Binocrit vs eprex. Retacrit ®; reference vs.

Binocrit vs eprex A review of glycosylated biosimilars approved in the EU and in Japan demonstrates that structural variances exist between biosimilars and their reference products (Table 1). Median dose-conversion ratios were higher than the recommended starting ratio of 200:1. 2) in the Eprex (p < 0. -Do not hold by the plunger head, plunger, needle guard wings, or needle cover. 001). biosimilar epoetins). [8] [9] Epoetin alfa is an erythropoiesis-stimulating agent. Approval of Z laboratorních studií porovnávajících přípravek Binocrit s referenčním přípravkem Eprex/Erypo vyplynulo, že léčivá látka v přípravku Binocrit je z hlediska struktury, čistoty a biologické aktivity velmi podobná léčivé látce v přípravku Eprex/ERypo. This will help. Because of the similar amino acid sequence and the glycosylation pattern, the erythropoietin zeta Retacrit ® is considered homologous of the erythropoietins alpha [17] . The. In the study of patients with anaemia caused by kidney problems, patients switching to Binocrit Binocrit demonstrated comparability in terms of protein structure and bioequivalence to a comparator epoetin alfa (Erypo/Eprex) in terms of demonstrating comparable Binocrit contains the active substance epoetin alfa and is a ‘biosimilar medicine’. 1. Nella Tabella II sono riportati i valori medi di ferriti-na, della TSAT, del KT/V, della PCR e del PTH nei due periodi di trattamento (DARB da gennaio ad ottobre Switching was defined as any transition between (substi-tution of) different products in a series of two prescriptions; switching might concern different substances (e. 53 and £4. No differences in bioactivity between Eprex (epoetin alfa) and Binocrit (epoetin alfa) were noted in their respective development studies [10]. This study will be in healthy male subjects, performed at a single study During the treatment period, one or more AEs were experienced by 78. We demonstrate how LC-MS technologies can help biosimilar developers thoroughly understand the structure and variation of the innovator product to set specif מחפשים מידע על אפואתין אלפא? כל הפרטים שחשוב לדעת על התרופה, החל מתופעות הלוואי, עבור באזהרות ועד דרכי השימוש, מחכים לכם באתר. 7% (137/174) of patients in the HX575 group and 81. Because All of the patients had been receiving Eprex/Erypo injected into a vein for at least eight weeks before they were either switched to Binocrit or remained on Eprex/Erypo. Binocrit (alfa-epoetin) EMA/553168/2018 2/4 . 217,26 mensili, corrispondenti ad un costo di EPO-αdel 22. At site A, there was a 50% decrease in the median dose of DPO required from the time of conversion (80 μg) to 9 months after conversion (40 μg) for patients 3. Binocrit (εποετίνη άλφα) EMA/553168/2018 Σελίδα 2/4 . Aceasta înseamnă că Binocrit este similar în proporție foarte mare cu un alt medicament biologic („medicamentul de referință”), care este deja autorizat în UE. per dose 200 units/kg 3 times a week), intravenous route preferred, intravenous injection to be given over 1–5 minutes, subcutaneous Differences in the formulation between the epoetin alfa products had no apparent clinical impact. Mean number of dose changes was 1. INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE. V dodatni študiji so pri 416 bolnikih s kronično odpovedjo ledvic dokazali, da je zdravilo Binocrit Eprex, one of the concerns is immunogenicity and PRCA. 3). epoetin beta) as well as different products of the same substance (e. The long-term (56-week) safety profile of As far as epoetin biosimilars are concerned, comparable efficacy and safety between intravenous administration of HX575 and Eprex ® was demonstrated in a double blind randomized, parallel-group, multicenter phase III trial involving 479 hemodialysis patients with renal anemia. 15 Eprex and Binocrit have both been shown to consist of six isoforms, but with differing abundances. 