Epoetins do not improve health of anaemic heart failure patients

Researchers from Sahlgrenska Academy have found that a commonly used drug to treat anaemia in heart failure patients does not improve patients’ health, nor does it reduce their risk of death from heart failure. Results of the international study were presented at the American College of Cardiology’s annual meeting in San Francisco on March 10 and published simultaneously online by The New England Journal of Medicine.

Initiated in 2006, the RED-HF (Reduction of Events With Darbepoetin Alfa in Heart Failure) trial involved 2,278 anaemic heart failure patients at 453 sites in 33 countries.

Similar clinical outcomes

Patients were randomly given either darbepoetin alfa or placebo. In the darbepoetin alfa group, 50.7 percent of the patients experienced death from any cause or hospitalisation for worsening heart failure. In the placebo group, 49.5 percent of the patients experienced similar clinical outcomes.

The trial was funded by Amgen, the maker of darbepoetin alfa (trade name: Aranesp).

Landmark study

“This landmark study provides answers to caregivers who treat patients with heart failure complicated by anaemia,” said James Young, MD, cardiologist and Chair of the Cleveland Clinic Endocrinology & Metabolism Institute, and co-investigator of the RED-HF trial. “Our findings do not support the use of darbepoetin alfa to treat anaemic heart failure patients.”

Anaemia a serious problem

Anaemia, the lack of red blood cells, is a common and serious problem in people who suffer from heart failure. It can lead to worse quality of life, higher rates of hospitalisation and death. Treatment options have focused on correcting anaemia with the use of intravenous iron or drugs that stimulate red blood cells.

Benefits questioned

“The benefits of erythropoietin-stimulating agents (ESAs) such as darbepoetin alfa to treat patients with heart failure and anaemia have been questioned due to contradictory research findings,” said Karl Swedberg, MD, PhD, a senior professor at the Sweden-based Department of Medicine, Sahlgrenska Academy and co-investigator of the RED-HF trial.

“Our study results show that the use of darbepoetin alfa to stimulate the production of red blood cells is an ineffective treatment for patients with heart failure and anaemia.”

No risk reduction

According to the study, researchers found that darbepoetin alfa treatment led to an early and sustained increase in haemoglobin compared with placebo. However, darbepoetin alfa treatment did not reduce the risk of death from any cause or hospitalisation from heart failure.

Findings suggest that haemoglobin is a marker of poor prognosis in heart failure, rather than a therapeutic target. There were no new safety findings identified in the study. However, researchers observed an increased risk of thrombosis in the darbepoetin alfa group.

Researchers note that further research is needed to identify treatment options for this patient population.

(Source: University of Gothenburg : New England Journal of Medicine)