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Controversial anemia drugs help some, hurt others

While reporting a story on the safety of certain extremely expensive anemia drugs taken by people with end-stage renal disease, I learned that Medicare isn't just for people 65 and up - it covers treatment of end-stage renal disease for all, no matter their age. It's the only federal program that covers the costs of treatment for a specific disease on what amounts to a universal basis.

"I don't think the government knew what they were getting themselves into," said Stanford professor Wolfgang Winkelmayer, MD, ScD, when we spoke last month about his upcoming anemia-drug article in JAMA The support goes largely to pay for long-term dialysis, which is the only treatment other than kidney transplant that keeps people with end-stage renal disease alive.

Winkelmayer's study begins to clear up long-standing confusion about the safety of the drugs commonly used to treat anemia in patients with end-stage renal disease - drugs that cost Medicare nearly $2 billion a year. Over the next four months both Medicare and the FDA are set to review the use of these drugs - blockbusters called ESAs (erythropoiesis-stimulating agents). The ESAs available in the United States are Aranesp, Epogen and Procrit.

Winkelmayer told me that Medicare won't be able to use the study to justify eliminating coverage for the drugs, at least not completely:

Eliminating coverage or severely restricting marketability of ESAs might mean pouring out the baby with the bath water. We give glimpses that show that such extreme action might not be warranted.

His study showed that while the drugs increased the risk of dying prematurely for people with mild anemia, they extended the lives of those with severe anemia.

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