SEARCHNARRATIVE_REVIEWnephrology, cardiology

narrative_review·nephrology, cardiology, hematology, internal medicine, systematic review·PMC10171438

Roxadustat: Do we know all the answers?

Biomolecules and Biomedicine · 9 authors, 2 centres

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TL;DR

This narrative review discusses the drug roxadustat for treating anemia in chronic kidney disease, summarizing its benefits and key safety concerns like cardiovascular risk.

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The review discusses the drug's mechanism of action and summarizes evidence from clinical trials suggesting efficacy in increasing hemoglobin levels, including in patients with inflammation and those with post-transplant anemia. However, it emphasizes significant safety concerns, particularly cardiovascular risks associated with the rate and level of hemoglobin improvement, and calls for more long-term, large-scale trials. Limitations include the narrative review design and the noted insufficiency of sample sizes in some cited trials.

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narrative_review

SPECIALTY

nephrology

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ORIGINAL PAPER

PMC10171438

Roxadustat: Do we know all the answers?

Biomolecules and Biomedicine

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ABSTRACT

Abstract Anemia is a common complication of chronic kidney disease (CKD), and its prevalence rises as the disease progresses. Intravenous or subcutaneous erythropoiesis-stimulating agents (ESAs) are advised to treat CKD-associated anemia, since shortage of erythropoietin (EPO) and iron is the main cause of anemia. However, ESA resistance and safety have spurred a lot of interest in the development of alternate anemia therapies. Roxadustat, an orally administered hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), which increases erythropoiesis and may modulate iron metabolism, was recently licensed in China, Chile, South Korea, Japan, and the European Union for the treatment of CKD-related anemia. Despite this, clinical trials have shown a number of adverse effects, including cardiovascular disease, hyperkalemia, and infections. Roxadustat’s potential effects on multiple organs and systems are also of concern. In this review, based on clinical evidence, we discuss the potentially detrimental effects of roxadustat to the known biology on systems other than kidney, and the need for long-term follow-up in order for roxadustat to be approved in more countries in the future. Keywords: Erythropoietin (EPO), hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), roxadustat, renal anemia, therapeutic potential

CITATION EXPORT

Qiu-Yu Li, Qian-Wen Xiong, Xuefeng Yao et al.. Roxadustat: Do we know all the answers?. Biomolecules and Biomedicine. (2023). https://doi.org/10.17305/bb.2022.8437

AUTHORS

9 · 2 CENTRES

Qiu-Yu Li, Qian-Wen Xiong, Xuefeng Yao, Fei Liu, Xiaoxiao Tang, Haidong Fu, Tong Tong, Jianhua Mao, Wan-Xin Peng

1Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China
2The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China