BMJ  2007;334:978-980 (12 May), doi:10.1136/bmj.39198.510347.AD

Feature

Erythropoietin

Too much of a good thing

Alison Tonks, associate editor

BMJ, London WC1H 9JR

atonks@bmj.com

Doctors in the US use epoetins more aggressively than those in the UK. Alison Tonks reveals how recent research has raised questions about US guidelines

The first 150 words of the full text of this article appear below.

Erythropoietin is a glycoprotein hormone with a long and controversial history. Thousands of patients worldwide rely on synthetic erythropoietins such as epoetin alfa to alleviate the anaemia that accompanies chronic renal disease and chemotherapy for cancer. But despite decades of use, experts can't seem to agree on one fundamental aspect of treatment: how aggressively should doctors use these agents to drive patients' concentrations of haemoglobin back towards normal?

Getting the answer should be a relatively simple matter—a few decent trials comparing the various options, usually full or partial correction of anaemia. But in the case of epoetin the truth has been lost in a blizzard of professional polemic complicated by the vested interests of big business. Balance is critical. Too little treatment and patients with chronic kidney disease are condemned to a lifetime of exhaustion, misery, and blood transfusions. Too much and they could be threatened with an increased risk . . . [Full text of this article]


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