ANNA Responds to FDA Black Box Warning on Erythropoiesis-Stimulating Agents The Food and Drug Administration (FDA) recently issued a public health safety warning regarding the use of erythropoiesis-stimulating agents (ESAs) which are used for the treatment of anemia. The drugs affected by this warning are darbepoietin alfa (Aranesp®), and darbepoietin alfa (Epogen® and Procrit®). The manufacturers of these products, Amgen and Ortho Biotech LP have concurred with the FDA and will change their product labels to include the safety warning, the black box warning, and new dosing recommendations. The FDA based its recommendations upon the results of two large clinical trials of ESA use in chronic kidney disease. They reported increased risks in patients who were treated with ESAs to target hemoglobins that were higher than the currently recommended hemoglobin concentrations. There also were other clinical trials done with cancer and surgical patients, which bore similar results but had different outcome measures. Based upon the collective evidence, the FDA has stated that it will continue to evaluate the safety of these products on the basis of the results of the recent clinical studies. The Center for Medicare & Medicaid Services (CMS) announced, in a press release dated March 14, 2007, that it will be reviewing all Medicare policies regarding the use of ESAs, and specifically its EPO monitoring policy for patients with ESRD, and who are dialyzed in renal facilities. ANNA recognizes that use of ESAs has greatly improved the quality of life in persons with chronic kidney disease. For dialysis patients, the use of ESAs has reduced the need for blood transfusions and its associated complications. ANNA understands that nurses, patients, and their families may have questions or concerns about starting or continuing the use of ESAs after they hear or read about the FDA public health warning. We strongly believe that treatment decisions relating to a patients care should remain with the physician, advanced practice nurse, and/or anemia manager and be based on scientific evidence, sound clinical judgment, and communication with patients and their family members. ANNA will continue to keep its members informed of any new developments from the FDA or CMS on this issue.