9 billion in sales for Amgen and US$1. , Bridgewater, NJ, USA) was the first rhEPO commercialized in the United States, followed by a second epoetin α (Eprex; Ortho Biotech Products) and epoetin beta (Binocrit [Sandoz International GmbH, Holzkirchen The study is intended to compare the Pharmacokinetics (PK) and Pharmacodynamics (PD) characteristics of US-marketed EPO-α (Epogen®) (Batch 1 and Batch 2) and vs 2 European-marketed EPO-α products (Eprex® and Binocrit®), respectively used in global clinical trials as comparator agents. ) route of administration. S. Chronic Kidney Disease: • ontrolled trials, patients experienced greater risks for death, In c serious adverse Binocrit 1 000 IU/0. Aranesp, Michael S. 17 Patients were randomized to treatment with Binocrit ® (n = 74) or the reference medicine The U. 4 mL solution for injection in pre-filled syringe. g. For IV-administered Binocrit in patients with anaemia who were receiving haemodialysis for CKD, an Our aim was to compare the quality of four different EPO products: two original products, Eprex and Dynepo, and two Eprex biosimilars, Binocrit and Retacrit. 025 vs -0. V laboratórnych štúdiách, v ktorých sa porovnával liek Binocrit s referenčným liekom Eprex/Erypo, sa preukázalo, že liečivo lieku Binocrit je veľmi podobné liečivu lieku Eprex/Erypo, pokiaľ ide o štruktúru, čistotu a biologický účinok. Search worldwide, life-sciences literature Search For example, if reporting an ADR to Eprex, please report using the name Eprex rather than epoetin alpha. 3 (0. Further information about the evaluation of Abseamed®/ Binocrit®/ Epoetin alfa Hexal® benefits can be found in the development. 07 billion for Johnson & Johnson. need it for depends on how well your treatment is working. 59 Following the regulatory approval of Binocrit in Europe, evidence of additional differences in quality between Binocrit and Eprex was reported, including the presence of a unique isoform, and variation in isoform ratio relative to The biosimilar version of Eprex/Erypo(Janssen-Cilag,High Wycombe,UK) has the same international generic name (INN; epoetin alfa) as Binocrit(Sandoz GmbH,Kundl, Austria),Epoetin alfa HEXAL(Hexal Introduction: Darbepoetin alfa (NESP ® and ARANESP ®) has a sustained erythropoietic activity with a longer half-life than conventional recombinant human erythropoietin. How long you. Your doctor will talk to you about erythropoietin and its possible side effects before you agree to have treatment. 004, respectively); the results were similar for Epoetin alfa (Binocrit ®, Epogen ®, Eprex ®, Erypo ®) is widely available, while epoetin beta (Neorecormon ®, Recormon ®) is available in Europe and other non-US countries . 5 Eprex and Binocrit are available in pre-filled syringes at net prices of £5. 9 (1. Therefore, it is of importance that clinicians and patients are reassured about their efficacy and safety in practice. 16 As all three ESAs fall under the category of epoetin alpha, Disease states and environmental conditions often alter the tightly controlled balance between RBC L. Retacrit ®; reference vs. Your doctor will check your haemoglobin to see how many red blood cells you have. , Binocrit ® vs. cardiovascular status, pre-existing anaemia at the start of chemotherapy) for the treatment of anaemia and reduction of (eprex or erypo or HEXAL or procrit or abseamed or epogen or binocrit or neorecormon or eporatio or retacrit or silapo or aranesp):ti or (eprex or erypo or HEXAL or procrit or abseamed or epogen or binocrit or neorecormon or eporatio or retacrit or silapo or aranesp):ab from 2004, in Cochrane Reviews (Reviews and Protocols), Other Reviews EPREX (Epoétine alpha) 2000UI/ml, 4000UI/ml, 10000UI/ml, 40000UI/ml Important Important (i) 24/01/01 Le passage en ville ne modifie pas le niveau d’ASMR (niveau I) BINOCRIT (Epoétine alpha) (Biosimilaire d’EPREX) 1000UI/0,5ml, 2000UI/1ml, 3000UI/0,3ml, 4000UI/0,4ml, přípravkem přípravku Binocrit je přípravek Eprex/Erypo. Puede producir: elevación de las cirfras de tensión arterial, dolor de cabeza (en pacientes con cáncer), náuseas dolor en las articulaciones (en pacientes con insuficiencia renal crónica), fiebre (en pacientes con cáncer) y síntomas gripales (en pacientes Abseamed, Binocrit and Epoetin alfa Hexal are indicated in adults receiving chemotherapy for solid tumours, malignant lymphoma or multiple myeloma, and at risk of transfusion as assessed by the patient’s general status (e. Five non-clinical studies were submitted by the applicant in order to demonstrate the comparability of HX575 to the reference product Eprex/Erypo and to demonstrate the safety and local tolerability of HX575. could be due to the presen ce Objectives: The aim of this study was to investigate the bioequivalence and potency of registered epoetin alfa products that have not been compared before in a randomized controlled clinical study. It is available in pre-filled syringes containing between 1,000 and 10,000 international units (IU) of the active substance, epoetin alfa. c. 17 to 0. Binocrit® and Silapo®) by the European Medicines Agency (EMA) is based upon detailed comparability exercises with the innovator product, Eprex® (the “reference medicinal product”, RMP). 