Erythropoiesis-stimulating agent

An erythropoiesis-stimulating agent (abbreviated ESA), also known as an erythropoiesis-stimulating drug (ESD) is a medicine similar to erythropoietin, which stimulates red blood cell production (erythropoeisis). ESAs, structurally and biologically, are similar to naturally occurring protein erythropoietin. They are used in conditions where reduced blood cell production causes anemia, such as advanced chronic kidney disease.

They are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.

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:

The following types of ESAs are available:

Recombinant erythropoietin has a variety of glycosylation patterns giving rise to alpha, beta, delta, and omega forms:

Darbepoetin alfa, which early literature during its development often termed as novel erythropoiesis-stimulating protein (NESP), is a form created by five substitutions (Asn-30, Thr-32, Val-87, Asn-88 and Thr-90) that create two new N-glycosylation sites. This glycoprotein has a longer terminal half-life, meaning it is possible to administer it less frequently.

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