A pilot study of chronic, low-dose epoetin-β following percutaneous coronary intervention suggests safety, feasibility, and efficacy in patients with symptomatic ischaemic heart failure

Aims Low-dose epoetin-beta improved neo-angiogenesis and cardiac regeneration in experimental models of ischaemic cardiomyopathy without raising haemoglobin. No clinical study has tested this approach to date. Methods and results We performed a randomized, placebo-controlled, double-blind, single-centre study of 35 IU/kg body weight epoetin-beta given subcutaneously once weekly for 6 months started within 3 weeks after successful percutaneous coronary intervention (PCI). Patients were included if they presented with a lesion within the proximal segment of the left anterior descending artery, the right coronary artery, or circumflex and had symptomatic heart failure. Patients with ST-segment elevation due to an acute myocardial infarct were excluded. The outcome variables were measured at baseline and at 6 months. Primary outcome measure was individual change in ejection fraction; secondary outcome was safety, change in N-terminal pro-brain natriuretic peptide, and peak VO2. Twenty-four patients completed the 6-month treatment course. No adverse event related to the treatment occurred. Low-dose epoetin-beta following PCI significantly improved global ejection fraction as measured by echocardiography (EPO: Delta EF 5.2 +/- 2.0%, P = 0.013; placebo: Delta EF 0.3 +/- 1.6%, P = 0.851; P = 0.019 for the inter-group difference) and cardiac magnetic resonance (EPO: Delta EF 3.1 +/- 1.6%, P = 0.124; placebo: 21.9 +/- 1.2%, P = 0.167; P = 0.042 for the inter-group difference). N-terminal pro-brain natriuretic peptide levels decreased in both groups without significant inter-group differences. Peak VO2 levels increased significantly by 3.9 +/- 1.1% (P < 0.05) in the EPO group, whereas in the placebo group the increase did not reach statistical significance (Delta peak VO2 3.0 +/- 1.6, P = ns). No significant difference regarding peak VO2 was observed between the EPO and placebo groups. Conclusions Low-dose epoetin-beta treatment following PCI is safe and feasible, and has possible beneficial effects on global ejection fraction and measures of exercise capacity. Extended low-dose epoetin-beta treatment warrants further mechanistic studies as well as larger clinical trials.