Darbepoetin alfa is a long-acting erythropoiesis-stimulating agent (ESA) used to treat anemia in patients with non-myeloid malignancies and myelodysplastic syndromes (MDS), especially in the low-risk IPSS-R category.
- Mechanism of Action: Binds to and activates the erythropoietin receptor on erythroid progenitor cells in the bone marrow, stimulating red blood cell (RBC) production.
- Dosing: Administered subcutaneously or IV, typically weekly or every 2–3 weeks due to its prolonged half-life.
- Indications:
- Anemia due to chemotherapy in cancer
- Anemia in low-risk MDS (best if serum EPO <500 mU/mL and low transfusion burden)
- Monitoring: Hemoglobin (target <12 g/dL), iron status (iron repletion needed), and signs of thromboembolic events.
- Boxed Warning: Risk of cardiovascular events, thrombosis, and tumor progression when used to target Hb >12 g/dL in cancer patients.