Anemia Drugs Linked to Stroke Study Deaths: FDA

By Steven Reinberg
HealthDay Reporter

FRIDAY, Sept. 26 (HealthDay News) -- Preliminary results from a German study suggest that stroke patients' use of anti-anemia drugs such as Aranesp, Procrit and Epogen might end up boosting their risk for death, the U.S. Food and Drug Administration (FDA) warned on Friday.

The goal of the study was to see if high doses of the anti-anemia drug epoetin alfa could improve the ability of stroke patients to take care of themselves after recovering from a stroke.

The hope was that the drug would be neuroprotective, but use of epoetin alfa now appears linked to a near-doubling of mortality.

This is not the first time that these drugs have come under scrutiny. In the United States, medications like Procrit were marketed heavily as anemia treatments, particularly for cancer patients and those with kidney failure.

However, in July of this year, the FDA called on manufacturers of Aranesp and Procrit to add a warning label that could limit their use for cancer patients.

These changes were spurred by studies that showed these types of medications might cause tumors to spread and also raise patients' risks for bleeding. These findings resulted in an FDA advisory committee recommending in June that while the drugs should remain on the market, they should not be used in patients whose cancer is curable.

The committee also voted to recommend against the drugs' use in patients with breast or head and neck cancer.

The new German study looked at the use of epoetin alfa as an aid to stroke recovery.

"These drugs are not licensed in the United States for this particular use," noted Dr. Kathy Robie-Suh, a team leader in the division of medical imaging and hematology at the Center for Drug Evaluation and Research, part of the FDA's Office of New Drugs and Office of Drug Safety.

"The drug has been approved for about 19 years for treating anemia in patients with acute renal [kidney] failure and in other settings," Robie-Suh said. "Today's warning doesn't have any bearing on the particular label uses of the product in the United States," she said.

The FDA will continue to look into the results of this study, Robie-Suh said. "We have asked for more information about the study. We would certainly like to receive the data, but those data are not in our hands or under our control," she said.

For the trial, 522 stroke patients were randomly assigned to receive relatively high doses of epoetin alfa or a placebo. Some patients were also given R-tPA, a powerful clot-busting drug.

Three months after the start of the trial, 16 percent of the patients who received high doses of the drug epoetin alfa died, compared with 9 percent of patients who were not given the drug, according to the U.S. Food and Drug Administration (FDA).

Among the deaths in the German trial, about 50 percent occurred within the first week after the drug was started. Among those receiving the drug, 4 percent died from bleeding within the brain compared with 1 percent of the patients who were not given the drug.

The FDA said that it expects to receive more data on the study "within the next several weeks," and when the agency's analysis is complete, it will "communicate our conclusions and recommendations to the public."

Friday's FDA notice was issued after Ortho Biotech -- the division of the pharmaceutical giant Johnson and Johnson, which makes Procrit -- alerted the agency to the results of the German trial.

"Ortho Biotech has become aware of preliminary data from an investigator-initiated experimental study of the effects of Epoetin alfa in patients with acute ischemic stroke," the company said in a Sept. 17 statement. "Ortho Biotech has reported this information to the U.S. Food and Drug Administration and to European regulatory authorities. Additional analyses are under way to better understand these preliminary results."

"This study is interesting, because people were looking at potential neuroprotective effects of erythropoiesis-stimulating agents (ESAs)," said Dr. Samuel M. Silver, a spokesman for the American Society of Hematology.

These patients were not anemic, Silver noted. "They were also receiving very powerful clot-busting drugs at the same time as relatively high doses of ESAs. These are not the typical patients in any way shape or form that usually receive these drugs," he said.

Silver doesn't think further action by the FDA is needed. "I don't think the drug needs to be looked at for patients who are currently being treated in this country, but it certainly will give pause to the way studies are being designed to look at the neuroprotective effects of these drugs," he said.

SOURCES: Kathy Robie-Suh, M.D., Ph.D., team leader, Division of Medical Imaging and Hematology, Office of New Drugs and Office of Drug Safety, Center for Drug Evaluation and Research, U.S. Food and Drug Administration; Samuel M. Silver, M.D., Ph.D., spokesman, American Society of Hematology; statement, Ortho Biotech, Bridgewater, N.J.

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