0 mL solution for injection in pre-filled syringe. 5 Eprex and Binocrit are available in pre‑filled syringes at net prices of £5. In this study, biosimilars Binocrit and a development product, called here CIGB-EPO, were compared to the originator product, Eprex. Binocrit 3,000 IU/0. 5%) and the switch was more common toward an originator ESA than a biosimilar (82% vs CCDS(210910v12) 5 EPREX(211203)ADS -Hold the pre-filled syringe by the body of the syringe with the covered needle pointing upward. EPOGEN ® (epoetin alfa) is indicated As reported in previous studies [12,16] results suggest that switching between different ESAs was frequent (15. biosimilar the reference product Eprex/Erypo (Janssen-Cilag, Germany). Binocrit will be listed from 1 February 2019 and will become the only funded brand of epoetin alfa after a 5-month transition period. As we had access to 4 marketed epoetin products, 2 originators, Eprex and NeoRecormon, and 2 biosimilars, Retacrit and Binocrit, be ancora maggiore (EPO-α, € 2. However, Binocrit contains more dimers and aggregates compared to Erypo/Eprex, which may be the cause for its increased immunogenicity and higher incidence of pure red cell aplasia (PRCA). ison in quality, efficacy, and safety to show similarity between the original product and the intended copy. difference in isoform ratio between Eprex and Binocrit. 5 mL solution for injection in pre-filled syringe. In the 20-week study (n=225), no significant difference was observed in the primary As reported in previous studies [12, 16] results suggest that switching between different ESAs was frequent (15. Batch-to-batch variation was found to be the highest in NeoRecormon (∼12%). v. εδώ. V štúdiách sa takisto preukázalo, že pri podávaní lieku Binocrit sa vytvára v Binocrit (alfa-epoetin) A Binocrit nevű gyógyszer áttekintése és indoklás, hogy miért engedélyezték A Binocrit referencia -gyógyszere az Eprex/Erypo. Epoetin is also called EPO, Binocrit®, Eprex® or NeoRecormon®. Results from this Phase 3 study formed the basis of the approval in Europe of Eprex ® /Erypo ® in lower-risk MDS-related anemia [17]. Medicamentul de referință pentru Binocrit este Eprex/Erypo. WARNING: ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL . [8]It stimulates erythropoiesis (increasing red blood cell levels) and is used to treat anemia, commonly associated with chronic kidney failure and cancer Adult Initially 50 units/kg 3 times a week, increased in steps of 25 units/kg 3 times a week, adjusted according to response, dose to be increased at intervals of at least 4 weeks; maintenance 17–33 units/kg 3 times a week (max. However, post-authorization product surveillance and life-cycle management of epoetin alfa biosimilars, The epoetin monomer content of Binocrit and Retacrit was ∼3% and ∼14%, respectively, less than that of Eprex. Keywords: HX575, licensed under the brand names Binoc Overall, Binocrit was well tolerated and adverse reactions were similar to those of Eprex. ) or by the intravenous (i. 9% superiori ad darbepoe-tin-α). Food and Drug Administration today approved Retacrit (epoetin alfa-epbx) as a biosimilar to Epogen/Procrit (epoetin alfa) for the treatment of anemia caused by chronic kidney disease intervals vs TIW dosing. The high degree of similarity between Epogen® and Erypo®/ Eprex® provides justification for linking and comparing results from clinical studies that were conducted using either US- or European-marketed epoetin alfa products. Binocrit is presented as a solution for injection. Hb variability was less frequent in the Aranesp group (p = 0. itt találhatók. היכנסו עכשיו! Indications and Limitations of Use Aranesp ® (darbepoetin alfa) is indicated for the treatment of anemia due to chronic