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Comparative Study
. 2024 Jul 1;63(13):1855-1861.
doi: 10.2169/internalmedicine.2501-23. Epub 2023 Nov 6.

The Comparison between Vadadustat and Daprodustat Regarding Dose, Cost, and Safety of Treatment for Renal Anemia in Non-dialysis Patients with Chronic Kidney Diseases

Enyu Imai  1   2   3 , Atsuhiro Imai  4
Affiliations
Comparative Study

The Comparison between Vadadustat and Daprodustat Regarding Dose, Cost, and Safety of Treatment for Renal Anemia in Non-dialysis Patients with Chronic Kidney Diseases

Enyu Imai et al. Intern Med. .

Abstract

Objective We retrospectively compared the dose, cost, and safety of vadadustat and daprodustat for the treatment of renal anemia in patients with chronic kidney diseases who were not undergoing dialysis. Methods The primary outcome of this study was the change in dose and cost from the initiation of vadadustat and daprodustat treatment. The secondary outcome was the drug safety. Patients We treated 30 patients each with the hypoxia-inducible factor prolyl-hydroxylase inhibitors (HIF-PHIs) daprodustat and vadadustat. The hemoglobin (Hb) concentration was targeted at 11-13 g/dL, and transferrin saturation was maintained at ≥20%, as per the 2018 Japanese guidelines for the diagnosis and treatment of chronic kidney disease. Results Hb levels increased from 10.7 to 11.5 g/dL after the first month of daprodustat administration, whereas those for vadadustat patients remained relatively stable, going from 10.7 to 10.6 g/dL. After six months, the Hb level reached 12.1 g/dL and 11.3 g/dL for daprodustat and vadadustat, respectively. The dosage of vadadustat was significantly increased by 46% and 70% after 3 and 12 months, respectively, compared with the initial doses, whereas that of daprodustat did not change substantially. The average cost of vadadustat also increased in the first 3 months and remained over 500 yen/day after 3 months, while that of daprodustat showed little change from the initial cost of 360 yen/day. Conclusion These results suggest that heterogeneity exists in the drug potency and dosage required for treatment between daprodustat and vadadustat. Serious adverse events [death, cardiovascular disease, end stage renal disease (ESRD), and malignancy] occurred in more than 20% of participants with both HIF-PHIs. Further studies are required to confirm the safety of HIF-PHIs.

Keywords: HIF-PH inhibitor; cost; dose; renal anemia; safety.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Change in Hb levels after treatment with HIF-PHI. Patients with advanced CKD who were not on dialysis were treated with daprodustat (n=30) or vadadustat (n=30) and followed for 12 months. All results are presented as the mean±SDs. ns: not significant, Ref: reference. The multiple t-test was applied with Bonferroni’ correction, and a p value <0.01 indicates statistical significance.
Figure 2.
Figure 2.
Changes in the HIF-PHI dose for treating renal anemia. Patients with advanced CKD who were not on dialysis were treated with daprodustat (n=30) or vadadustat (n=30) and followed for 12 months. All results are presented as the mean±SDs. ns: not significant, Ref: reference. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001, ANOVA followed by Dunnett’s post hoc test.
Figure 3.
Figure 3.
The mean percent change in the HIF-PHI dose after treatment of renal anemia. Patients with advanced CKD who were not on dialysis were treated with daprodustat (n=30) or vadadustat (n=30) and followed for 12 months. All results are presented as the mean±SDs. ns: not significant, Ref: reference. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001, ANOVA followed by Dunnett’s post hoc test.
Figure 4.
Figure 4.
Daily cost of HIF-PHI after treatment of renal anemia. Patients with advanced CKD who were not on dialysis were treated with daprodustat (n=30) or vadadustat (n=30) and followed for 12 months. All results are presented as the mean±SDs. ns: not significant, Ref: reference. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001, ANOVA followed by Dunnett’s post hoc test.
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