Background and importance Multifactorial anaemia is a common disease in elderly patients, usually treated with darbepoetin in different dosages.

Aim and objectives To maintain normal haemoglobin (Hb) values (>12 g/dL in women and >13 g/dL in men according to the WHO) in multifactorial anaemic patients older than 75 years, using high doses of darbepoetin with initial monthly dosage, eliminating weekly/fortnightly induction, facilitating treatment.

Material and methods A retrospective, multicentre, observational study was conducted in patients who started treatment with monthly doses of darbepoetin in the last 3 years (1 April 2017 to 1 April 2020), without previous induction doses. The first follow-up visit was made 1 month after the first dose was administered or just after the second dose, testing that Hb was maintained >12–13 g/dL. If the tests showed higher results, doses were lowered (20–25%); if the tests showed lower results, the dose was increased. The procedure was repeated the following month only in patients not in the range. In these cases, after two checks of stability, the test became quarterly. Variables measured were dosage, and initial, monthly and quarterly Hb values. Patients with insufficient information, or younger than 75 years, were excluded (because of different optimal values). Data were obtained from the hospital’s clinical information systems. Patients were informed if they required a different dosage than usual, giving their consent.

Results 36 patients initiated darbepoetin monthly during the study (7 men, 29 women). Median age was 86 years. Six patients were excluded, one for age, and five for not having sufficient data. Dosage by prescribers was 1.5 µg/kg/month. Average Hb starting treatment was 9.76 g/dL (range 7.6–10.5) and in the first control (4–8 weeks) it was 11.11 g/dL (range 8.8–13.6). In 70% (21/30) of patients, it was not necessary to change the initial dose because therapeutic objectives were progressively achieved. This dose was maintained until the successive quarterly controls. In the other 30% (9/30), 4 had their dose increased and 5 had their dose decreased to keep within range. In successive quarterly controls, the average value was 12.62 g/dL (10.5–15.3), achieving the therapeutic goals in all but two patients. Two patients were transfused due to acute processes that could alter the results.

Conclusion and relevance The monthly starting dosage in elderly patients appeared an effective and safe way to achieve therapeutic goals in multifactorial anaemia. The advantage over weekly/biweekly induction lies in better therapeutic adherence, reducing the number of doses needed in patients who also have many other medications.

Conflict of interest No conflict of interest