/s41581-021-00515-2. Nat Rev Nephrol. 2022. PMID: 34824467 No abstract available.
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Daprodustat and On-Treatment Cardiovascular Events in Chronic Kidney Disease.N Engl J Med. 2022 Dec 29;387(26):2481-2482. doi: 10.1056/NEJMc2208182. N Engl J Med. 2022. PMID: 36577110 No abstract available.
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Daprodustat and On-Treatment Cardiovascular Events in Chronic Kidney Disease.N Engl J Med. 2022 Dec 29;387(26):2482. doi: 10.1056/NEJMc2208182. N Engl J Med. 2022. PMID: 36577111 No abstract available.
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Daprodustat and On-Treatment Cardiovascular Events in Chronic Kidney Disease. Reply.N Engl J Med. 2022 Dec 29;387(26):2482-2485. doi: 10.1056/NEJMc2208182. N Engl J Med. 2022. PMID: 36577112 No abstract available.
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