一種與紅血球生成激素有關的藥物是紅血球生成激素刺激劑（ESA）。這種藥物可以在體外合成再輸入身體中。However, such molecules can at a latter stage be detected, since they differ slightly from the endogenous ones in e.g. features of posttranslational modification.
歷史
血液學家 Dr. John Adamson 和腎臟專家Dr. Joseph W. Eschbach在1970年代，研究了綿羊和其它動物的許多腎衰竭例子和紅血球生成激素在血紅細胞形成所扮演的角色。這兩個科學家建立了這一原則“在骨髓中紅血球生成激素刺激血紅細胞的製造”，根據這個發現為治療人類貧血症奠定了基礎。
在1980年代，Adamson, Eschbach和其他科學家在美國西北腎臟中心進行了人工合成激素Epogen的臨床試驗。這個試驗非常成功，其結果被發表在1987年1月底新英格蘭醫學期刊。
1989年，美國食品藥品監督管理局（FDA）批准了Epogen在臨床上的使用。
調節
EPO是由腎皮質的成纖維細胞生成的。其調節被認為是依賴於血氧的反饋機制。EPO的轉錄因子, 缺氧誘導因子（HIFs）在有氧狀態下被羥基化且被蛋白酶所分解。.
使用
被用於治療的EPO是通過DNA重組技術在哺乳動物細胞的細胞培養下產生的。它被用來治療由於慢性腎病所導致的，或者由於放療和化療治療癌症所導致的貧血症。
慢性腎病所導致的貧血症
在進行透析治療的患者（第5期 慢性腎病(CKD)）在進行EPO治療時需要補充鐵質。.
除了透析患者，EPO也被用來治療沒有做透析治療的慢性腎病所導致的貧血(第3，4期慢性腎病和做工腎移植的患者)。有兩類（3個品牌的）EPO用於慢性腎病（無透析）貧血症的治療，他們是：
epoetin (Procrit(also known as Eprex), NeoRecormon)darbepoetin (Aranesp).
PDpoetin(an erythropoietin produced in Iran by Pooyesh Darou Pharmaceuticals)
美國市場品牌: epoetin (Procrit and Epogen)
癌症治療所導致的貧血症
2008年3月，美國食品藥品監督管理局（FDA）的一個顧問團支持為了癌症患者而保留Amgen公司和強生公司的紅血球生成激素刺激劑（ESA）在市場上。這是由於FDA認為一些研究結果顯示服用抗貧血藥物的化療病人有增加死亡和腫瘤生長的危險。根據FDA的數據，各類癌症都有增加，包括乳腺癌，淋巴癌，宮頸癌，頭，頸，和非小細胞的肺癌。
危重病人的貧血症
市場上有2種EPO（3個品牌）可以用於危重病人的貧血症治療。它們是
epoetin (Procrit(also known as Eprex), NeoRecormon)darbepoetin (Aranesp).
PDpoetin(an erythropoietin produced in Iran by Pooyesh Darou pharmaceuticals)
最近的隨機對照臨床試驗
Blood doping
EPO has a history of usage as a blood doping agent in endurance sports such as cycling, rowing, distance running, cross country skiing, biathlon, triathlons, and most recently, billiards.
Adverse effects
Erythropoietin is associated with an increased risk of adverse cardiovascular complications in patients with kidney disease if it is used to increase haemoglobin levels above 13.0 g/dl.
Early treatment with erythropoietin has been shown to significantly increase the risk of Retinopathy of prematurity in premature infants, and is not recommended.
Safety advisories in anaemic cancer patients
Amgen sent a "dear doctor" letter in January, 2007, that highlighted results from a recent anaemia of cancer trial, and warned doctors to consider use in that off-label indication with caution.
Amgen advised the United States FDA as to the results of the DAHANCA 10 clinical trial. The DAHANCA 10 data monitoring committee found that 3-year loco-regional control in subjects treated with Aranesp was significantly worse than for those not receiving Aranesp (p=0.01).
In response to these advisories, the FDA released a Public Health Advisory
In addition, on March 9, 2007, drug manufacturers agreed to new black box warnings about the safety of these drugs.
On March 22, 2007, a congressional inquiry into the safety of erythropoeitic growth factors was reported in the news media. Manufacturers were asked to suspend drug rebate programs for physicians and to also suspend marketing the drugs to patients.
Several recent publications and FDA communications have increased the level of concern related to adverse effects of ESA therapy in selected groups. In a revised Black Box Warning FDA notes significant risks associated with use. ESAs should only be used in patients with cancer when treating anemia specifically caused by chemotherapy and not for other causes of anemia. Further, it states that ESAs should be discontinued once the patient's chemotherapy course has been completed. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#ESA2, http://www.fda.gov/cder/foi/label/2007/103234s5158lbl.pdf, http://www.fda.gov/cder/foi/label/2007/103951s5164lbl.pdf and http://www.fda.gov/cder/drug/infopage/RHE/default.htm.
See also
ErythropoiesisAmgen, producer of artificial EPO (Brand Names: Epogen and Aranesp)
Dynepo, trademark name for an erythropoiesis stimulating protein, by TKT
Blood doping, transfusions and EPO use as doping methods; testing and enforcement
Jehovah's Witnesses and blood transfusions
The German company AplaGen BiopharmaceuticalsHydroxyethylstarch). Half-Life is increased by increase of molecular weight above the filtration threshold of the kidney, comparable to PEGylation. The so-called supravalence concept has significant advantages to PEGylation, because Half-Life and efficacy are improved simultaneously but not of the cost of the each other. The drug is completely biodegradable and can thus be eliminated even by dialysis patients. At the moment the drug is still preclinical.
Additional images
References
Further reading
External links
NYT 1987 announcement of Epogen's clinical successPatient information on Epogen
Patient information on Aranesp
Patient information on Procrit
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