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FDA Warnings about Anemia Drugs

Below are some links on EPO risks, thanks to Lindaz. The Copy Past is from hiveandhepatitis.
Not sure what its means when taking it for HepC though.


New Data Support FDA Warnings about Anemia Drugs

In March 2007 and again this past November, the U.S. Food and Drug Administration (FDA) approved “black box” warnings and other safety-related product label changes for erythropoiesis-stimulating agents (ESAs). These drugs -- the most common of which is erythropoietin (EPO; brand names Procrit, Epogen) -- stimulate red blood cell production and are used to treat anemia.
The action by the FDA and drug manufacturers was in response to new study data indicating that ESAs may significantly increase the risk for serious cardiovascular complications in people with kidney disease.

In addition, other studies showed that use of these agents by people with certain types of cancer was associated with more rapid tumor growth and increased risk of death. Cancer patients use ESAs to manage the hemotoxic side effects of chemotherapy, as do many people with HIV and hepatitis C to counter the side effects of AZT (zidovudine; Retrovir) and ribavirin, respectively.
These findings prompted the FDA to undertake a more through review of the research on ESAs. Following is the edited text of a January 3, 2008 agency announcement about additional study data that have since become available:

FDA Receives New Data on Risks of Anemia Drugs Consistent With Previous Data on Tumor Growth and Death

The U.S. Food and Drug Administration (FDA) is reviewing new data from two studies that provide further evidence of the risks of anemia drugs known as erythropoiesis-stimulating agents, or ESAs. The studies show that patients with breast or advanced cervical cancers who received ESAs to treat anemia caused by chemotherapy died sooner or had more rapid tumor growth than similar patients who didn’t receive the anemia drug.

These two studies were not among the six studies that were described in revised labeling approved by FDA Nov. 8, 2007, which strengthened warnings about ESAs in cancer patients.
Taken together, all eight studies show more rapid tumor growth or shortened survival when patients with breast, non-small cell lung, head and neck, lymphoid, or cervical cancers received ESAs compared to patients who did not receive this treatment. In all of these recent studies, ESAs were administered in an attempt to achieve a hemoglobin level of 12 grams per deciliter (g/dL) or greater, although many patients did not reach that level.

FDA plans to discuss this new data and revisit the risks and benefits of using ESAs in patients with chemotherapy-induced anemia at a public advisory committee meeting in the next few months.
“This new information further underscores the safety concerns regarding the use of ESAs in patients with cancer, which FDA addressed in previous communications,” said Janet Woodcock, MD, FDA's deputy commissioner for scientific and medical programs, chief medical officer, and acting director of the Center for Drug Evaluation and Research.

“FDA is reviewing these data and may take additional action. In the meantime, FDA recommends that health care providers review the risks and benefits of ESAs outlined in the product label and discuss this information with their patients.”

ESAs are a bioengineered version of a natural protein made in the kidney that stimulates the bone marrow to produce more red blood cells.

Physicians determine whether a patient is anemic and decide on ESA dosing by measuring how much of the protein known as hemoglobin is present in a patient's red blood cells, typically expressed in grams per deciliter.

FDA-approved uses of ESAs are for the treatment of anemia in patients with chronic kidney failure; for cancer patients whose anemia is caused by chemotherapy; and for those infected with the human immunodeficiency virus (HIV) whose anemia is caused by the HIV drug AZT (zidovudine). ESAs are also approved to reduce the number of transfusions during and after major surgery.
On Nov. 30, Amgen, manufacturer of the three ESAs – Aranesp [darbepoetin], Epogen, and Procrit -- provided FDA with information from the 733-patient PREPARE study of women who received chemotherapy before undergoing surgery for breast cancer. After three years, 14 percent of the patients who received Aranesp to treat their anemia had died, compared to 9.8 percent who did not receive the drug. Tumor growth was also faster in patients receiving Aranesp.

On Dec. 4, Amgen informed FDA of the results of a study by the National Cancer Institute’s Gynecologic Oncology Group of patients receiving chemotherapy and radiation for advanced cervical cancer. The patients were administered either Procrit to maintain hemoglobin levels above 12 g/dL or blood transfusions as needed. After three years, 66 percent of the patients who did not take Procrit were alive and free of cancer growth compared to 58 percent who had received the drug.
FDA approved revised boxed warnings and other safety-related product labeling changes for ESAs in November and March 2007. Safety concerns regarding ESAs were discussed during advisory committee meetings in 2004 and 2007 and labeling was revised in 1997, 2004 and 2005 to reflect new safety information

This communication is in keeping with FDA's commitment to inform the public about its ongoing safety reviews. FDA is committed to strengthening the science that supports medical product safety at every stage of the product life cycle from pre-market testing and development through post-market surveillance and risk management.

U.S. Food and Drug Administration. FDA Receives New Data on Risks of Anemia Drugs. Press release. January 3, 2008.

6 Responses
Avatar universal
Nothing about hep c?
Avatar universal
No but its given to us Off label.
Avatar universal
Thanks for the updated links. The EPO warnings have been upgraded for some time now. As far as I know, leading hepatologists are still prescribing epo for HCV treatment, no doubt because the feel the rewards outweigh the risks. Helper drugs aside, the SOC drugs are not without risks either -- and again, we treat in large part because we feel the rewards outweigh the risks. Future studies may further define the risk with epo, one way or another.

-- Jim
Avatar universal
I don't know what I would have done without the Procrit. During my treatment I had an AFP bloodtest a few times. Now that I think about it, it was a bit of insurance before taking Procrit. What would be even more interesting is an AFP after treatment.
There should be studies done on people with any cancer. Just one question have you ever taken an EPO..
Avatar universal
I know i was given it in the last 3 months of my 1 year tx only 20,000 units a week , and my blood pressure rose steadily the whole time, i ended  up having to stay on blood pressure meds over one year post....
Avatar universal
I just took my 40,000 units last night.
(Bled like a geyser too)

I take it twice a month instead of 4 times a month now.
If I feel OK I may go a bit longer but I don't want my hgb
to crash and have to play catch-up or transfuse.

For me, (as scary as the procrit is) I feel so much
better with it. If I had a desk job, maybe I could get by without.

I have a heart cond. and feel that I can't breath and my heart is pounding,leg and arm
pains, tingling fingers, white as a sheet, headaches, fatigue, etc without it)

I've been on blood pressure pills for 15+ years and even with the Procrit my pressure is normal.
(So far)

You gotta weigh the risks vs. the benifits while tx'ing.
(Just the tx'ing in itself is scary if you read the inserts that come with the meds)

I don't want to stop working, I enjoy it. (Most days) - If I were to stay home I would probably lay around all day.  It's better to get out and be with other people & try to keep busy (for me anyway) It makes this journey more bearable...

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