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• W4381805888 abstract "Abstract Background Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are new therapeutic agents for anaemia of chronic kidney disease (CKD). We evaluated by metanalysis and meta-regression efficacy and safety of HIF-PHIs in patients with CKD-related anaemia. Methods We selected phase-3 randomized clinical trials (RCTs) comparing HIF-PHIs and erythropoiesis stimulating agents (ESAs) in dialysis and non-dialysis patients. Efficacy outcomes were the changes from baseline of haemoglobin, iron parameters (hepcidin, serum iron, TIBC, TSAT, ferritin,) and intravenous iron dose; as safety outcomes we considered cancer, adjudicated major adverse cardiovascular events (MACE), MACE+ (MACE plus hospitalization for hearth failure or unstable angina or thromboembolic event), thrombotic events (deep vein thrombosis, pulmonary embolism), artero-venous fistula (AVF) thrombosis, and death. Results We included 26 RCTs with 24,387 patients. Random effect meta-analysis of unstandardized mean difference between HIF-PHIs and ESAs showed a significant change in haemoglobin levels from baseline of 0.10 g/dL (95%CI, 0.02-0.17). Meta-regression analysis showed significantly higher haemoglobin change for HIF-PHIs in younger patients and versus short-acting ESA (0.21 g/dL, 95%CI, 0.12-0.29 versus -0.01, 95%CI, -0.09-0.07 in studies using long-acting ESA, P&lt;0.001). No significant effect on heterogeneity was found for type of HIF-PHIs. In comparison with ESAs, HIF-PHIs induced a significant decline in hepcidin and ferritin and a significant increase in serum iron and TIBC, while TSAT did not change; intravenous iron dose was lower with HIF-PHI (-3.1 mg/week, 95%CI -5.6 to -0.6, P = 0.020). Rate ratio of cancer (0.93, 95%CI: 0.76-1.13), MACE (1.00, 95%CI: 0.94-1.07), MACE+ (1.01, 95%CI: 0.95-1.06), thrombotic events (1.08, 95%CI: 0.84-1.38), AVF thrombosis (1.02, 95%CI: 0.93-1.13) and death (1.02, 95%CI: 0.95-1.13) did not differ between HIF-PHIs and ESAs. Conclusions HIF-PHIs at the doses selected for the comparisons are effective in correcting anaemia in comparison with ESA therapy with a significant impact on iron metabolism without notable difference among various agents. No safety signals emerge with use of HIF-PHIs." @default.
• W4381805888 created "2023-06-24" @default.
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• W4381805888 date "2023-06-22" @default.
• W4381805888 modified "2023-09-25" @default.
• W4381805888 title "Efficacy and Safety of Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors in Patients with Chronic Kidney Disease: Metanalysis of Phase-3 Randomized Controlled Trials" @default.
• W4381805888 doi "https://doi.org/10.1093/ckj/sfad143" @default.
• W4381805888 hasPublicationYear "2023" @default.
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