RESUMO
INTRODUCTION: Erythropoiesis-stimulating agents (ESAs) prevent transfusions among anemic patients with chronic kidney disease (CKD). Clinical trials, meta-analyses, and guidelines identify arterial and venous thromboembolism as well as myocardial event risks with the traditional ESAs, erythropoietin (EPO), and darbepoietin. Side effects of anemia treatment, considering frequency and dosage of treatment as well as targeted hemoglobin levels when utilizing ESAs, greatly impact overall well-being and the quality of life. There is a need for less frequent but equally effective ESAs in this setting. AREAS COVERED: The three generations of ESAs used in CKD-associated anemia are described. Cost effectiveness of the utilization of these therapies, in addition to emerging therapies, is also presented. The few clinical and controlled trials only highlight the need for clarity in molecular biology surrounding the components that control EPO levels and utilization. EXPERT OPINION: Anemia associated with CKD is an important area for development of newer therapies which are potentially safer and more convenient to administer.
Assuntos
Anemia/tratamento farmacológico , Eritropoetina/análogos & derivados , Hematínicos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Anemia/sangue , Anemia/etiologia , Darbepoetina alfa , Descoberta de Drogas , Epoetina alfa , Eritropoetina/administração & dosagem , Eritropoetina/efeitos adversos , Eritropoetina/uso terapêutico , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Hemoglobinas/análise , Humanos , Qualidade de Vida , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicaçõesRESUMO
Cancer is a debilitating disease affecting millions of people daily. Over the years, cancer treatment has advanced in leaps and bounds. Antibodies are important breakthrough therapeutic agents for cancer. These agents, proteins produced by B lymphocytes of the immune system in response to antigens, bind to receptors on cell surfaces so that the antigen-antibody complexes can be recognized and destroyed by phagocytes. While each B cell synthesizes only one kind of antibody, an entire population of different types of B cells and their respective antibodies are produced in response to various antigens to which the organism had been exposed. However, to be useful clinically, substantial amounts of a single antibody must be generated from a single ancestral B cell. These antibodies produced by a specific population of B cells are the monoclonal antibodies that have become the cornerstone of treatment for cancer and many immunologic illnesses. The purpose of this report is to provide an overview of the clinical development of biosimilars in clinical oncology, focusing on rituximab and like biosimilars.
