Roxadustat effective in patients with CKD with varying blood CRP levels, reveals research

A new study published in the journal of BMC Nephrology showed that the effectiveness of roxadustat is comparable at varying blood C-reactive protein (CRP) levels. A variety of diseases can cause chronic kidney disease (CKD), which is a progressive disorder that eventually results in irreparable changes to the structure and function of the kidneys. By blocking hypoxia-inducible factor prolyl hydroxylase, these medications stabilize hypoxia-inducible factor (HIF).

The patients with chronic kidney illness frequently have chronic inflammation, which contributes to the development of renal anemia and is indicated by elevated blood C-reactive protein levels. This systematic review is to look at how CRP affects how well hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) work to treat renal anemia in CKD patients.

Until May 19, 2022, this study searched a wide range of electronic databases, including Pubmed, Embase, Web of Science, CNKI, Wanfang, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP). This research conducted a comprehensive analysis of the data from randomized controlled trials that used HIF-PHIs to treat renal anemia. Using a random-effects model, the meta-analysis result was the mean difference (MD) in changes in hemoglobin concentration (∆Hb) before and after therapy. The groups having CRP levels below the upper limit of normal (ULN) and above or equal to the ULN were compared. Further, a comparison between erythropoiesis-stimulating agents (ESA) and HIF-PHIs was carried out in the CRP≥ULN group.

The study comprised 7 papers from 6 publications, where a total of 524 participants from 4 trials were included in the study to compare the CRP ≥ ULN group with the CRP < ULN group. The main treatment for every patient was roxadustat. There was no discernible difference in ΔHb between patients with baseline CRP ≥ ULN and those with baseline CRP < ULN, according to the pooled data. Also, 3 trials with 1399 patients assessed the effectiveness of erythropoiesis-stimulating drugs (ESAs) and roxadustat within the CRP ≥ ULN group. The findings showed that patients treated with ESAs and HIF-PHIs did not significantly vary in their ΔHb levels.

Regarding medicine dosage, several studies showed that the ESA dose increased with time, especially in the CRP‥ULN group. The roxadustat dose remained constant over time and was unaffected by the baseline CRP levels. Overall, the effectiveness of roxadustat is consistent throughout a range of CRP values. Furthermore, roxadustat can sustain effectiveness equivalent to ESA in the CRP≥ ULN group without the need for dosage escalation.

Source:

Luo, X., Li, G., Yang, H., Chen, L., Gao, Y., Cong, J., Luo, H., & Zhang, W. (2024). Impact of C-reactive protein on the effect of Roxadustat for the treatment of anemia in chronic kidney disease: a systematic review of randomized controlled trials. In BMC Nephrology (Vol. 25, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-024-03474-5