European Heart Journal Advance Access originally published online on August 6, 2007
European Heart Journal 2007 28(18):2208-2216; doi:10.1093/eurheartj/ehm328
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Randomized, double-blind, placebo-controlled study to evaluate the effect of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia
1 Department of Cardiology, University Medical Center Groningen; University of Groningen; PO Box 30.001; 9700RB Groningen; The Netherlands
2 Stavanger University Hospital, Stavanger, Norway
3 University Hospital Beaujon, Clichy, France
4 Deventer Hospital, Deventer, The Netherlands
5 Amgen Inc, Thousand Oaks, CA, USA
6 Amgen Limited, Cambridge, UK
7 University of Hull, Castle Hill Hospital, Hull, UK
8 Military Hospital, Wroclaw, Poland
Received 12 April 2007; revised 4 July 2007; accepted 6 July 2007; online publish-ahead-of-print 6 August 2007.
* Corresponding author. Tel: +31 50 3612355; fax: +31 50 3614391. E-mail address: d.j.van.veldhuisen{at}thorax.umcg.nl
See page 2185 for the editorial comment on this article (doi:10.1093/eurheartj/ehm331)
Aims: Anaemia is common in chronic heart failure (CHF) and associated with worse outcome. This randomized, double-blind, placebo-controlled study evaluated the effect of two darbepoetin alfa dosing regimens on haemoglobin (Hb) rate of rise and clinical effects in patients with CHF and anaemia.
Methods and results: Patients with CHF (
3 months), left ventricular ejection fraction (LVEF) 
40%, and Hb 9.0 to 12.5 g/dL received darbepoetin alfa subcutaneously every 2 weeks for 26 weeks at a starting weight-adjusted dose of 0.75 mcg/kg (n = 56) or a fixed dose of 50 mcg (n = 54), or placebo (n = 55), to gradually achieve and maintain a target Hb of 14.0 ± 1.0 g/dL. Endpoints included rate of Hb rise per week during titration, safety, and changes in 6 min walk distance, New York Heart Association (NYHA) class, LVEF, and quality of life. Most subjects were NYHA class II–III. Mean (SD) age was 71 (11) years, LVEF was 28 (9), and Hb 11.5 (0.7) g/dL. Rate of Hb rise was equivalent between darbepoetin alfa weight-based (+1.87 ± 1.36 g/dL) and fixed dosing (+1.64 ± 0.98 g/dL) groups, vs. + 0.07 ± 1.08 g/dL in the placebo group. Mean Hb concentrations by week 27 were 13.4 and 13.2 g/dL, in the weight-based and fixed dosing groups, respectively. There were non-significant improvements in the combined darbepoetin alfa group vs. placebo for 6 min walk distance (P = 0.074) and Patient’s Global Assessment score (P = 0.057). There was a significant improvement in Kansas City Cardiomyopathy Questionnaire total symptom score (8.2 vs. 1.5 points; P = 0.027) but no change in NYHA class, LVEF, and Minnesota Living With Heart Failure Questionnaire score. Six treatment-unrelated deaths occurred in the 110 darbepoetin alfa treated patients, and none in the 55 placebo treated patients. Other adverse events were similar between groups.
Conclusion: In this study of patients with CHF and anaemia, treatment with darbepoetin alfa raised Hb using different dosing regimens. Darbepoetin alfa improved some quality of life indices, but its safety requires further exploration. Larger trials are needed to determine the effects on long-term morbidity and mortality.
Key Words: Anaemia • Heart failure • Exercise • Haemoglobin • Trials
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