Excerpt

This review compares the efficacy and adverse effects of specific erythropoietic stimulants (i.e., epoetin [alfa or beta], darbepoetin alfa) when used to manage anemia in patients undergoing cancer therapy (i.e., chemotherapy and/or radiation). This review also addresses questions relevant to optimizing the use of erythropoietic stimulants as a general class: the outcomes of using alternative thresholds to initiate or discontinue treatment and whether there are early predictors of response to treatment.

Contents

• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • Scope and Key Questions
• 2. Methods
  • Technical Expert Panel
  • Literature Search
  • Study Selection
  • Data Extraction
  • Quality Assessment
  • Data Synthesis
  • Peer Review
• 3. Results
  • Key Question 1. What are the comparative efficacy and safety of epoetin (alfa or beta) and darbepoetin?
  • Key Question 2: How do alternative dosing strategies affect the comparative efficacy and safety of epoetin and darbepoetin?
  • Key Question 3: How do alternative thresholds for initiating treatment, or alternative criteria for discontinuing therapy or duration of therapy, affect the efficacy and safety of erythropoietic stimulants?
  • Key Question 4. Are any patient characteristics at baseline or early hematologic changes useful to select patients or predict responses to treatment with erythropoietic stimulants?
• 4. Future Research
• Cited References and Included Studies
• Abbreviations
• Appendixes
  • Appendix A Exact Search Strings
  • Appendix B Sample Data Abstraction Forms
  • Appendix C Evidence Tables
  • Appendix D Excluded Studies
  • Appendix E Technical Expert Panel (TEP) and Peer Reviewers
  • Appendix F Statistical Heterogeneity
  • Appendix G Clinical Trials
  • Appendix H Community Studies

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0026. Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center EPC, Chicago, Illinois.

Suggested citation:

Seidenfeld J, Piper M, Bohlius J, Weingart O, Trelle S, Engert A, Skoetz N, Schwarzer G, Wilson J, Brunskill S, Hyde C, Bonnell C, Ziegler KM, Aronson N. Comparative Effectiveness of Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment. Comparative Effectiveness Review No. 3. (Prepared by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-02-0026.) Rockville, MD: Agency for Healthcare Research and Quality. May 2006. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0026). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov