Use of the anemia biologic epoetin alfa (Procrit) to treat critically ill patients after admission to intensive care did not reduce the need for blood transfusions, but it did reduce mortality particularly among trauma patients, according to a report in the Sept. 6 New England Journal of Medicine.

"Unlike prior studies, this trial found that we didn't reduce blood transfusions, although it still increased hemoglobin levels," said chief researcher Dr. Howard L. Corwin of the Dartmouth-Hitchcock Medical Center in Lebanon, NH. "What we did find, particularly in trauma patients, was a reduction in mortality."

in the trial, the researchers enrolled 1,460 medical, surgical or trauma patients following their admission to the intensive care unit, and patients received either epoetin alfa or a placebo weekly for a maximum of three weeks. Patients were followed for 140 days.

The researchers had hypothesized based on an earlier study that giving epoetin alfa would reduce the need for transfusions. Critically ill patients often develop anemia and require blood transfusions, which involve considerable risks.

"It didn't decrease the need for transfusions, which was the primary endpoint. And, in the majority of patients, which would be medical and surgical non-trauma patients, it did not improve survival," said Dr. Christian Cable of Texas A&M Health Science Center College of Medicine.

However, the mortality rate in patients receiving epoetin alfa was lower than among those receiving a placebo, and the reason seemed to be something other than the biologic's ability to enhance red blood cell formation.

"More research is needed to look at the trauma patients and the mechanism for epoetin alfa effect on mortality," Corwin said.

"There's some data in animal studies and small clinical studies suggesting that epoetin alfa has a lot of other effects in addition to making blood cells, and we think it's one of these other mechanisms that is causing the mortality benefit," Corwin said. "There is a whole range of other areas where epoetin alfa may have potential benefits through these other mechanisms."