RESUMO
OBJECTIVES: To survey practices of iron and recombinant human erythropoietin (rhEpo) administration to infants born preterm across Europe. STUDY DESIGN: Over a 3-month period, we conducted an online survey in 597 neonatal intensive care units (NICUs) of 18 European countries treating infants born with a gestational age of <32 weeks. RESULTS: We included 343 NICUs (response rate 56.3%) in the survey. Almost all NICUs (97.7%) routinely supplement enteral iron, and 74.3% of respondents to all infants born <32 weeks of gestation. We found that 65.3% of NICUs routinely evaluate erythropoiesis and iron parameters beyond day 28 after birth. Most NICUs initiate iron supplementation at postnatal age of 2 weeks and stop after 6 months (34.3%) or 12 months (34.3%). Routine use of rhEpo was reported in 22.2% of NICUs, and in individual cases in 6.9%. RhEpo was mostly administered subcutaneously (70.1%) and most frequently at a dose of 250 U/kg 3 times a week (44.3%), but the dose varied greatly between centers. CONCLUSIONS: This survey highlights wide heterogeneity in evaluating erythropoietic activity and iron deficiency in infants born preterm. Variation in iron supplementation during infancy likely reflects an inadequate evidence base. Current evidence on the efficacy and safety profile of rhEpo is only poorly translated into clinical practice. This survey demonstrates a need for standards to optimize patient blood management in anemia of prematurity.
RESUMO
OBJECTIVES: To evaluate the effects of epoetin (EPO) alfa treatment on overall survival, event-free survival and response duration in patients with myelodysplastic syndrome (MDS) who were treated at a haematological referral centre in northeastern Brazil. METHODS: This was a retrospective cohort study of 36 patients diagnosed with MDS and treated with EPO alfa at 30,000 to 60,000 IU per week. Clinical data were collected from medical records. The events assessed were non-response to treatment and progression to acute myeloid leukaemia (AML). Statistical analyses were performed using GraphPad Prism 7 and SPSS 24 software. RESULTS: The overall survival of patients who received EPO alfa treatment was 51.64%, with a median of 65 months of treatment, and the overall survival of this group was 100% during the first 24 months. We detected a 43.5-month median event-free survival, with a response rate of 80.5%. We observed responses from 25 to 175 months. Patients with transfusion dependence and those with a high-risk stratification, as determined by the International Prognostic Scoring System (IPSS), the Revised International Prognostic Scoring System (IPSS-R), the WHO classification-based Prognostic Scoring System (WPSS) and the WHO 2016, had a lower event-free survival than other patients. CONCLUSIONS: Despite the wide use of EPO alfa in the treatment of anaemia in patients with MDS, the median response duration is approximately only 24 months. Our data provide encouraging results concerning the benefits of using EPO alfa for the improvement of the quality of life, as patients treated with EPO showed higher overall survival, event-free survival rates and longer response durations than have been previously described in the literature.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/tratamento farmacológico , Epoetina alfa/uso terapêutico , Hematínicos/uso terapêutico , Contagem de Plaquetas , Valores de Referência , Fatores de Tempo , Transfusão de Sangue , Brasil , Hemoglobinas/análise , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Progressão da Doença , Estimativa de Kaplan-Meier , Cariótipo , Intervalo Livre de ProgressãoRESUMO
In this study, we compared the results of potency determination of recombinant human erythropoietin (rhEPO) obtained between 2010 and 2012 by the National Institute of Quality Control in Health (INCQS/Fiocruz), i.e., the National Control Laboratory (NCL), and by a manufacturer of rhEPO. In total, 47 different batches of commercially prepared rhEPO (alpha isoform) were analyzed. All results, including those of the control and warning limits, remained within the limits recommended by European Pharmacopoeia (Ph. Eur.). All relative error (RE) values were less than ± 30%, wh ereas most were approximately ± 20%. Applying the Bland-Altman plot, only two of 47 values remained outside the limits of agreement (LA). In addition, agreement of potency determination between INCQS and the manufacturer coefficient of variation of reproducibility (% CVR) was considered satisfactory. Taken together, our results demonstrate (i.) the potency assay of rhEPO performed at INCQS, is standardized and controlled, (ii.) the comparison of our results with those of the manufacturer, revealed an adequate inter-laboratory variation, and (iii.) the critical appraisal proposed here appears to be a feasible tool to assess the reproducibility of biological activity, providing additional information regarding monitoring and production consistency to manufacturers and NCLs.
