המידע באדיבות medicontext.co.il
Last Updated: 2001-08-21 11:32:00 EDT (Reuters Health)
By Karla Gale
WESTPORT, CT (Reuters Health) – It is not clear whether epoetin treatment in cancer patients with hemoglobin concentrations above 10 g/dL reduces the need for transfusion or improves quality of life, investigators report.
Dr. Jerome Seidenfeld, of the Blue Cross and Blue Shield Association in Chicago, Illinois, and associates conducted a systematic review of literature published between 1985 and 1998 that compared the outcomes of patients with chemotherapy-associated anemia who received epoetin treatment with the outcomes of those who received transfusions.
"The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) nominated this topic to the federal Agency for Health Care Research and Quality (AHRQ)," Dr. Seidenfeld told Reuters Health. "The relevant clinical specialties clearly perceived a need to develop an evidence-based clinical guideline and advise their members on appropriate use of this drug," he added.
According to Dr. Seidenfeld, ASCO and ASH served as partners to the Agency on development of the specific questions to be addressed, the literature search strategy, study selection criteria, and analytic approach.
As reported in the Journal of the National Cancer Institute for August 15, the group's meta-analysis included 22 trials that met the study selection criteria. Combined results of the studies, which included evaluable data for 1838 patients, showed that epoetin reduced the odds of transfusion by a factor of 0.38 compared with patients who did not receive epoetin. On average, 4.4 patients would need to be treated to prevent one transfusion.
The decrease in transfusion use was about the same for trials where epoetin was used for hemoglobin concentrations greater than 10 g/dL and those where the hormone was restricted to patients with hemoglobin levels less than 10 g/DL.
"Evidence is insufficient to determine whether initiating epoetin earlier spares more patients from transfusion than waiting until the hemoglobin concentration declines to nearly 10g/dL," the authors conclude.
There was also little evidence that epoetin treatment at hemoglobin levels exceeding 10 g/dL resulted in a better quality of life. However, "the possibility exists that patients do experience an improvement in their quality of life if they are started on erythropoietin before their hemoglobin drops to 10g/dL," Dr. Seidenfeld commented.
"The point we want to make in this analysis is that a good study to address that question really needs to be done," he added. "It may well prove to be true, though we don't think it's likely based on the data we've seen so far."
Since the investigators completed the evidence review and the Agency gave final approval on the full evidence report, the ASH/ASCO panel has been working on a clinical guideline, Dr. Seidenfeld noted. "We expect the guideline to be presented to ASH members at their annual meeting next December, and we hope it will be published in both societies' journals some time after that."
J Natl Cancer Inst 2001;93:1204-1214.
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