Efficacy and safety of HIF prolyl-hydroxylase inhibitor vs epoetin and darbepoetin for anemia in chronic kidney disease patients not undergoing dialysis: A network meta-analysis

医学 贫血 肾脏疾病 内科学 安慰剂 促红细胞生成素 透析 血红蛋白 科克伦图书馆 阿尔法 胃肠病学 随机对照试验 病理 替代医学
作者
Qiyan Zheng,Huisheng Yang,Luying Sun,Ruojun Wei,Xinwen Fu,Ya‐Hui Wang,Yishan Huang,Yu Ning Liu,Wei Jing Liu
出处
期刊:Pharmacological Research [Elsevier BV]
卷期号:159: 105020-105020 被引量:55
标识
DOI:10.1016/j.phrs.2020.105020
摘要

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of oral medicines being developed for the treatment of anemia in chronic kidney disease (CKD) patients. This study aimed to compare the efficacy and safety of HIF-PHI vs epoetin and darbepoetin in CKD patients with anemia not undergoing dialysis. The PubMed, Embase, Cochrane Library, Web of Science, and clinicaltrials.gov databases were searched from inception to October 2019 for randomized controlled trials investigating different agents (six HIF-PHIs, epoetin, darbepoetin, and placebo) for treating CKD patients with anemia that did not undergo dialysis. The outcomes included a change in hemoglobin (Hb) levels and all-cause mortality. A total of 19 studies were included. Compared with the placebo, except for vadadustat (mean differences: 1.12, 95 % confidence interval [CI]: ‒0.11–2.35), the other drugs significantly increased Hb levels, with mean differences of 2.46 (95 % CI: 0.93–3.99) for desidustat, 1.81 (0.87–2.75) for enarodustat, 1.68 (0.64–2.72) for molidustat, 1.66 (0.89–2.44) for epoetin, 1.63 (0.69–2.56) for darbepoetin, 1.61 (0.99–2.22) for roxadustat, and 1.55 (0.74–2.36) for daprodustat. No differences were found in the Hb level elevations among these eight drugs. Compared with the placebo, there also was no significant association between the drugs and all-cause mortality (molidustat of RR, 0.39 [95 % CI, 0.06–2.59]; roxadustat, 0.40 (0.06–2.84); enarodustat, 0.33 (0.01–16.25); desidustat, 0.34 (0.01–17.00); epoetin, 0.50 (0.18–1.42); daprodustat, 0.54 (0.09–3.31); darbepoetin, 1.03 (0.65–1.65); and vadadustat, 1.43 (0.15–13.27)). No differences were observed in the all-cause mortality among the drugs. In conclusion, these HIF-PHIs are effective and relatively tolerant for treating anemia patients with CKD not undergoing dialysis. Further research should consider the limitations of our study to evaluate the value of these HIF-PHIs in clinical settings.
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