Roxadustat

How it works

By inhibiting prolyl hydroxylase, it stabilises hypoxia-inducible factor, stimulating endogenous erythropoietin production and improving iron utilisation to increase haemoglobin.

Prescribing in practice

• Thromboembolic and cardiovascular events have been reported, so assess vascular risk and ensure haemoglobin is not raised excessively or too rapidly.
• Separate dosing from phosphate binders and other cation-containing products, which can reduce roxadustat absorption.
• Iron status should be assessed and managed, and concurrent strong CYP and OATP interactions considered as detailed in the SPC.

Monitoring

Monitor haemoglobin regularly and assess iron parameters, adjusting therapy to keep haemoglobin within the target range.

Counselling the patient

• Take this tablet at a separate time from phosphate binders and indigestion remedies.
• Report chest pain, leg swelling or breathlessness, which could indicate a clot.

Evidence & guidelines

NICE has appraised roxadustat as an option for CKD-related anaemia, supported by phase 3 randomised controlled trials versus placebo and erythropoiesis-stimulating agents.