Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: A parallel, randomized, double blind study

BACKGROUND: Recombinant human erythropoietin (EPO) is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. METHODS: A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A), a newly developed product and Eprex (CILAG AG, Switzerland, formulation B), as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA) during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. RESULTS: Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively). The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8 – 1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their intensity. The more frequent events were pain at injection site (35.3%) and hypertension (29%). Additionally, further treatment of the patients with the study product yielded satisfactory increases in hemoglobin and hematocrit values. CONCLUSION: The formulations are comparable. The newly developed product should be acceptable for long-term application

Seismic assessment of a heavy-timber frame structure with ring-doweled moment-resisting connections

The performance of heavy-timber structures in earthquakes depends strongly on the inelastic behavior of the mechanical connections. Nevertheless, the nonlinear behavior of timber structures is only considered in the design phase indirectly through the use of an R-factor or a q-factor, which reduces the seismic elastic response spectrum. To improve the estimation of this, the seismic performance of a three-story building designed with ring-doweled moment resisting connections is analyzed here. Connections and members were designed to fulfill the seismic detailing requirements present in Eurocode 5 and Eurocode 8 for high ductility class structures. The performance of the structure is evaluated through a probabilistic approach, which accounts for uncertainties in mechanical properties of members and connections. Nonlinear static analyses and multi-record incremental dynamic analyses were performed to characterize the q-factor and develop fragility curves for different damage levels. The results indicate that the detailing requirements of Eurocode 5 and Eurocode 8 are sufficient to achieve the required performance, even though they also indicate that these requirements may be optimized to achieve more cost-effective connections and members. From the obtained fragility curves, it was verified that neglecting modeling uncertainties may lead to overestimation of the collapse capacity