Biosimilar recombinant human erythropoietin induces the production of neutralizing antibodies

Kidney Int. 2011 Jul;80(1):88-92. doi: 10.1038/ki.2011.68. Epub 2011 Mar 23.


Recombinant human erythropoietin (r-HuEpo) has been used for the treatment of renal anemia. With the loss of its patent protection, there has been an upsurge of more affordable biosimilar agents, increasing patient access to treatment for these conditions. The complexity of the manufacturing process for these recombinant proteins, however, can result in altered properties that may significantly affect patient safety. As it is not known whether various r-HuEpo products can be safely interchanged, we studied 30 patients with chronic kidney disease treated by subcutaneous injection with biosimilar r-HuEpo and who developed a sudden loss of efficacy. Sera from 23 of these patients were positive for r-HuEpo-neutralizing antibodies, and their bone marrow biopsies indicated pure red-cell aplasia, indicating the loss of erythroblasts. Sera and bone marrow biopsies from the remaining seven patients were negative for anti-r-HuEpo antibodies and red-cell aplasia, respectively. The cause for r-HuEpo hyporesponsiveness was occult gastrointestinal bleeding. Thus, subcutaneous injection of biosimilar r-HuEpo can cause adverse immunological effects. A large, long-term, pharmacovigilance study is necessary to monitor and ensure patient safety for these agents.

MeSH terms

  • Adult
  • Aged
  • Anemia / drug therapy*
  • Anemia / etiology
  • Anemia / immunology
  • Antibodies, Neutralizing / biosynthesis*
  • Erythropoietin / administration & dosage
  • Erythropoietin / adverse effects*
  • Erythropoietin / immunology*
  • Female
  • Humans
  • Injections, Subcutaneous
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy
  • Kidney Failure, Chronic / immunology
  • Male
  • Middle Aged
  • Pilot Projects
  • Recombinant Proteins
  • Red-Cell Aplasia, Pure / chemically induced
  • Risk Factors
  • Thailand


  • Antibodies, Neutralizing
  • Recombinant Proteins
  • Erythropoietin