Physician Perspectives and the Impact of Payer Policy on Prescribing
An estimated 121 million people are living with chronic kidney disease (CKD) in China. This high prevalence can be attributed to China’s aging population as well as an increase in the prevalence of hypertension and diabetes, which substantially increase the risk of CKD. Complications arising from CKD include anemia and mineral disorders such as hyperphosphatemia and secondary hyperparathyroidism. These complications present opportunities for drug treatment. However, owing to a multitude of factors, including limited access to newer drugs with better efficacy and safety profiles, many patients are being treated suboptimally with existing anemia therapies. Erythropoiesis-stimulating agents (ESAs) are the most commonly used drug in the treatment of renal anemia. Although ESAs can be reimbursed partially through the state insurance schemes, the out-of-pocket expenses associated with these agents are still considered too high for many patients. Moreover, only short-acting ESAs are currently available. The limited treatment options for CKD create an opportunity for oral drugs with a new mechanism of action, such as AstraZeneca/FibroGen’s hypoxia-inducible factor prolyl hydroxylase inhibitor roxadustat (especially for CKD patients not on dialysis), and for long-acting ESAs (e.g., Jiangsu Hansoh Pharmaceutical’s EPO-018B [pegol-sihematide]) to address unmet needs in the Chinese market.