Erythropoeitin Retrospective Study

							Erythropoietin
Retrospective Study
Recombinant Human Erythropoietin:
Dogs and Cats with Naturally Occurring Renal Failure




Dr. Dianne E. Kittrell, DVM
Dr. Cathy Langston, ACVIM
The Animal Medical Center
January 30, 2003
Retrospective Overview

 Background Information
 Population Signalment

 Results and Discussion

 Case Study Examples
Background Information
   The Problem: Anemia of renal failure
    – Both Human recognition and animal incidence
          anemia of human CRF, recognized 1836
          Anemia present 35% feline CRF, reported1992


   Main Causes: Pathogenesis of anemia
    – Inadequate erythropoietin
          Limits red blood cell production
    – shortened red cell survival, recognized 1953
    – platelet dysfunction, recognized 1956
    – Iron deficiency and uremic bleeding
Background Information

   The Solution: r-HuEPO
    – Structurally conserved among species
          R-HuEPO suitable replacement, 1985
          Efficacy established in animals, 1998


   The Objective:
    – Evaluate resolution of anemia and resultant
      complications of erythropoietin treatment
Population Signalment
   Male:Female                            Age Distribution (Yrs.)


                                                 55%

   F 27%
                                         27%
           M 73%                                        9%      9%

                                          <5     5-10   10-15   > 15


                                  Canine (17%)


                   Feline (83%)




                                                 42%

   F 42%                                                28% 25%
           M 58%
                                          6%
                                          <5     5-10   10-15   > 15

   Male:Female                            Age Distribution (Yrs.)
Adverse Effects of Treatment

 Antibody formation
 Hypertension

 Seizure activity

 Polycythemia

 Pain on injection site
Population Response to Therapy
                                              other
                                                            AB
                                                           22%


                                                        NC
                                                       73%


              Indeterminate (27%)
                                     Responsive (57%)
          Unresponsive (16%)




other

           AB
          20%
                                    Conclusion: Population
                                    sample demonstrates strong
         NC
        70%
                                    response to therapy with
                                    limited complications
Median Survival from EPO Start

       160

             Indeterminate
       140
             Unresponsive
       120   Population
             Responsive
       100
Days




       80


       60


       40


       20
                             p<0.0001
        0
Canine; Median Survival from EPO

       60
            Indeterminate

       50
            Unresponsive
            Population
            Responsive
       40
Days




       30


       20


       10

                            p<0.0001
       0
Feline; Median Survival from EPO

       200
             Indeterminate
       180
             Unresponsive
       160   Population
       140   Responsive

       120
Days




       100

       80

       60

       40

       20
                             p<0.0001
        0
Case Study Comparisons
           60
                                                            Case 715009:
                                       Alex Steinbuch, Feline Siamese MC
           50


           40
 PCV (%)




           30


           20


           10
                                                            Case 714687:
                      100 Day Sample
                                          Sylvester McGee, Feline DSH MC
            0
                -10      30     70     110    150     190    230   270     310
                                       Days from EPO Start
Case 01: Optimal Response
           60
                                                             Case 715009:
                                        Alex Steinbuch, Feline Siamese MC
           50

           40
 PCV (%)




           30

           20

           10
                      Begin                          PCV
                       EPO                         Plateaus
           0
                -10    0      10   20   30   40   50     60   70   80   90   100
                                        Days from EPO Start
Case 02: Antibody Complications
           60
                                                                 Case 714687:
                                               Sylvester McGee, Feline DSH MC
           50


           40
 PCV (%)




           30


           20


           10
                      Begin               PCV                Terminate
                       EPO              Plateaus                EPO
            0
                -10    0      10   20     30       40   50   60   70     80   90   100
                                          Days from EPO Start
Concluding Remarks
   Evidence suggests that erythropoietin
    treatment positively impacts animals quality
    of life

   Final comments

   Further research

   Research Citations
References
   Cowgill LD, James KM, Levy JK, Browne JK, Miller A, Lobinger RT, Egrie JC.
    Use of recombinant human erythropoietin for management of anemia in
    dogs and cats with renal failure. JAVMA, Vol 212, No 4, Feb 15, 1998.

   Osborne CA, Lulich p, O’Brien TD, Polzin DJ. Feline renal failure:
    Questions, answers, questions. The Compendium, Vol 14, No 2, Feb 1992.

   Eschbach JW, Egriem JC, Michael RD, Browne JK, Adamson JW. Correction
    of the anemia of end-stage renal disease with recombinant human
    erythropoietin. The New England Journal of Medicine, Jan 8, 1987.
    pp.73-78

   Eschbach JW, Haley NR, Adamson JW. The anemia of chronic renal failure:
    Pathophysiology and effects of recombinant erythropoietin. Complications
    in chronic renal failure. Contrib Nephrology. Vol 78, 1990. pp.24-37

   Rrslev AJ. Erythropoietin. The New England Journal of Medicine, May 9,
    1991, Vol 324, No 19. pp. 1339-1344