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Renal anemia, a prevalent complication of chronic kidney disease (CKD), is typically treated with iron supplements and erythropoietin stimulating agents (ESAs). Several ESAs are prescribed in clinical practice and can be divided into two categories: short-acting ESAs such as Epogen and Procrit (epoetin alfa), requiring multiple injections per week, and long-acting ESAs such as Aranesp (darbepoetin alfa) and Mircera (methoxy polyethylene glycol-epoetin beta) which are administered at one to four-week intervals.

In May 2015, Roche entered into an exclusive license agreement with Galenica1, the parent company of Vifor Pharma, for the commercialization of Mircera in the United States. Furthermore, Galenica entered into a supply agreement with Fresenius Medical Care North America (FMCNA). Under this agreement, Galenica will supply Mircera for FMCNA’s sole ESA use within its dialysis facilities.

Epogen has been the most commonly-prescribed ESA among U.S. hemodialysis (HD) patients for nearly two decades. In October/November 2015, our tracking study2 indicated that less than 12% of HD patients were on Mircera. However, according to our data collected in October 20163, Mircera use has increased, accounting for nearly one-quarter of ESA-treated HD patients, with this increase in use occurring primarily at the expense of Epogen. As expected, surveyed nephrologists primarily affiliated with FMCNA reported using significantly more Mircera than did nephrologists affiliated with all other dialysis segments, including DaVita. Our study3 suggested that use of Mircera in HD increased from 37% to 69% in FMCNA-affiliated nephrologists within the last year.

Mircera use in the U.S. is expected to continue to grow and dominate within FMCNA as they aim to move more dialysis patients from Epogen to Mircera4,5. In addition, Mircera has already established itself as a treatment option for renal anemia in Europe and Japan. In-depth analysis of factors that drive and constrain ESA treatment, as well as ESA brand shares based on CKD stage, are presented in Decision Resources Group’s Current Treatment: Renal Anemia Q4 2016 insights3.


2Decision Resources Group’s TreatmentTrends® Nephrology Q4 2015 (U.S.), a quarterly report series, examines the management of dialysis and mid-to late-stage CKD patients from the perspective of 300 nephrologists. Emphasis is on renal anemia management, calcium-phosphorus metabolism, secondary hyperparathyroidism, and hyperkalemia. The content provides insight into practice patterns, attitudes and perceptions, and current and projected use of various products. It evaluates perceived product advantages and disadvantages, as well as sales and messaging efforts, of key market players.

3Decision Resources Group’s CurrentTreatment® Renal Anemia Q4 2016 (U.S.) provides a deep dive and longitudinal information on the renal anemia market dynamics. It examines the management of dialysis and mid-to late-stage CKD patients from the perspective of 100 nephrologists. How is renal anemia being treated in the U.S. today, and what are the factors behind those treatment decisions? Also included in this content are sales and messaging efforts of key market players and coverage of late-stage products for the treatment of renal anemia.