PUK26 - IMPACT OF EMERGING HIF-PH INHIBITORS ON RENAL ANEMIA TREATMENT

Abstract

Renal anemia (RA) is currently managed using iron supplements and erythropoiesis-stimulating agents (ESAs). ESAs are extremely efficacious, but concerns remain around their association with serious adverse cardiovascular events, including stroke. In addition to these safety concerns, nephrologists frequently lament the need for more convenient and cost-effective therapies. This research explores how the emergence of novel oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHi) will change the RA treatment paradigm and how reimbursement decisions will impact the prescribing and uptake of HIF-PHi in both chronic kidney disease-nondialysis (CKD-ND) and dialysis patients. Interviews with 20 thought-leading nephrologists in seven major pharmaceutical markets. 100 US nephrologists were also surveyed regarding their current and expected prescribing of iron supplements and ESAs, and future prescribing of HIF-PHi for treating RA. Interviewed nephrologists anticipate that HIF-PHi will be used in a variety of ways to treat RA in CKD-ND and dialysis patients, such as a direct alternative to ESAs in patients unable to tolerate ESAs or for whom ESAs are contraindicated. The majority of surveyed nephrologists indicate that oral administration of HIF-PHi will provide the greatest benefit to CKD-ND patients. Therefore, we expect HIF-PHi will garner significantly more patient share in CKD-ND than in dialysis populations. The gain in share for HIF-PHi will come primarily at the expense of ESAs in both the CKD-ND and dialysis markets. Assuming availability, nephrologists expect HIF-PHi to be prescribed in over a third of their RA patients. However, the anticipated high price of HIF-PHi will likely drive payers to adopt prior authorization requirements leading to use in later lines of therapy. Overall, nephrologists view HIF-PHi with excitement but express concerns regarding pricing, and access. Securing favorable reimbursement is critical for uptake of HIF-PHi, given the long-standing history of ESAs and availability of biosimilar ESAs.