Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after the TREAT trial

BMC Nephrol. 2021 Aug 21;22(1):284. doi: 10.1186/s12882-021-02491-y.


Background: Variation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning.

Method: We used a segmented regression approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial, Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians' characteristics.

Results: Use of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician's gender, and age were not consistent across insurance populations and types of ESA.

Conclusions: Physician specialty has a dominant role in prescribing decision, and that specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.

Keywords: De-adoption; Medical safety; Medication utilization; Physician prescribing.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anemia / drug therapy*
  • Anemia / etiology
  • Darbepoetin alfa / therapeutic use*
  • Diffusion of Innovation
  • Epoetin Alfa / therapeutic use*
  • Hematinics / therapeutic use
  • Humans
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Regression Analysis
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / drug therapy*
  • Safety-Based Drug Withdrawals
  • United States
  • United States Food and Drug Administration


  • Hematinics
  • Darbepoetin alfa
  • Epoetin Alfa