0918 Concerns about clinical use of erythropoietin

In summaries 0629 and 0839 some of the concerns around erythropoietin use have been highlighted. Erythropoietin certainly stimulates red cell production, but receptors are also found in many other tissues. Objective effects such as correction of anaemia have been observed in renal and cancer patients and there have also been subjective benefits such as impact on fatigue. However increased mortality from cardiac events has also been shown in renal patients when the target has been a normal haemoglobin, and questions have been raised about risks of correcting anaemia in cancer involving organs or tissues with erythropoietin receptors. In this regard, while not seeking to explain the excess in mortality, a recent meta-analysis of 53 trials involving 19 933 adult and paediatric subjects found that erythropoietin administration resulted in a 17% increase in mortality risk. To these concerns about adverse effects of erythropoietin one must add the concern about the increased risk of retinopathy when erythropoietin is administered to correct anaemia of prematurity and reduce transfusion requirements. The association has been recognised for at least ten years, and several studies have reported on a relationship between ROP and both timing of dose and cumulative dose. A Cochrane Review also notes the complication of ROP with early administration of erythropoietin. Given this concern plus the view expressed in current neonatology reviews that there is not yet consensus on the use of erythropoietin in VLBW and ELBW neonates, one has to ask whether it will continue to be regarded as a therapeutic option. One also has to consider medicolegal consequences of prescribing a treatment once concerns have been raised about its safety.

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Lancet 2009; 373: 1532-42
Clin Perinatol 2009; 36: 111-23
Cochrane Database Syst Rev 2006; Jul 19;3:
CD004865 J AAPOS 2008; 12: 233-8