Evaluating Long-Term Clinical Efficacy of ESAs Among Patients With Low‑Risk or Intermediate‑1‑Risk MDS

Multicenter, Real‑World Data 

According to a real-world long-term extension study, the clinical efficacy of erythropoiesis‑stimulating agents (ESAs) epoetin alfa and darbepoetin alfa among patients with low‑risk or intermediate‑1‑risk myelodysplastic syndromes (MDS) began to plateau starting from the 24th month of therapy, followed by a steady decrease in response rates, regardless of treatment type, risk status, or gender.

These results were presented at the Society of Hematologic Oncology (SOHO) 2023 Annual Meeting in Houston, Texas by Müzeyyen Aslaner Ak, MD, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.

Despite these overall findings, higher hemoglobin levels and notable improvement in transfusion-need was noted in the epoetin-treated vs darbepoetin-treated patient groups, as well as the low-risk vs intermediate-risk patient groups, respectively. 

The purpose of the study was to “evaluate the long-term clinical efficacy of epoetin alfa and darbepoetin alfa in patients with myelodysplastic syndromes in the real-life setting,” explained Dr Aslaner Ak and coauthors. 

In this evaluation, data from 204 patients with low-risk or intermediate-1-risk MDS who received epoetin alfa or darbepoetin alfa was analyzed. Hemoglobin levels and transfusion-need were recorded before and during 12-month, 24-month, 36-month and 48-month treatments. 

At 36-month (P = .025) and 48-month (P = .022) visits, epoetin alfa vs darbepoetin alfa yielded significantly higher hemoglobin levels. Transfusion-need was also significantly lower in epoetin alfa vs darbepoetin alfa groups at 24-month (P = .012), and in low risk vs intermediate risk groups at their 24-month (P = .018), 36-month (P = .025) and 48-month ( P < .001) visits. 

The treatment response rates recorded at the 24-month, 36-month and 48-month visits in epoetin alfa (43.0%, 33.6%, and 27.1%), darbepoetin alfa (29.9%, 22.7%, and 16.5%), low risk (39.3%, 30.0%, and 26.0%) and intermediate risk (29.6%, 24.1%, and 11.1%) groups were lower than 12-month response rates, significantly at the 36-month and 48-month visits (P ranged from < .05 to < .001). 

“This real-life long-term ESA extension study investigated the clinical efficacy of epoetin alfa and darbepoetin alfa for up to 48 months and revealed the treatment efficacy to reach plateau starting from the 24th month of therapy with a continuing decrease in treatment response rates, regardless of treatment type, risk status or gender,” the study authors concluded. 

“Nonetheless, significantly higher hemoglobin levels and marked improvement in transfusion-need was evident in the epoetin-treated vs darbepoetin-treated groups and in the low risk vs intermediate risk groups,” they added. 

Source:

Aslaner Ak M, Gedük A, Halil Açar I, et al. The long‑term efficacy of erythropoiesis‑stimulating agents in patients with low‑risk or intermediate‑1‑risk myelodysplastic syndrome: multicenter real‑life data. Presented at 2023 SOHO Annual Meeting; September 6-9, 2023; Houston, TX. Abstract MDS-225