Nephrologists settling into new anemia treatment standards

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Nephrologists settling into new anemia treatment standards

Copyright 2008 by Virgo Publishing.
http://www.renalbusiness.com/
Posted on: 10/28/2008

EXTON, Pa.— Nephrologists appear to be settling into new renal anemia treatment standards, and more than two-thirds do not anticipate making any additional changes to their use of anemia drugs in chronic kidney disease or dialysis, according to a new report.

Some of the new renal anemia treatment standards include lower target hemoglobin levels, lower levels for anemia drug initiation, holds, and dose reductions.

The new anemia treatment findings were part of two reports released Oct. 28 by BioTrends Research Group Inc. The reports were based on survey results from 204 nephrologists and 201 renal dietitians in the United States, which looked into trends in the most used pharmaceuticals in renal care.

Amgen's anemia drug Epogen continues to dominate the dialysis market, BioTrends said. However, their survey found that there did seem to be some brand shifting between Amgen's Aranesp and Ortho Biotech's Procrit in CKD.

Nephrologists do not predict significant changes in anemia drug market share in CKD or dialysis in the near-term, but they do project that bundling will have an impact on anemia drug use, most likely through shifts to subcutaneous dosing and less aggressive treatment of hypo-responders, the report found. In addition, new anemia drugs in development could also shift market dynamics particularly if these products are able to meet what nephrologists identified as the most desired attributes in a new anemia drug.

IV Iron Trends

In terms of IV iron, American Regent's Venofer remains the market leader in both dialysis and CKD, however, office-based nephrologists report significantly higher CKD share for Venofer and hospital-based nephrologists report significantly higher CKD share for Watson's Ferrlecit, according to the BioTrends report.

In the dialysis market, very little brand switching took place in the past year, although 60 percent of nephrologists primarily affiliated with Fresenius units expect their use of Venofer to increase following the news that Fresenius will be marketing and distributing Venofer in dialysis units, BioTrends found.

BioTrends also found awareness of AMAG Pharmaceutical's ferumoxytol continues to be low. Among those familiar with the product, expected benefits center around dosing and administration, particularly for CKD patients. More than half of nephrologists said they believe that the introduction of this new product will lead to an overall increase in their use of IV iron in CKD.

Phosphate Binder Use

In the phosphate binder market, the introduction of Genzyme's sevelamer Renvela has given the overall sevelamer market share a boost compared to the same quarter last year, according to BioTrends, although most of the patients on Renvela have been switched from Genzyme’s other sevelamer, Renagel.

Phosphate binders are used to treat hyperphosphatemia, which is when the body contains too much phosphorus. The condition is common in kidney disease patients as the kidneys can no longer filter out the excess phosphorus. The U.S. Food and Drug Administration approved Renvela in late October 2007, and Genzyme launched the new drug in early 2008.

According to the BioTrends report, nearly two-thirds of doctors and more than three-quarters of renal dietitians have used Renvela in their hemodialysis patients. However, Renagel and Fresenius’s PhosLo remain the two most frequently prescribed phosphate binders among dialysis patients.

While sevelamer has the highest share across all types of dialysis units, Shire's Fosrenol does its best in DaVita dialysis units whereas PhosLo does its best in Fresenius dialysis units.

Nephrologists are divided as to their first line preference in dialysis—approximately half choose a calcium-based binder and half choose a non-calcium based binder compared to over two-thirds of RDs who choose to start with a non-calcium based binder, according to the report. In patients with CKD not on dialysis, 73 percent of nephrologists prefer to start with calcium-based phosphate binders.

PTH Modifiers

In the parathyroid hormone (PTH) modifier market, RDs report a high level of influence in the choice of Vitamin D, according to BioTrends. Approximately 80 percent of RDs reported that their dialysis center generally encourages the use of Abbott's Zemplar, compared to only 29 percent who report they are encouraged to use Genzyme's Hectorol.

While Zemplar IV is the overwhelming market share leader in hemodialysis and leads in every type of dialysis unit, Hectorol does its best in non-chain dialysis clinics and its worst in DaVita clinics, according to BioTrends.

In CKD, nephrologists continue to use oral calcitriol most often, the report said. Compared to the prior year, RDs reported a high and growing influence in decisions regarding the use of Sensipar. Treatment prevalence with Sensipar in hemodialysis patients, according to both MDs and RDs has been lingering at around 30 percent.

Although Sensipar is often used second line to Vitamin D, it does seem to impact Vitamin D dose, with the majority of RDs reporting that patients on Sensipar tend to be on lower doses of Vitamin D, according to BioTrends.

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