Erythropoietic stimulating agents.

IMPORTANCE OF THE FIELD: The synthesis of recombinant forms of erythropoietin, epoetin alpha, beta and darbepoetin alpha, has represented a major achievement in anemia therapy. AREAS COVERED IN THIS REVIEW: This review analyzes the therapeutic options of existing erythropoietic stimulating agents (ESAs) in patients with cancer, renal and heart failure anemia and shows the main features of new ESAs under development. Peer-reviewed scientific literature and abstracts published during the last 10 years were reviewed. WHAT THE READER WILL GAIN: Randomized clinical trials carried out in patients with anemia associated with chronic renal disease or malignancies have consistently demonstrated that ESAs increase hemoglobin levels, reduce blood transfusion requirements and improve quality of life. However, in spite of the positive effects, treatment with ESAs, particularly in oncologic patients, is associated with an increased mortality and cardiovascular complications. These observations imply the absolute need for using ESAs in the context of currently available guidelines. TAKE HOME MESSAGE: A razionalization in the clinical use of ESAs according to current guidelines is required to improve the benefits derived from therapy with these drugs. New ESAs are under development and their introduction in therapy could provide a significant improvement in anemia management.