ESA adult dosing
| Dose and modifications . | Epoetin alfa* . | Darbepoetin alfa . | ||
|---|---|---|---|---|
| Initial dose† | 150 U/kg SC TIW‡ | 40,000 U SC weekly§ | 2.25 µg/kg SC weekly‡ | 500 µg SC Q3W§ |
| Dose increases | Increase dose to 300 U/kg SC TIW if HgB increases by < 1 g/dL and remains below 10 g/dL after 4 weeks of therapy | Increase dose to 60,000 U SC weekly if HgB increases by < 1 g/dL and remains below 10 g/dL after 4 weeks of therapy | Increase dose to 4.5 µg/kg weekly if HgB increases by < 1 g/dL and remains below 10 g/dL after 6 weeks of therapy | N/A |
| Dose reductions | Decrease dose by 25% when HgB reaches a level needed to avoid transfusion or HgB increases > 1 g/dL in 2 weeks | Decrease dose by 40% when HgB reaches a level needed to avoid transfusion or HgB increases > 1 g/dL in 2 weeks | ||
| Dose withholding | If HgB exceeds a level needed to avoid transfusion, restart dose at 25% below previous dose when HgB approaches a level where transfusion may be required | If HgB exceeds a level needed to avoid transfusion, restart dose at 40% below previous dose when HgB approaches a level where transfusion may be required | ||
| Discontinue‖ | Following completion of chemotherapy course or if no response after 8 weeks of therapy (measured by HgB levels or continuing need for transfusions) | Following completion of chemotherapy course or if no response after 8 weeks of therapy (measured by HgB levels or continuing need for transfusions) | ||
| Dose and modifications . | Epoetin alfa* . | Darbepoetin alfa . | ||
|---|---|---|---|---|
| Initial dose† | 150 U/kg SC TIW‡ | 40,000 U SC weekly§ | 2.25 µg/kg SC weekly‡ | 500 µg SC Q3W§ |
| Dose increases | Increase dose to 300 U/kg SC TIW if HgB increases by < 1 g/dL and remains below 10 g/dL after 4 weeks of therapy | Increase dose to 60,000 U SC weekly if HgB increases by < 1 g/dL and remains below 10 g/dL after 4 weeks of therapy | Increase dose to 4.5 µg/kg weekly if HgB increases by < 1 g/dL and remains below 10 g/dL after 6 weeks of therapy | N/A |
| Dose reductions | Decrease dose by 25% when HgB reaches a level needed to avoid transfusion or HgB increases > 1 g/dL in 2 weeks | Decrease dose by 40% when HgB reaches a level needed to avoid transfusion or HgB increases > 1 g/dL in 2 weeks | ||
| Dose withholding | If HgB exceeds a level needed to avoid transfusion, restart dose at 25% below previous dose when HgB approaches a level where transfusion may be required | If HgB exceeds a level needed to avoid transfusion, restart dose at 40% below previous dose when HgB approaches a level where transfusion may be required | ||
| Discontinue‖ | Following completion of chemotherapy course or if no response after 8 weeks of therapy (measured by HgB levels or continuing need for transfusions) | Following completion of chemotherapy course or if no response after 8 weeks of therapy (measured by HgB levels or continuing need for transfusions) | ||
Food and Drug Administration product labels were accessed on June 8, 2018, for epoetin (https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/103234s5363s5366lbl.pdf) and for darbepoetin (https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/103951s5374lbl.pdf).
ESA, erythropoiesis-stimulating agent; HgB, hemoglobin; N/A, not applicable; Q3W, every 3 weeks; SC, subcutaneously; TIW, three times per week.
Including epoetin alfa-epbx.
Initiate only if HgB is < 10 g/dL and there is a minimum of two additional months of planned chemotherapy. Use and dosing differ in patients with myelodysplastic syndromes.
Weight-based dose.
Fixed dose.
Patients who do not respond to ESA treatment should be re-evaluated for underlying tumor progression, iron deficiency, or other etiologies for anemia.