Methoxy polyethylene glycol epoetin beta (MPG-epoetin beta)

Methoxy polyethylene glycol epoetin beta Brand Name– MIRCERA

What is Methoxy polyethylene glycol epoetin beta

Methoxy polyethylene glycol epoetin beta (MPG-epoetin beta), also called continuous erythropoietin receptor activator, is a long-acting synthetic erythropoietin protein approved for the treatment of anemia associated with chronic kidney disease.

Studies in patients with chronic kidney disease who were either dialysis-dependent or dialysis-independent have shown similar efficacy in achieving target hemoglobin concentrations and reducing red blood cell transfusion dependence as comparator erythropoiesis-stimulating agents (ESAs).

The primary advantage of MPG-epoetin beta versus other ESAs is that it can be dosed less frequently (up to every 4 weeks) due to its extremely long half-life. MPG-epoetin beta should only be used in patients with chronic kidney disease and should not be used to treat cancer-related anemia.

A dose-ranging study of MPG-epoetin beta in patients with cancer was terminated early because of more deaths in the patients receiving MPG-epoetin beta compared to another ESA.

Indications

  • anemia
  • Evaluate the iron status in all patients before and during treatment. Administer supplemental iron when the serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%.
  • Correct or exclude other causes of anemia such as vitamin deficiency, metabolic or chronic inflammatory conditions, and bleeding before initiating methoxy polyethylene glycol-epoetin beta (MPG-epoetin beta). Monitor hemoglobin (Hgb) weekly until stable and sufficient to minimize the need for red blood cell (RBC) transfusions.
  • MPG-epoetin beta has not been shown to improve symptoms, physical functioning, or health-related quality of life.
  • MPG-epoetin beta is not indicated and is not recommended:
    • In the treatment of anemia due to cancer chemotherapy
    • As a substitute for RBC transfusions in patients who require immediate correction of anemia
  • In adult patients with chronic kidney disease on dialysis, initiate when the Hgb concentration is less than 10 g/dL.
  • In adult patients with chronic kidney disease not on dialysis, initiate when the Hgb is less than 10 g/dL, the rate of Hgb decline indicates the likelihood of requiring a RBC transfusion, and reducing the risk of alloimmunization and/or other RBC transfusion-related risks is a goal.

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. anemia
  4. angioedema
  5. antibody formation
  6. back pain
  7. bronchospasm
  8. cough
  9. diarrhea
  10. edema
  11. encephalopathy
  12. fever
  13. headache
  14. heart failure
  15. hyperkalemia
  16. hypertension
  17. hypotension
  18. infection
  19. myocardial infarction
  20. pharyngitis
  21. pruritus
  22. rash
  23. red cell aplasia
  24. seizures
  25. sinus tachycardia
  26. Stevens-Johnson syndrome
  27. stroke
  28. thrombocytopenia
  29. thromboembolism
  30. thrombosis
  31. toxic epidermal necrolysis
  32. vomiting

Monitoring Parameters

  • ferritin
  • hemoglobin/hematocrit
  • serum iron
  • transferrin

Contraindications

  • breast-feeding
  • cardiac disease
  • coagulopathy
  • coronary artery bypass graft surgery (CABG)
  • dialysis
  • folate deficiency
  • geriatric
  • hamster protein hypersensitivity
  • heart failure
  • hematological disease
  • hemoglobin concentration greater than 11 g/dl
  • hemolytic anemia
  • hypertension
  • infection
  • inflammation
  • iron-deficiency anemia
  • mannitol hypersensitivity
  • mortality
  • myocardial infarction
  • neoplastic disease
  • osteitis
  • pregnancy
  • red cell aplasia
  • seizure disorder
  • seizures
  • sickle cell disease
  • stroke
  • surgery
  • thalassemia
  • thromboembolism
  • vitamin B12 deficiency

Interactions

  • Androgens
  • Danazol
  • Esterified Estrogens; Methyltestosterone
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ferric carboxymaltose
  • Ferumoxytol
  • Fluoxymesterone
  • Iron
  • Iron – Injectable Only
  • Iron Dextran
  • Iron Salts
  • Iron Sucrose, Sucroferric Oxyhydroxide
  • Methyltestosterone
  • Nandrolone Decanoate
  • Oxandrolone
  • Oxymetholone
  • Polysaccharide-Iron Complex
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
  • Testolactone
  • Testosterone