Artificial Intelligence (AI) Tool Decreases Epoetin Beta (Mircera) Drug Exposure and Maintains Hemoglobin at Desired Levels
Michael E. Brier, Adam E. Gawęda, George R. Aronoff · Journal of the American Society of Nephrology · 2022
Background: We innovated a clinical decision support tool for anemia management with epoetin alfa. This tool uses AI methods to classify patients into multiple doseresponse categories combined with predictive control to achieve target hemoglobin over time. The tool was modified for use with long acting epoetin isoforms. We report clinical results with epoetin beta. Methods: Data were abstracted from commercially available software Strategic Anemia Advisor (SAA, Dosis Inc, San Francisco, CA) between Dec 2018 and Mar 2022 and include dose and hemoglobin information on 2116 patients in 19 dialysis facilities receiving epoetin beta. Data were aggregated by month SAA use. Not every patient provided prior initiation data. Comparisons were the 12 month control period prior to SAA use, a 1 month washout period and a 12 month treatment period by linear regression and ANOVA using the factors Time (1-12) and SAA use. Epoetin beta is reported as the total monthly dose and hemoglobin as the mean monthly concentration. Results: Statistical analysis demonstrated a mean monthly use of epoetin beta of 140 mcg/patient/month in the control period and an initial 40 mcg decrease with the use of SAA (p<0.001) that decreased over time (p=0.009) achieving a final dose of 84 mcg/patient/month. Achieved hemoglobin was 10.7 g/dL and not different in the Control periods and in SAA months 5-12. Mean Hb was 10.5 g/dL in SAA months 1-4 (p=0.05). These results are shown in Figure 1. Conclusions: An AI-powered anemia management program developed using epoetin alfa response data was adapted for use with epoetin beta. Treatment of patients in a realworld setting confirm previous observations where efficacy is maintained over a 12 month period while decreasing epoetin beta dose 29% initially ending with a mean dose of 84 mcg/month (Months 9-12). Further, the tool achieves the stated goal for ESA therapy using the least amount of ESA to avoid transfusion.