Erythropoietin stimulating agent

Erythropoiesis-stimulating agents (ESA) are medications which stimulates the bone marrow to make red blood cells. They are used to treat anemia due to end stage kidney disease, chemotherapy, major surgery, or certain treatments in HIV/AIDS. In these situations they decrease the need for blood transfusions. The different agents are more or less equivalent. They are given by injection. Erythropoiesis-stimulating agents (ESA) are medications which stimulates the bone marrow to make red blood cells. They are used to treat anemia due to end stage kidney disease, chemotherapy, major surgery, or certain treatments in HIV/AIDS. In these situations they decrease the need for blood transfusions. The different agents are more or less equivalent. They are given by injection. Common side effects may include joint pain, rash, vomiting, and headache. Serious side effects may include heart attacks, stroke, increased cancer growth, or pure red cell aplasia. It is unclear if use is safe during pregnancy. They work similar to naturally occurring erythropoietin. They were first approved for medical use in the United States in 1989. They are on the World Health Organization's List of Essential Medicines, which lists the most effective and safe medicines needed in a health system. Commercially available agents include epoetin alfa and darbepoetin alfa, as well as biosimilars. The wholesale cost of one version in the developing world, as of 2015, is about 3.80 USD per 2000 unit vial. In the United Kingdom this amount costs about 10 pounds as of 2015. Use among athletes is prohibited by the World Anti-Doping Agency. ESAs are used to maintain hemoglobin at the lowest level that both minimizes transfusions and best meets a person's needs. Medical speciality professional organizations do not recommend the use of ESAs in people with chronic kidney disease (CKD) who have hemoglobin levels greater than 10 g/dL and do not have anemia symptoms. There is no evidence that one agent is better than another in the setting of CKD. ESAs may fail to achieve an adequate therapeutic response when one or more of the following is present: