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Biotech / Medical : Biotech Valuation
CRSP 56.61-0.6%3:59 PM EST
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DaveAu
tuck
To: tuck who wrote (50598)12/31/2018 4:36:51 PM
From: Biomaven2 Recommendations  Read Replies (2) of 52153
 
I think this is all a confusion. Hematocrit is *very* highly correlated with Hb, except it is subject to more errors in measurement and (I think) slight possible confounding from iron levels. It will only really differ in some rare types of anemia.

ESA will cause both Hb and hematocrit to rise in parallel. The studies have shown high doses of ESA correlate with increased mortality. In my mind this is very likely due to the folks that have high CRP (proxy here for hepcidin) and are thus resistant to ESA's - hence you need high ESA doses and more iron to bring their Hb levels up. And the increased iron load makes their ESA resistance worse by increasing hepcidin further.

I think it is this subset of patients that cause the increased mortality with ESA. Other studies have shown generally higher mortality in CKD patients with worse anemia, so I doubt it is the Hb (or hematocrit) level itself that is the problem.

Roxa works the same in patients with high CRP - indeed over time you seem to need decreasing doses.

I doubt vada is going to be much different, except the daily dosing has the potential to create a feedback loop requiring higher dosing over time.
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