A new study published in the Journal of the American Medical Association has concluded that patients in for-profit dialysis chains routinely get higher doses of the antianemia drug Epogen. These larger doses, while lucrative for the chains, can sometimes boost red blood cells above FDA levels. Part of the reason for the higher doses is financial. Medicare reimbursement encourages use of the drug, and clinics take in about 25 percent of their revenue through Epogen payments. What's more, drug maker Amgen offers volume discounts, which also encourages overuse. Another, more troubling reason for the large doses is that kidney specialists often hand off Epogen dosing decisions to dialysis clinic staffers, which means that doses aren't calibrated to individual needs. Meanwhile, the FDA is concerned enough about Epogen--and other erythropoietin drugs--that it placed its most severe warning on all of them.
The clinics, of course, contend that neither finances nor administrative issues influence their drug use patterns. Michael Lazarus, medical director of dialysis chain Fresenius North America, said that Epogen has been key to having a greater percent of patients meet red-blood cell level guidelines. To make that happen, it's inevitable that some patients will overshoot the levels doctors want to see.
To get more information on Epogen dosing:
- read this article from The Boston Globe
ALSO: Research has concluded that one in four cancer patients given Amgen's erythropoietin drug Aranesp died after 19 weeks, about 5 percent more than those on placebos. Release