Epoetins and mortality in patients with cancer – Authors' reply

[...] the target haemoglobin concentration was more than 130 g/L in 75% of patients (ie, higher than that needed to correct anaemia), and the ESA dose was twice the standard recommended dose in one study.4 If these randomised trials had been testing radiotherapy, chemo therapy, or insulin doses that were 50-100% higher than those recommended (or had used them in disorders for which they were not approved) and adverse events resulted, would the usefulness of appropriate radiotherapy, chemotherapy, or insulin be questioned? On the basis of publish ed data, patients in the control groups received more trans fusions and achieved lower haemoglobin levels than patients treated in the ESA groups. [...] it remains unclear whether the higher mortality seen in the ESA groups is to be attributed to the higher haemoglobin levels achieved or to other ESA effects.\n Another issue pointed out by Clavo and colleagues is that the studies included in the meta-analysis did not follow current guidelines.