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The fifth study comparing the biosimilar HX575 with epoetin alpha was stopped after patients receiving HX575 subcutaneously developed anti‐epoetin antibodies and no results were available.Īdverse events were poorly reported in all studies and did not differ significantly within comparisons. Two studies (165 participants) compared epoetin delta with epoetin alpha, with no results available since the pharmaceutical company withdrew epoetin delta for commercial reasons. One study found significantly higher pain scores with subcutaneous epoetin alpha compared with epoetin beta. One study compared epoetin theta with epoetin alpha and found no significant differences in Hb levels (288 participants: MD ‐0.02 g/dL, 95% CI ‐0.25 to 0.21). There were no significant differences in final haemoglobin (Hb) levels when dosing every two weeks was compared with weekly dosing (4 studies, 785 participants: MD ‐0.20 g/dL, 95% CI ‐0.33 to ‐0.07), when four weekly dosing was compared with two weekly dosing (three studies, 671 participants: MD ‐0.16 g/dL, 95% CI ‐0.43 to 0.10) or when different total doses were administered at the same frequency (four weekly administration: one study, 144 participants: MD 0.17 g/dL 95% CI ‐0.19 to 0.53).įive studies evaluated different interventions.
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One study compared both different frequencies of epoetin alpha at the same total dose and at the same frequency using different total doses.ĭata from only 7/14 studies could be included in our meta‐analyses. Attrition bias was at low risk of bias in eight studies while selective reporting was at low risk in six included studies.įour interventions were compared: epoetin alpha or beta at different frequencies using the same total dose (six studies) epoetin alpha at the same frequency and different total doses (two studies) epoetin alpha administered intravenously versus subcutaneous administration (one study) epoetin alpha or beta versus other epoetins or biosimilars (five studies). Blinding of outcome assessment was judged at low risk in 13 studies as the outcome measures were reported as laboratory results and therefore unlikely to be influenced by blinding. Blinding of participants and personnel was at low risk of bias in one study. The risk of bias was high in most studies only three studies demonstrated adequate random sequence generation and only two studies were at low risk of bias for allocation concealment. We identified 14 RCTs (2616 participants) nine studies were multi‐centre and two studies involved children.