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6 protocols using aranesp

1

Standardized Protocols for Anemia Management

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As all clinical parameters, the two primary outcomes, monthly ESA consumption and hemoglobin levels were routinely collected according to standardized clinical protocols and procedures of the NephroCare clinics [30 (link)].
All ESA doses were normalized to IUs (international units). For darbepoetin alfa (Aranesp, Amgen, Thousand Oaks, CA, USA) and methoxy-polyethylene-glycol-epoetin beta (MIRCERA; F. Hoffmann-La Roche Ltd, Basel, Switzerland), the original doses (in μg) were converted to IUs by using the factors 200 and 225, respectively [31 , 32 (link)]. The monthly ESA dose was calculated as the total ESA consumption within a 4-week interval (28 days).
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2

Anemia-Management Drugs Costs for Hemodialysis Patients

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A recent report published by CMS on costs of anemia-management drugs for hemodialysis (HD) patients provided mean per HD session doses for the ESA drugs (Epogen® and Aranesp® [Amgen Inc., CA, USA]) and IV iron drugs (Venofer® [American Regent, Inc., NY, USA] and Ferrlecit®, [Sanofi US, Bridgewater, NJ, USA]).2 Utilization costs of these four drugs were based on RED BOOK costs combined with CMS base rate and actual usage in 2011. Regarding ESAs and CMS base rates, Epogen was used much more frequently than Aranesp, with a calculated PPPY cost of US$12,243. For Aranesp, the calculated PPPY cost was US$1,426. For actual 2011 utilization, the PPPY costs for Epogen and Aranesp were US$9,545 and US$543. For iron, when applying the CMS base rate to RED BOOK costs, Venofer was used more frequently than Ferrlecit, and had a calculated PPPY cost of US$1,057. On the other hand, Ferrlecit usage resulted in a calculated PPPY cost of US$432. Calculated PPPY costs for Venofer and Ferrlecit based on actual 2011 utilization were US$1,148 and US$209, respectively. Table 1 lists the sources of information used for determining utilization costs, and the resulting lower, middle, and upper cost boundaries. We set the upper bound of triangle distributions equal to the mode plus 10%.
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3

Erythropoietin and Sildenafil Effects in Rats

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Recombinant human erythropoietin was used in the form of injections (Aranesp, Amgen, Holland). A dose of 1,000 IU/kg was injected intraperitoneally in the rats of group C (low-dose erythropoietin group) and a dose of 3,000 IU/kg was injected intraperitoneally in the rats of group D (high-dose erythropoietin group). Sildenafil in the form of commercially packed tablets (Viagra; Pfizer, Walton Oaks, UK) was also obtained. Each tablet contained 100 mg of sildenafil. The tablets were grinded and dissolved in sterile 0.9% w/v NaCl solution, forming a 20% w/v sildenafil solution. A dose of 0.7 mg/kg was injected intraperitoneally in the rats of group E (sildenafil group). These doses of erythropoietin and sildenafil have been reported by previous studies (16 (link)–22 (link)).
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4

Erythropoietin Effects on Hematocrit

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A detailed description of the original study design has been published previously (11 (link)). In brief, in the present sub-study, volunteers were allocated in a single-blinded, randomized, parallel design to either a sedentary and placebo treatment control (C) group (n = 9) or a sedentary and ESA (Darbepoietin–α, Aranesp; Amgen, Thousand Oaks, CA) treatment group (n = 8) for 10 weeks. Once a week, ESA was administered subcutaneously at a dose of 40 µg for the first 3 weeks and 20 µg for the remaining 7 weeks. Hematocrit was measured weekly throughout the study. The first three subjects, however, received treatment twice a week for the first 3 weeks, which led to a greater increase in the hematocrit than expected (50–54%). Hence, the number of injections was reduced to once a week. As per protocol, some subjects were intermittently switched to placebo in order to keep the hematocrit value below 55%. From 1 week before the treatment until the end of the study the subjects were supplemented with 100 mg iron orally/day (Ferrosulfat, Ferro Duretter; GlaxoSmithKline, Brentford, UK).
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5

Western Blot Analysis of Erythropoietin Variants

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Reference standards used were as follows: methoxypolyethylen‐glycol‐epoetin beta, MIRCERA (CERA; Roche, Basel Switzerland), darbepoetin alfa, Aranesp (Novel erythropoietin stimulating protein, NESP; Amgen; CA, USA), human EPO‐alpha Fc (EPO‐Fc; ProSpec; Rehovot, Israel), and biological reference protein (BRP—a reference substance for rEPOs; European Directorate for the Quality of Medicines and HealthCare, Strasbourg, France). Methanol was from J.T. Baker (NJ, USA). Bromophenol blue and Immobilon® ECL Ultra Western HRP Substrate were from Merck Millipore Ltd (MA, USA). Sodium N‐lauroylsarcosinate (SAR), sodium dodecyl sulphate (SDS), 3‐(N‐morpholino)‐propane sulfonic acid (MOPS), ethylenediaminetetraacetic acid (EDTA), glycine, glycerol, tris (hydroxymethyl)aminomethane and DL‐dithiothreitol (DTT) were from Sigma‐Aldrich (MO, USA). NuPAGE antioxidant and Gibco phosphate‐buffered saline (PBS) tablets were purchased from Thermo Fisher Scientific (MA, USA). Powdered milk was purchased from Carl Roth (Karlsruhe, Germany). Extra thick blot paper was from Bio‐Rad (CA, USA). Human EPO biotinylated antibody monoclonal mouse IgG2A clone #AE7A5 was from R&D Systems (MN, USA), and Streptavidin‐POD conjugate was from Roche (Basel, Switzerland).
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6

Depo Dose and Treatment Study

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Dose study. To detect the appropriate dose of Depo (Aranesp; AMGEN, Thousand Oaks, CA, USA) we randomly divided 60 female adult rats into 6 groups: L-NAME (20 mg/kg/day; Sigma Aldrich, St. Louis, MO, USA) alone, L-NAME + 0.1 µg/kg Depo, L-NAME + 0.25 µg/kg Depo, L-NAME + 0.5 µg/kg Depo, L-NAME + 2.5 µg/kg Depo, and L-NAME + 10 µg/kg Depo. Due to the half-life of Depo, it was injected once every 3 days. According to the survival and blood parameters, 0.25 µg/kg Depo was determined as the highest dose that did not change the blood parameters and was used as the treatment dose throughout the rest of the study (Table 1).
Treatment study. We randomly separated 60 female adult rats into 6 groups and we injected the study drugs for 30 days: Control (1 mL/kg/day saline); L-NAME (20 mg/kg/day); L-NAME (20 mg/kg/day) + Depo (0.25 µg/kg once every 3 days); L-NAME (20 mg/kg/day) + Rem (5 mg/kg/day infliximab [Inf]; Janssen Biotech, Inc., Horsham, PA, USA); L-NAME (20 mg/kg/day) + Depo (0.25 µg/kg once every 3 days) + Rem (5 mg/kg/day); and Depo (0.25 µg/kg once every 3 days).
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