Review and Meta-Analysis: Roxadustat for Treatment of Anemia in CKD

Chronic kidney disease (CKD) is commonly associated with renal anemia. Roxadustat is the first-in-class oral hypoxia-inducible factor prolyl hydroxylase inhibitor for the treatment of anemia. Li Zheng and colleagues in China conducted a systematic review and meta-analysis to examine the efficacy and safety of roxadustat in the treatment of anemia in patients with CKD. Results were reported online in the British Journal of Clinical Pharmacology [doi.org/10.1111/bcp.15055].

The researchers searched PubMed, Cochrane Library, Embase, and clinicaltrials.gov from inception to February 2021. The search included randomized controlled trials comparing the efficacy and safety of roxadustat to the efficacy and safety of an erythropoiesis-stimulating agent (ESA) or placebo in the treatment of anemia in patients with CKD.

The search revealed nine randomized controlled trials involving 2743 patients. Results of the meta-analysis demonstrated that roxadustat increased hemoglobin level by 0.91 g/dL (95% confidence interval [CI], 0.47-1.43; P<.05), transferrin level by 0.50 mg/dL (95% CI, 0.34-0.65; P<.05), and total iron-binding capacity by 50.64 µg/dL (95% CI, 36.21-65.07; P<.05). There were also decreases in hepcidin (mean difference [MD], –23.16; 95% CI, –37.12 to –9.19; P<.05) and ferritin (MD, –38.35; 95% CI, –67.41 to –9.29; P<.05).

The incidence of adverse events was similar between roxadustat and control groups. The incidence of adverse events was significantly higher among patients in the roxadustat group compared with those in the ESA group (odds ratio, 1.33; 95% CI, 1.06-1.68; P<.05).

In conclusion, the authors said, “Roxadustat can significantly improve renal anemia in CKD patients by increasing hemoglobin level and iron metabolism. However, attention must be paid to the risk of serious adverse events during treatment.”