Epoetin for use in patients with renal disease will be supplied from the tertiary referral centre. For all other indications supply |
will usually be organised through a home delivery company. |
|
RED Darbepoetin alfa (Aranesp®) Prefilled disposable SureClick™ devices |
100micrograms, 150micrograms, 300micrograms, 500micrograms. |
RED Epoetin alfa (Eprex®) |
Vial 40 000unit/ml 1ml |
Prefilled syringes 1000units, 2000units, 4000units, 5000units, 6000units, 8000units, 10,000units. |
|
NICE TA323 - replaces NICE TAG142 |
Erythropoiesis-stimulating agents (epoetin and darbepoetin) are recommended, within their marketing authorisations, as options |
for treating anaemia in people with cancer having chemotherapy. |
|
NICE TA807: Roxadustat for treating symptomatic anaemia in chronic kidney disease Roxadustat is recommended as an option for treating symptomatic anaemia associated with chronic kidney disease |
(CKD) in adults only if: |
> they have stage 3 to 5 CKD with no iron deficiency and |
> they are not on dialysis at the start of treatment |
> the company provides roxadustat according to the commercial arrangement |
RED Roxadustat [Evrenzo] tablets 20mg, 50mg. 70mg, 100mg, 150mg |
ICB Commissioned, Blueteq required |
|
Iron Overload |
Iron overload is the result of many disorders and can lead per se to the development of organ damage and increased mortality. |
In humans total body iron stores is maintained within the range of 200-1500 mg by adequate adjustment of intestinal iron |
absorption, since no excretory mechanisms exist. Frequent blood transfusions lead to excessive accumulation of iron with a toxic |
accumulation in 3 to 10 years. The toxicity of iron results from two related events: |
|
1. excess iron deposits in various tissues of the body, particularly in liver, heart and |
endocrine organs with the consequence of liver diseases, diabetes mellitus and |
other complications, and |
2. free iron that catalyzes the formation of highly reactive hydroxyl radicals which |
lead to membrane damage and denaturation of proteins. |
|
Once iron exceeds a certain level, these effects lead to significant morbidity and mortality. Without specific chelation therapy to |
remove the iron, in 3 to 10 years almost all regularly transfused patients will have acquired a toxic accumulation of iron. |
The main cause of death is due to cardiac complications. The management of established iron overload also involves |
venesection which is not always possible. The subsequent aim is to make the iron as safe as possible by binding the toxic iron |
pools responsible for causing tissue damage. Iron chelation therapy reduces iron-related morbidity, reduces and retards liver |
diseases, diabetes and other endocrine failures, normalizes growth and sexual development, prevents, and in some cases |
reverses, cardiac insufficiency and improves quality of life. Consequently iron chelation therapy dramatically reduces mortality. |