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ESA Drugs Treat Anemia by Stimulating Red Blood Cell

Production
NAAC Article Published: April 8, 2009

Medications that increase the production of red blood cells, called erythropoiesis-stimulating agents
(ESAs), are one of the most common drugs used to treat anemia. ESAs stimulate your body’s natural
process for making more red blood cells. They can be given alone or in combination with some other
treatments for the underlying cause of anemia. Before the mid-1980s there were no effective therapies
to increase the production of red blood cells. People with severe anemia were treated with blood
transfusions, which can cause infections, allergic reactions and other immunologic effects.
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In 1989, the
first ESA drug was approved for use, revolutionizing the treatment of anemia. Today, blood transfusions
are usually reserved for life threatening situations and ESAs have become a common treatment for
anemia.

Medications that increase the production of red blood cells, called erythropoiesis-stimulating agents
(ESAs), are one of the most common drugs used to treat anemia. ESAs stimulate your body’s natural
process for making more red blood cells. They can be given alone or in combination with some other
treatments for the underlying cause of anemia. Before the mid-1980s there were no effective therapies
to increase the production of red blood cells. People with severe anemia were treated with blood
transfusions, which can cause infections, allergic reactions and other immunologic effects.
1
In 1989, the
first ESA drug was approved for use, revolutionizing the treatment of anemia. Today, blood transfusions
are usually reserved for life threatening situations and ESAs have become a common treatment for
anemia


The Roles of Natural Erythropoietin and ESAs
If you have anemia your blood isn’t able to carry and distribute enough oxygen to different
tissues and organs. As a result, you may feel tired or have other symptoms depending on the
severity of anemia. People with severe anemia may feel tired, fatigued or experience shortness of
breath, which can cause problems carrying out routine activities. Erythropoietin is a natural
substance made by certain kidney cells. These kidney cells are very sensitive to the amount of
oxygen in your blood. When these cells determine that your oxygen level is low, they release
more erythropoietin. The erythropoietin then signals your bone marrow to make more red blood
cells in order to carry more oxygen throughout the body.
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Erythropoiesis-stimulating Agents Available in the United States
Trade Name Generic Name (Brand)
Procrit Erythropoietin alfa
Epogen Erythropoietin alfa
Aranesp Darbepoetin alfa
Product Package Inserts. August 2008.
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Sometimes the kidneys cannot make enough erythropoietin. If this is the case, your doctor may
prescribe an ESA. Synthetic ESA drugs act like the natural erythropoietin, and are given to help the body
produce more red blood cells and raise hemoglobin levels. Currently there are two ESA drugs available
in the United States to treat anemia: erythropoietin alfa, which is also referred to by the brand names
Epogen
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and Procrit,
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and darbepoetin alfa, which is also referred to by the brand name Aranesp.
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What Types of Patients Receive ESAs?
ESAs are approved by the Food and Drug Administration (FDA) to treat anemia which has been
caused by cancer chemotherapy treatment, kidney failure, or a drug used to treat AIDS.
Erythropoietin has also been approved for use to increase the red blood cell count in anemic
patients who are scheduled to have surgery. This can decrease the need for blood transfusions
following surgery. Though not yet approved by the FDA, ESAs have also been shown to be of
benefit in managing anemia in elderly people,
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in people with inflammatory bowel disease,
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and
in people with rheumatoid arthritis.
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How Are ESAs Administered?
ESAs are given by injection, either subcutaneously (under the skin) or intravenously (through an IV).
They can be given in many dosing schedules, ranging from several times a week to once a month,
depending on the drug chosen, the dose needed, and the reason you are receiving it.
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It may take
several weeks to raise your hemoglobin level and relieve some of your symptoms. This
is because your body must make new red blood cells to replace those that were lost. It normally takes
about five to seven days to make a health

How Are ESAs Administered?
Erythropoietin is a natural substance made n your body by the kidneys. Sometimes the kidneys
cannot produce enough erythropoietin to make the red blood cells you need. If this is the case,
your doctor may prescribe an erythropoiesis-stimulating agent (ESA). Synthetic ESA drugs act
like the natural erythropoietin, and can be given to increase red blood cells.
Monitoring Your Body’s Response to ESAs
It is important to note that not everyone responds to ESAs and your hemoglobin levels may not
go up. It is estimated that as many as 5-10% of patients have a decreased response, or no
response, to ESA treatment. Some of the reasons for this lack of response include iron
deficiency, blood loss, infection or inflammation. Sometimes correcting these problems will help
your body to better respond to ESA drugs.
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ESAs stimulate your bone marrow to make more red blood cells. Having more red blood cells raises your
hemoglobin level. If your hemoglobin level stays too high or if your hemoglobin goes up too quickly, this
may lead to health problems.
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Recently, the FDA has changed the instructions for ESA drugs, in order to
make sure that hemoglobin levels stay below 12 g/dL.
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A recent study has shown that patients who
need high doses of ESAs to maintain their hemoglobin levels may have a greater risk of cardiovascular
problems and death.
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Your doctor will monitor your red blood cell counts on a regular basis if you are taking ESAs. All
medicines may cause side effects, but many people have no, or minor, side effects. Occasionally, these
medications may affect your heart function or may increase your chance of developing a blood clot, or
after prolonged use, cause your red blood cell count to decrease. Let your doctor know immediately if
you have chest pain, shortness of breath, or leg swelling and pain.
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Treating Anemia
The first step to treating anemia is to determine its cause. Once the cause is determined, your doctor
can decide on the best treatment to correct the anemia. Many kinds of anemia can be alleviated by
treating the underlying disease or problem. Several medications, including ESAs, are available to help
correct anemia. ESAs have been administered successfully to millions of patients worldwide and are the
standard of care for anemia treatment. ESAs may be the best treatment for you, but always discuss all
treatment options thoroughly with your doctor. Communicate symptoms before, during and following
any type of treatment, especially ESA treatment