RESUMO
A method based on CZE for the determination of glutamic acid, glycine, and alanine in a biopharmaceutical formulation containing recombinant human erythropoietin was developed. The separation was achieved within less than 5 min, using a fused-silica capillary column (55 cm × 50 µm id) and 30 mmol/L phosphate buffer at pH 11.5, containing 0.6 mmol/L CTAB and 10% v/v methanol, as BGE solution. Applied potential of -25 kV, temperature of 15°C and hydrodynamic injection time of 15 s, at 50 mbar, were employed. The detection of the analytes was carried out without any derivatization reaction, at 220 nm using an UV-DAD detector. Linear ranges from 50 to 2500 mg/L and quantification limits of 40, 39, and 37 mg/L were obtained for glutamic acid, glycine, and alanine, respectively. Sample preparation required only a dilution step. Considering peak area and migration time values, the method presented good repeatability (RSD <1.7%; n = 9) and intermediate precision (RSD <1.0%; n = 6). Recovery evaluation using a commercial sample led to values between 97.5 ± 5.2% and 101.5 ± 4.6%, demonstrating the feasibility of the method, which was successfully applied in the quantification of the amino acids of interest in biopharmaceutical samples.
Assuntos
Aminoácidos/análise , Eritropoetina/química , Proteínas Recombinantes/química , Anemia/tratamento farmacológico , Eletroforese Capilar/métodos , Eritropoetina/análise , Eritropoetina/uso terapêutico , Humanos , Concentração de Íons de Hidrogênio , Limite de Detecção , Modelos Lineares , Proteínas Recombinantes/análise , Proteínas Recombinantes/uso terapêutico , Reprodutibilidade dos TestesRESUMO
The recombinant human erythropoietin (rhEPO) is a glycoprotein hormone. In face of the broad range of rhEPO-containing products in the market, the scope of their therapeutic indication and the characteristics of the rhEPO users, the biological activity testing is of high relevance for their batches releasing process. The potency testing is a laboratory evaluation for assessing the effectiveness of the final product, recommended by the European Pharmacopoeia (Ph. Eur.). This paper aimed at evaluating the agreement between the biological activity results obtained when the strain of mice-B6D2F1, recommended by Ph. Eur., was used in comparison to the Swiss Webster (SW). Twenty-two batches were assayed using these two mice strains, and a total of 44 valid assays were obtained with satisfactory results. In none of these analyses, neither repeating assays nor results combination were needed. The inter-strains variation and the accuracy were evaluated, and the following results were detected: Coefficient of Variation (VC) 10 % and Relative Error % (RE) 10 %, respectively. The tested lineage provided homogeneous results, and no statistically significant difference between them was found. The SW strain might be used as an alternative in place of B6D2F1 for performing the biological potency evaluation of rhEPO.(AU)
A eritropoietina humana recombinante (rhEPO) é um hormônio glicoproteico. Diante da gama de produtos contendo rhEPO disponíveis no mercado, da abrangência da indicação terapêutica e das características dos usuários de rhEPO, o ensaio de atividade biológica é de grande importância para o processo de liberação de lotes deste produto. O teste de potência é uma avaliação laboratorial para averiguar a eficácia do produto final, recomendada pela Farmacopeia Europeia (Ph. Eur.). Este trabalho teve como objetivo avaliar a concordância entre os valores de potência biológica obtidos quando a linhagem de camundongos preconizada pela Ph. Eur. (B6D2F1) foi utilizada em comparação com a Swiss Webster (SW). Vinte e dois lotes foram testados usando-se estas duas linhagens, e 44 ensaios válidos foram obtidos com resultados satisfatórios. Em nenhuma das análises houve necessidade de efetuar repetição de ensaios, bem como a combinação de resultados. A variação entre linhagens e a veracidade foram avaliadas, obtendo-se os seguintes resultados: Coeficiente de Variação (CV) 10 %; Erro Relativo % (ER %) 10 %, respectivamente. As linhagens testadas geraram resultados homogêneos sem diferença estatisticamente significativa entre elas. A linhagem SW mostrou características adequadas para ser empregada como alternativa à linhagem B6D2F1 na avaliação da potência biológica de rhEPO.(AU)