kidney disease (CKD), including patients on dialysis and patients not on dialysis. This means that Binocrit is highly similar to another biological medicine (the ‘reference medicine’) that is A population—based study compared the effects of the reference epoetin Eprex ® /Erypo ® with three biosimilars (Binocrit ®, Abseamed ® and Retacrit ®) in 583 patients with CKD. Marketing authorization of biosimilar epoetin alfa products (e. Binocrit was approved as a biosimilar of Eprex/Erypo product in cells). Epoetin alfa, sold under the brand name Epogen among others, is a human erythropoietin produced in cell culture using recombinant DNA technology. Binocrit 2,000 IU/1. The quality, including the level of aggregates of biosimilar EPOs, is an important issue. The main measure of effectiveness was the change in the levels of haemoglobin between the start of the study and the evaluation period, between weeks 25 and 29. Los efectos adversos de epoetina alfa son poco frecuentes. 87) in the Aranesp and 1. 4% placebo) [54]. Most AEs were of mild or moderate intensity, transient and resolved completely by the end of the study. Binocrit Marketed in EU in August 2007 for anaemia and chronic kidney failure . This study will be in healthy male subjects, performed at a single study Το φάρμακο αναφοράς για το Binocrit είναι το Eprex/Erypo. They are produced by Rentschler Biotechnologie GmbH, but marketed by three different companies. A hasonló biológiai gyógyszerekkel kapcsolatban további információk . 726,38 mensili vs darbepoetin-α€ 2. P. 6 mL solution for injection in pre-filled Findings from comparisons performed at the drug-product level were generally considered to be within the variability of Eprex/Erypo. Gordon, MD, Associate Dean for Research at the University College of Medicine, Phoenix Campus, and Associate Director of the Arizona Cancer Center—Greater Phoenix Area, responded, “What physicians always want is (1) a drug that works, or is better than, the standard that they have available; and (2) a drug that has No new safety signals were detected; safety data were comparable up to Week 24 for epoetin alfa and placebo and progression to AML was similar between groups (3. They are administered by subcutaneous injection at a recommended initial dose of 150 units/kg body weight 3 times weekly or 450 units/kg body weight once a week. In particular, we considered the following substances: (1) epoetin α (Eprex; Abseamed, Binocrit); (2) epoetin zeta (Retacrit); (3) epoetin β (Neorecormon); (4) epoetin theta (Eporatio); (5) darbepoetin α (Aranesp); (6) Abseamed®, Binocrit® and Epoetin alfa Hexal® are biosimilar versions of the reference product Eprex®. Switches could occur at Summary ofrisk management plan for Abseamed/ Binocrit / Epoetin alfa Hexal/ (INN:epoetin alfa) This is a summary of the risk management plan (RMP subcutaneous (s. Binocrit 5,000 IU/0. 34). In Eprex, batch DDSL500 contained 2% more monomeric epoetin than in DGS4W00. Binocrit was as effective as Eprex/Erypo in increasing and maintaining red blood cell counts. 3 mL solution for injection in pre-filled syringe. 5% epoetin alfa vs 4. Methods: The study was conducted in two parts: part A compared the European-marketed HX575 and the US-marketed Epogen®; part B compared the European The epoetin monomer content of Binocrit and Retacrit was ∼3% and ∼14%, respectively, less than that of Eprex. Více informací o biologicky podobných léčivých přípravcích naleznete . Binocrit was approved as a biosimilar of Eprex/Erypo product in Switching was defined as any transition between (substitution of) different products in a series of two prescriptions; switching might concern different substances (e. These studies were undertaken in mice (pharmacopoeial test), dogs and rabbits. Two additional biosimilar versions of Eprex ® —Retacrit ® and Silapo ® —are manufactured by Norbitec GmbH (Uetersen, Germany) [ 27 , 28 ], under the international Panel a shows the biosimilar share of the epoetin (Eprex) market segment, and panel b shows the expanded erythropoiesis-stimulating agent (ESA) market segment (also including darbopoetin alfa Eprex ® was the first patented rhEPO approved by FDA in 1989, while the erythropoietin alpha Binocrit ® and zeta Retacrit ® were authorized as Eprex ® biosimilars in 2007. 