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Drugs to combat anemia boost risk of death
Source: (cancerfacts.com)
Wednesday, May 06, 2009
SEATTLE, WA – May 6, 2009 – A pair of studies reported this week have confirmed earlier studies that drugs used to boost red blood cell production in cancer patients who have lost a lot of these cells due to chemotherapy or the cancer itself increase the risk of death.
In a Canadian study led by Dr. Marcello Tonelli, the researchers at the University of Alberta showed that the class of drugs called erythropoiesis-stimulating agents, increases the risk of death and serious adverse events such as blood clots. The study appears in this month's Canadian Medical Association Journal.
"These findings suggest that erythropoiesis-stimulating agents (ESAs) should not be routinely used as an alternative to blood transfusion in patients with chemotherapy-induced anemia unless future studies document safety and clinical benefits in this population," the authors wrote.
This study pooled data from 52 clinical trials involving 12,006 participants, and was based on work done for the Canadian Agency for Drugs and Technologies in Health (CADTH) to summarize the benefits and harms of these agents in adults with cancer-related anemia.
While the relative increased risk of death was 15 percent to 16 percent, because of the high mortality rates in cancer patients, this increase could translate into significant numbers of people.
The findings, which are consistent with studies from the United States and the United Kingdom, provide important information for clinicians treating cancer patients and for Canadian policy makers regarding drug reimbursement plans.
In a European study published in the British journal The Lancet, Swiss researchers led by Dr. Julia Bohlius, of the University of Bern, Switzerland, and German researchers led by Dr. Andreas Engert, at the University of Cologne, found a 17 percent increased risk of death from these drugs, compared to chemotherapy patients not given the ESAs.
In this study, researchers combined data from 38 trials involving 10,441 patients. They found that 1,530 patients died during the active study period and 4,933 died overall. ESAs were associated with a relative increase in mortality during the active study period of 17 percent. When an analysis was done of only cancer patients receiving chemotherapy, however, the relative increase in deaths attributable to ESAs was 10 percent. The type of anticancer treatment given did not make a difference to outcomes.
Anemia in cancer patients can develop because of the cancer itself or because of treatments such as chemotherapy. Treatment with agents to stimulate red blood cell formation has been widely used to improve quality of life for many patients and as an alternative to blood transfusions. However, these agents are expensive and reimbursement policies in Canada vary across provinces and territories.
"Our findings suggest that existing practice guidelines should be revised to recommend against the routine use of erythropoiesis-stimulating agents as an alternative to blood transfusion in patients with cancer," concluded the Canadian authors. The authors add that erythropoiesis-stimulating agents may be warranted in situations where blood transfusions are not possible or practical.
SOURCE: adapted from press materials provide by the Canadian Medical Association Journal, and by The Lancet.
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