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
- abdominal pain
- anaphylactoid reactions
- anemia
- angioedema
- antibody formation
- back pain
- bronchospasm
- cough
- diarrhea
- edema
- encephalopathy
- fever
- headache
- heart failure
- hyperkalemia
- hypertension
- hypotension
- infection
- myocardial infarction
- pharyngitis
- pruritus
- rash
- red cell aplasia
- seizures
- sinus tachycardia
- Stevens-Johnson syndrome
- stroke
- thrombocytopenia
- thromboembolism
- thrombosis
- toxic epidermal necrolysis
- 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
