Feb 15, 2004
Dear Dr. Bob,
Heard through the grapevine there was a new Procrit called Arinest or something like that. Searched the archives and didn't see it. Can you fill us in? Dosing? Scheduling? Better side effect profile? What's up you stud you?
Response from Dr. Frascino
Well, you were close. It's Aranesp, not Arinest. I'm sure Google tried its best to locate it for you. O.K., so what is it? Well, its technical name is darbepoetin alfa. (Just as Procrit's technical name is epoetin alfa.) Aranesp was created by adding two nitrogen-linked chains to epoetin alfa to increase its sialic acid-containing carbohydrate content. There, aren't you glad you asked?
O.K., so why bother doing this biochemical mumbo-jumbo? The purpose was to increase the biologic activity of the molecule and hopefully its half-life, i.e. make it last longer. Why bother doing this? Well, epoetin alfa is often used three times per week for treating patients with anemia due to chronic kidney disease. It was hoped that this new product would decrease the frequency of administration to a more convenient once-a-week schedule. Did it work? Yes, in clinical trials of patients with anemia of CKD (chronic kidney disease), darbepoetin alfa's half-life was three times longer than epoetin-alfa's. So the FDA has approved Aranesp for the treatment of anemia associated with chronic renal failure and for anemia associated with chemotherapy for non-myeloid malignancies. That's the scoop!
Now as to your final questions: 1) Is it a new Procrit? 2) Does it have a better side effect profile? 3) "What's up you stud you?"
1. Although closely related to erythropoietin (Procrit) and acting similarly to stimulate the production of new red blood cells, Aranesp is a new compound. It has limited FDA indications so far and none of those indications include HIV-related conditions.
2. Does it have a better side effect profile than Procrit? As I mentioned, this drug is not yet indicated for HIV-related conditions, so we really don't know yet. For patients with chronic renal disease and those on cancer chemotherapy, the side effect profile is acceptable. Procrit has a remarkable track record for efficacy and safety, and has been used extensively in patients with HIV disease for over a decade. It does not have any drug-drug interactions with HIV or non-HIV drugs, and its side effects profile is essentially identical to placebo. So it's going to be difficult to have a "better" side effect profile than that. Also, I've mentioned in this forum many times that originally we used Procrit three times per week, but more recent clinical trials clearly show that once a week is equally effective.
3. "What's up you stud you?" Well first off, shouldn't that question be more politely phrased, "What's up Doc?" To which I would have to say, "Up" is the antithesis of down, just as John Kerry (up) is the antithesis of GeeDubya (down). So there you have it. Down with GeeDubya!
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