ABSTRACT
OBJECTIVE: The purpose of the present study was to compare the dosage requirements of recombinant human erythropoletin (rHuEPO) administered subcutaneously (SC) either one or three times weekly. DESIGN: A randomized, prospective study. SETTING: The patients were recruited from two university hospitals and five county hospitals. PATIENTS: Thirty-three anemic patients on continuous ambulatory peritoneal dialysis (CAPD) treatment for end-stage renal failure completed the study. INTERVENTIONS: Initially, all were treated with rHuEPO SC three times a week until hemoglobin blood levels (Hb) remained constant between 105 and 121 g/L for three months. Following randomization, 17 patients continued the same treatment schedule (group A), while 16 patients received the same dose, but administered only once weekly for three months (group B). MAIN OUTCOME MEASURES: The Hb levels and rHuEPO doses at the start and at the end of the three-month study period. RESULTS: In group A the median Hb at randomization was 118 g/L (109-119) (25-75 percentiles) and, after three months, was 113 g/L (106-119) (p = 0.13), while in group B the median Hb was 114 g/L (108-119) and 114 g/L (106-120), respectively (p = 0.50). In group A the weekly dose of rHuEPO remained virtually unchanged during the study period, 65 (55-86) and 66.3 (55-95) U/kg/week, respectively, while in group B it was increased from 60.2 (46-88) to 77 (60-90) U/kg/week. The 22% increase (p = 0.03) took place during the last two weeks. CONCLUSIONS: Our findings indicate that a once-weekly SC dosing regimen of rHuEPO in anemic CAPD patients was equally effective in maintaining a stable hemoglobin level as a thrice-weekly dosing regimen.
Subject(s)
Erythropoietin/administration & dosage , Peritoneal Dialysis, Continuous Ambulatory , Anemia/therapy , Blood Pressure/drug effects , Body Weight/drug effects , Drug Administration Schedule , Ferritins/blood , Hemoglobins/analysis , Humans , Injections, Subcutaneous , Kidney Failure, Chronic/therapy , Prospective Studies , Recombinant Proteins/administration & dosageABSTRACT
The central actors on the health arena are industry, doctors and bureaucracy. Whilst general trends towards industrialization, professionalization and bureaucratization are not limited to the health field, developments there have been extremely rapid and show unique features. The three actors often cooperate in harmony despite different goals. On the other hand, bureaucracy is often unable to reach its goals because of resistance from the other two actors. Conflicts, however, occur and are intensive in many third world countries. In industrial countries, too, trade interest in pharmaceuticals may over-ride public health considerations. Conflicts concerning individual drugs have received much publicity. In general, doctors as an organized profession tend to protest against bureaucracy but not against industry. In recent years it has become more and more apparent that health issues cannot be treated as the internal affairs of the actors. New actors have entered the arena. Patients' and consumers' organizations, small groups of doctors and new bodies such as Health Action International have changed the scene. Acting together with fundamental societal changes, this adds a new dimension to the debate and raises the question of including a social element in doctors' ethics. Medical research will also be more directed towards the health care system and become closer to the traditional problems of social science. Social scientists will therefore have contributions to make - studying how the relations between the actors influence the health care system and public health, for instance.
