Real-world use of HIF-PH inhibitors and ESAs in non-dialysis-dependent CKD with anaemia: insights from a Japanese database study.

BACKGROUND

Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors were introduced for the treatment of anaemia in chronic kidney disease (CKD) in Japan in 2020; however, data on their use in clinical practice remain limited.

METHODS

This retrospective cohort study used data from the Medical Data Vision database to assess treatment patterns and hemoglobin trends in non-dialysis-dependent (NDD)-CKD anaemia. Cohort 1 included patients starting HIF-PH inhibitors or erythropoiesis-stimulating agents (ESAs) between 2021 and 2024, while Cohort 2 included patients who had received ESAs in 2020. Sub-cohort 1, patients with iron repletion status in Cohort 1, were also examined.

RESULTS

Cohort 1 included 9,253 patients. The patients starting HIF-PH inhibitors increased annually from 15.1% in 2021 to 54.8% in the first quarter of 2024. In Sub-cohort 1, prescriptions of HIF-PH inhibitors also annually increased. In these cohorts, initiation with HIF-PH inhibitors showed trends to maintain higher hemoglobin levels than ESAs. In patients with functional iron deficiency, the reduction in proportion with Hb <10 g/dL was more pronounced in HIF-PH inhibitors than ESAs. Cohort 2 (n = 1,998) had a low annual switch rate from ESAs to HIF-PH inhibitors (2.4%-3.9%), and improvement of anaemia was observed in the switched patients in whom ESAs do not sufficiently correct anaemia.

CONCLUSIONS

Real-world database analysis shows that initiation of HIF-PH inhibitors for renal anaemia in NDD-CKD increased to match that of ESAs by 2024, although switching from ESAs remained low. HIF-PH inhibitors showed a trend towards improvement in anaemia compared to ESAs, suggesting clinical benefit.