Variability, Severity, Preventability, and Outcomes of Adverse Drug Reactions to HIF-PHIs in CKD Case Reports: A Systematic Review
Author(s):
Sara Maria Majernikova
Background: Underdiagnosed and undertreated renal anaemia remains an issue among individuals with chronic kidney disease (CKD). Hypoxiainducible factor prolyl-hydroxylase inhibitors (HIF-PHIs) offer significant options. However, there are unmapped areas regarding adverse drug reactions (ADRs) to HIF-PHIs. Thus, this systematic review aims to find ADRs to HIF-PHIs and analyse their variability, severity, preventability, and outcomes in individual CKD patients reported as case reports.
Methods: A literature search of published case reports was conducted between 2018 and 2024 across various electronic sources. Of the total identified studies (N=2123), only 8 case reports (13 patients) were included after applying inclusion and exclusion criteria.
Results: ADRs to roxadustat (8/13;61.5%) and daprodustat (5/13;38.5%) included retinal haemorrhage (7.7%), hypertension (15.4%), stroke (23.1%), hypothyroidism (7.7%), rhabdomyolysis (7.7%), and elevation of serum copper (38.4%). The mean ADRs time-to-onset was 6.5 months. Specific causality and non-preventability of ADRs to HIF-PHIs were confirmed in one report (1/8;12.5%), and definite probability and severity in two reports (2/8;25%) due to HIF-PHIs ADRs.
Conclusion: This review suggests HIF-PHIs could be safe for patients to treat CKD anaemia. Thanks to personalised dosages that maintain the recommended Hb value and sufficient management of comorbidities, the probability and severity of ADRs could be decreased.
