Erythropoietin

Aka: Erythropoietin, Epoetin, Procrit, Epogen

1. Indications
   1. Illicit use by athletes as ergonomic aid (banned)
   2. Anemia
      1. Chronic Renal Failure
         1. Indicated to maintain Hemoglobin 10-12 mg/dl
         2. Decreases cardiovascular morbidity and mortality
         3. Increases quality of life
      2. Cancer Chemotherapy
         1. Indicated to maintain Hemoglobin >10 g/dl
         2. Contraindicated if serum Erythropoietin >200 mU/ml
         3. Increases Hemoglobin 2 g/dl
         4. Decreases transfusion need
         5. Increases quality of life
         6. Does not improve survival or delay disease progress
            1. Henke (2003) Lancet 362:1255-60
      3. Anemia secondary to HIV Management (e.g. Zidovudine)
         1. Contraindicated if serum Erythropoietin >500 mU/ml
         2. Increases quality of life (e.g. Energy)
         3. Prolongs AIDS survival
      4. Prophylaxis before elective surgery (non-cardiac)
         1. Indicated before surgery where transfusion is otherwise predicted
      5. Other possible indications (covered by Medicare)
         1. Myelodysplastic Syndrome
         2. Hepatitis C (during treatment)
         3. Inflammatory Bowel Disease
         4. Rheumatoid Arthritis
         5. Systemic Lupus Erythematosus
2. Adverse effects
   1. Hypertension (25% of Renal Failure patients)
      1. Hypertensive encephalopathy
      2. Seizures
   2. Thrombotic events (e.g. Myocardial Infarction)
   3. May promote growth of certain Breast Cancers
3. Disadvantages
   1. See adverse effects above
   2. Cost: $3000 for 8 week cancer course
4. References
   1. (2001) Med Lett Drugs Ther 43(1104):40-1
   2. (2001) Am J Kidney Dis 37(suppl 1):S182
   3. Andrade (1996) Am J Orthop 25:533
   4. Demetri (1998) J Clin Oncol 16:3412
   5. Henry (1992) Ann Intern Med 117:739
   6. Moore (1999) Clin Infect Dis 29:44
   7. Tsakiris (2000) Nephron 85(suppl 1):2