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Nephrologists Report Decline in Use of ESAs in Hemodialysis and Peritoneal Dialysis Patients Compared With 1 Year Ago

Survey finds interest in hyperkalemia drugs ZS-9 and patiromer

Decision Resources Group, a health care research firm based in Burlington, Mass., finds that surveyed nephrologists report significant declines in the use of erythropoiesis-stimulating agents (ESAs) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD), whereas the use of ESAs in stage 4 has remained statistically flat and use in stage 3 has increased, compared with the first quarter of 2013.

Other key findings from the report include:

  • Most of the surveyed nephrologists believe that biosimilars (in general and for epoetin alfa in particular) are very similar or somewhat similar to their branded protein product counterparts.
  • Six months from now, surveyed nephrologists expect the use of oral iron to increase in HD and to remain statistically flat in PD, stage 4 and stage 3.
  • Injectafer (American Regent), an intravenous iron approved in July 2013, has reached low single-digit chronic kidney disease (CKD) non–dialysis-reported patient share.

In other key findings, a new drug application was recently submitted to the FDA for Triferic (Rockwell Medical), an iron compound that is delivered to HD patients via the dialysate. Compared with the first quarter of 2013, mean familiarity with Triferic has significantly increased.

The greatest perceived need for new therapies among a list of common areas in nephrology included slowing the progression of kidney disease, diabetic nephropathy, acute kidney injury, polycystic kidney disease, and glomerulonephritis.

Based on common medications prescribed to patients with CKD, surveyed nephrologists believe that pre-dialysis patients are most compliant with diuretics — significantly more than with iron therapies, renin inhibitors, and phosphate binders.

General impressions on bundling were more positive since the bundling program started almost 3 years ago. In the first quarter of 2014, about 29% of nephrologists viewed bundling positively versus 12% in the first quarter of 2011. Based on mean ratings, surveyed nephrologists were under the most pressure to restrict the measurement of nonessential labs; to have more-stringent hemoglobin targets, resulting in less ESA use; and to use more iron at the expense of ESAs.

“In terms of the renal pipeline, surveyed nephrologists’ perceptions of ZS-9 [ZS Pharma] and patiromer [Relypsa] are both high after reviewing their product profiles,” said analyst Rob Dubman. “These are late-stage agents in development for the treatment of hyperkalemia. This finding is in line with the fact that this study also found that the need for new hyperkalemia treatment options was rated 6.9 on a scale of 1 to 10, with 10 being a high need for an improved therapy.”

Source: BioTrends Research Group; April 9, 2014.

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