Methoxy polyethylene glycol epoetin beta and the treatment of anaemia in chronic heart failure

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Abstract

Aim. To study erythropoietic activity and safety of methoxy polyethylene glycol epoetin beta (MEB) and its effects on haemoglobin (Hb), erythropoietin, ferritin, NT-proBNP, cytokines, and chronic heart failure (CHF) symptoms and signs. Material and methods. In total, 84 patients with Functional Class (FC) II–IV (NYHA) CHF and anaemia were examined (mean age 59,7±1,6 years; 54 men and 30 women). Anaemia criteria were Hb levels <120 g/l in men and <110 g/l in women. CHF was due to coronary heart disease, CHD (post-infarction cardiosclerosis; n=40); to CHD in combination with Type 2 diabetes mellitus, DM-2 (n=10), and arterial hypertension, AH (n=14); and to the combination of CHD, AH, and DM-2 (n=10). Left ventricular ejection fraction (LVEF) in CHF patients with FC II, III, and IV was ≤45%, ≤40%, and ≤30%, respectively. At baseline and after 6 months of MEB treatment, the levels of ferritin, transferrin, erythropoietin, NT-proBNP, and pathologic cytokines were assessed. MEB was administered to patients without iron deficiency. All participants were randomised into two groups: Group I (n=44) received standard treatment with ACE inhibitors, digoxin, beta-blockers, and diuretics; Group II (n=40) received standard therapy and subcutaneous MEB (0,60 mkg/kg (50 U) once a month, for 6 months). Results. LVEF in Group II increased by 23,3% (р<0,02). Exercise capacity (6-minute walk test), decreased at baseline, also significantly increased in patients receiving MEB, compared to individuals receiving placebo (+42,8%; p<0,01). Positive hemodynamic effects were accompanied by a marked clinical improvement, as demonstrated by a reduced need for diuretics (–32–35%) and by the quality of life improvement. In Group I, mean Hb levels significantly increased and reached 104,5 g/l, while in Group II, this significant increase was even higher (up to 113,7 g/l). Group II, compared to Group I, demonstrated an increase in Hb levels by 21,9% (p<0,05) and normalisation of erythropoietin levels. Of note, an increase in erythropoietin levels was accompanied by a slight reduction in ferritin levels (up to 102,7±21,2 mkg/l) in participants with ferritin saturation >20%. In Group II, the increase in erythropoietin levels was associated with suppressed cytokine activation, decreased levels of interleukin-6 (–48,4%; p<0,05) and tumour necrosis factor-alpha (–39,7%; p<0,01), and a slight increase in interleukin-1 levels (+0,97%; p<0,02). Conclusion. The use of MEB for the anaemic syndrome correction in CHF patients effectively treats erythropoietin deficiency, anaemia, and cytokine activation.

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Zakhidova, K. K., & Kuliev, F. A. (2013). Methoxy polyethylene glycol epoetin beta and the treatment of anaemia in chronic heart failure. Russian Journal of Cardiology, 101(3), 74–80. https://doi.org/10.15829/1560-4071-2013-3-74-80

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