OBJECTIVES: To compare the real-world clinical effectiveness between erythropoiesis-stimulating agents and roxadustat in the treatment of anemia among adult CKD patients in China.

METHODS: A regional cohort data from Tianjin Inspur Healthcare Big Data was used. Patients with renal anemia aged more than 18 years who had visited any hospital in Tianjin area from January 2018 to June 2023 were included as study subjects. The total population was divided into four subgroups based on treatment modality: 1) roxarestat-only group; 2) ESA-only group; 3) roxarestat+ESA group; and 4) non-users group. The FDA defines mean hemoglobin at weeks 28-52 (mean of weeks 18-24) as the efficacy endpoint. Comparison of hemoglobin changes at baseline and weeks 28-52.

RESULTS: A total of 130863 patients with renal anemia were included in the study. They were categorized into four groups based on the pattern of medication during the follow-up period, roxarestat only, ESA only, both and neither, 436, 4878, 36,319 and 89,230 respectively.

The change from baseline in mean hemoglobin at weeks 28-52 was 12.08 (2.19) g/dl, 11.50 (1.19) g/dl, 10.02 (0.41) g/dl, and 11.95 (0.51) g/dl for these groups. during weeks 28-52, the mean hemoglobin (SD) was were 11.13 (0.58) g/dl, 10.38 (0.72) g/dl, 10.61 (0.17) g/dl and 12.52 (0.50) g/dl respectively during 28-52 weeks indicating a change in hemoglobin level. It is noteworthy that hemoglobin levels of patients in the roxarestat group (only) were consistently higher than those of patients in the ESA group (only) during this period.

CONCLUSIONS: This study showed that hemoglobin improvement was more pronounced with roxadustat compared to ESA for patients with anemia in chronic kidney disease in China based on real-world data.