SynthesisBMC nephrology2025
Comparative effectiveness of darbepoetin vs other agents in chronic kidney disease-related anemia: a systematic review and network meta-analysis.
Synthesis in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIn the advanced stages of chronic kidney disease (CKD), anemia impacts 78.9% to 96.5% of patients. Darbepoetin is utilized for the treatment of anemia associated with chronic kidney disease (CKD). The function of darbepoetin alfa can be clarified by comparing it with other agents. A comprehensive review and network meta-analysis were conducted to assess the safety and efficacy of Darbepoetin alfa compared to other agents in the treatment of anemia associated with chronic kidney disease (CKD).
methodsA systematic review and network meta-analysis were conducted adhering to PRISMA-NMA guidelines. A systematic search was performed in databases Medline, Embase, and Scopus from inception to November 24, 2024, without language limitations. Randomized controlled trials assessing erythropoietin-stimulating agents (ESAs) or placebo in adults with chronic kidney disease (CKD)-related anemia were included. Data extraction and risk of bias assessment (RoB 2.0) were performed separately. Bayesian network meta-analysis using random-effects models was carried out using BUGSnet in R. Treatment effects were measured as odds ratios (ORs) or mean differences (MDs) with 95% credible intervals. Heterogeneity, inconsistency, and publication bias were evaluated, and certainty of evidence was assessed using the GRADE approach.
resultsIn this network meta-analysis of 21 randomized trials involving over 4,000 CKD patients with anemia, Methoxy polyethylene glycol-epoetin beta showed the greatest hemoglobin increase, while Molidustat demonstrated the best cardiovascular and thrombotic safety despite lower efficacy. Daprodustat provided moderate hemoglobin improvement with a safety profile comparable to darbepoetin, showing no significant differences in mortality or cardiovascular events. Transferrin saturation, hypertension, and diabetes-related adverse events did not differ significantly across treatments. Roxadustat was associated with a higher incidence of gastrointestinal adverse events, particularly diarrhea.
conclusionDaprodustat and roxadustat indicated equivalent or higher efficacy when compared to darbepoetin in elevating hemoglobin levels in CKD-related anemia, with daprodustat demonstrating a good safety profile. While conventional ESAs remain beneficial, HIF-PHIs offer promising oral alternatives with possible benefits in cardiovascular safety and decreased hypertension risk. Further head-to-head trials are necessary to confirm these findings and guide individualized treatment strategies. CLINICAL TRIAL NUMBER: Not applicable.
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