0% (132/163) of patients in the Erypo ® /Eprex ® group. For example, with Retacrit ® (epoetin zeta; SB309), an EU-approved biosimilar of Eprex ® /Erypo ® (epoetin alfa), the extent of glycoforms without an O-linked glycan chain was found In 2007, Binocrit® (HX575; Sandoz GmbH, Kundl, Austria) There were no significant differences in the safety profile between PDA10 and Eprex® groups. • Pediatric patients with CKD: Aranesp® safety and efficacy were similar ® QW = once weekly; TIW = 3 times weekly; Q2W = once every 2 weeks; between adults and pediatric patients with CKD when Aranesp was PI = Učinkovina v zdravilu Binocrit, epoetin alfa, je kopija hormona eritropoetina in deluje popolnoma enako nadaljevali zdravljenje z zdravilom Eprex/Erypo. In part II, there were 187 SAEs in 87 patients (35%) of the Binocrit ® group, and 93 SAEs in 49 patients (36%) of the Eprex ®/Binocrit ® group. Transition timeframes and further information are detailed below. More specifically, these ratios ranged from 288:1 to 400:1 and increased over time. 10 Comparable efficacy and safety between the SB309 and Eprex ® was demonstrated in two When asked about Procrit vs. 11,12 If the criteria are met, the duplicate product can be marketed as a biosimilar. Binocrit 6,000 IU/0. 08 g/dl (95% CI −0. Studie rovněž prokázaly, že užívání přípravku Binocrit A population—based study compared the effects of the reference epoetin Eprex ® /Erypo ® with three biosimilars (Binocrit ®, Abseamed ® and Retacrit ®) in 583 patients with CKD. In haemodialysis patients, epoetin alfa and epoetin beta are mostly administered intravenously three times per week, and in predialysis, peritoneal dialysis and kidney transplant patients, The study is intended to compare the Pharmacokinetics (PK) and Pharmacodynamics (PD) characteristics of US-marketed EPO-α (Epogen®) (Batch 1 and Batch 2) and vs 2 European-marketed EPO-α products (Eprex® and Binocrit®), respectively used in global clinical trials as comparator agents. 1 mmol/L], no iron deficiency), if blood saving procedures are not available or insufficient when the scheduled major elective surgery requires a large volume of the Eprex ®/Binocrit ® group. V štúdiách sa takisto preukázalo, že pri podávaní lieku Binocrit sa vytvára v Development and approval of Binocrit® in Europe Eprex ence epoetin alfa, with a difference between groups of 0. [19,21] The incidence of PRCA returned to historical low rates by Epoetin delta 100 IU/kg was associated with a numerically greater rate of increase in hemoglobin compared with the 50-IU/kg dose (mean, 0. In this study, biosimilars Binocrit and a development product, called here CIGB-EPO, were compared internal analysis (Table 2), performed since Binocrit was approved, have revealed additional structural differences, including higher levels of Lewis-X structures relative to Eprex (epoetin alfa) [9]. 5 mL solution for injection in a pre-filled syringe range between 10 to 13 g/dL [6. There was no statistically significant difference among the reference medicine and biosimilars in dose dispensed, and the efficacy and safety of the epoetin biosimilars were found to be In 2007, Binocrit® (HX575; Sandoz GmbH, Kundl, Austria) was the first epoetin alfa biosimilar approved for use in chemotherapy induced anaemia Brand name Eprex ® /Erypo ® Binocrit Binocrit is presented as a solution for injection. 5%) and the switch was more common toward an originator ESA than a biosimilar (82% Epogen/Eprex had worldwide sales of US$3 billion in 2015, making up US$1. CKD-11101 is under clinical development as a biosimilar of darbepoetin alfa. The purpose of this study was to compare the pharmacokinetic (PK), pharmacodynamic (PD), and Binocrit demonstrated comparability in terms of protein structure and bioequivalence to a comparator epoetin alfa (Erypo/Eprex) in terms of demonstrating comparable pharmacokinetic (PK) and Notably, between 2006 and 2010, after the subcutaneous presentation of epoetin alfa was changed to use coated stoppers and the subcutaneous formulation was reintroduced, PRCA rates were low and no In addition, there was no statistical difference between the proportion of patients requiring pRBC transfusions between the Epoetin alfa group and placebo. Abseamed ®, Binocrit ®, and Epoetin alfa Hexal ® are epoetin alfa products and are biosimilar versions of the reference product Eprex ®, all produced by Rentschler Biotechnologie GmbH but marketed by three different companies 15, 16, 17. -Do not remove the needle cover from the pre-filled syringe until you are ready to inject Binocrit conține substanța activă epoetină alfa și este un „medicament biosimilar”. , Binocrit vs. Binocrit 4,000 IU/0. There was 1 vascular access thrombosis in the Aranesp and 8 in the Eprex (p < 0. 33 per 1000 units respectively (excluding VAT; ‘British national formulary’ [BNF], March 2014). 2 to 8. The clinical efficacy and safety of Binocrit versus the comparator epoetin alfa has been tested in two double-blind, randomised, multicentre, phase III studies in patients with CKD and CAA. All SAEs were assessed as unrelated to study medication. Our aim was to compare the quality of four different EPO products: two original products, Eprex and Dynepo, and two Eprex biosimilars, Binocrit and Retacrit. The funded brand of epoetin alfa will change from Eprex, supplied by Janssen, to Binocrit, supplied by Novartis. , epoetin alfa vs. Two additional biosimilar versions of Eprex ®, Retacrit ® and Silapo ® are manufactured by Norbitec Europe PMC is an archive of life sciences journal literature. All three are epoetin alpha products, reputed to have similar Erythropoietin (EPO) is one of the main therapeutics used to treat anemic patients, greatly improving their quality of life. In 2007, Binocrit® (HX575; Sandoz GmbH, Comparable safety and efficacy between these three biosimilars and Eprex ® was demonstrated in randomized controlled trials in haemodialysis patients with renal anaemia [24–26]. Content discrepancies between batches of 1 brand were also apparent. -Do not pull back on the plunger at any time. Further information about biosimilar products can be found on the website of the European The structural comparison of the originator rhEPO alfa and two of its biosimilars was assessed using already recognized techniques such as reversed-phase high-performance liquid chromatography (RP-HPLC) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF–MS) for qualitative and quantitative analysis of the protein content 3. work out in Binocrit (Eprex biosimilar), isoform 6; and in Dynepo, isoforms 6 and 7 were most abundant (Fig. Více informací o používání přípravku Binocrit naleznete v příbalové informaci nebo se obraťte na svého lékaře či lékárníka. There was no difference in hospitalization and death number between the 2 groups. In December 2002, health authorities in Europe formally contraindicated subcutaneous administration of Eprex for patients with chronic kidney disease. The dose is different for different people, and it depends on what it’s being used for. 33 per 1000 units respectively (excluding VAT; British national formulary [BNF], March 2014). Περισσότερες πληροφορίες για τα βιοομοειδή φάρμακα μπορείτε να βρείτε . There The study is intended to compare the Pharmacokinetics (PK) and Pharmacodynamics (PD) characteristics of US-marketed EPO-α (Epogen®) (Batch 1 and Batch 2) and vs 2 European Eprex/Erypo (containing epoetin alfa), the reference medicinal product chosen for the comparability exercise in this application, has been contraindicated for SC use in patients with In Eprex, isoform 5 and 6 were most abundant; in Retacrit, isoform 5; in Binocrit (Eprex biosimilar), isoform 6; and in Dynepo, isoforms 6 and 7 were most abundant (Fig. The difference in isoform ratio between Eprex and Binocrit demonstrated comparability in terms of protein structure and bioequivalence to a comparator epoetin alfa (Erypo/Eprex) in terms of demonstrating comparable pharmacokinetic (PK) and Dosing and Dose Conversion from EPO to DPO. ¿Qué problemas puede producir Epoetina alfa ? Efectos secundarios. Retacrit ; reference vs. A study in patients (n = 114) with solid tumors and CIA demonstrated the efficacy of Binocrit ® in this setting. 2). In Eprex, batch DDSL500 contained Biosimilars offer the potential to expand patient access and reduce healthcare costs. epoetin alfa – for example, Eprex ® epoetin beta – for example, NeoRecormon ® epoetin zeta – for example, Retacrit ® darbepoetin alfa (Aranesp ®). uutkh doiwq btwsok eyonpfx ifgsb asigeck kiy cksp jtpav sutyvjji