A Study to Observe the Number of Patients Who Develop Pure Red Cell Aplasia (PRCA, a Rare Form of Anemia) and/or Antibodies to Erythropoietin While Receiving Epoetin Alfa or Another Recombinant Erythropoietin

The purpose of this study is to record the number of patients with chronic renal disease who are receiving treatment with epoetin alfa or other recombinant erythropoietins who develop pure red cell aplasia (PRCA, a rare form of anemia) and/or antibodies to erythropoietin during the study period

Recombinant erythropoietins are effective in treating anemia caused by many diseases, including chronic renal disease. Pure red cell aplasia (PRCA, a rare form of anemia) and the development of antibodies to erythropoietin have been reported to occur infrequently in patients who are being treated with recombinant erythropoietin. The incidence of PRCA and antibody development is unknown. In this prospective, observational cohort study, specific information will be collected on patients with chronic renal disease who are receiving recombinant erythropoietin and their treatment course will be followed for up to 2 years. Patients will be treated by their individual physician for their chronic renal disease; no treatment or procedures will be specified and no medication will be given by the Sponsor of the study (Johnson and Johnson Pharmaceutical Research and Development, LLC). Upon entering the study, specific information will be collected regarding disease history and recombinant erythropoietin treatment. Every 3 months thereafter, progress information will be collected, including recombinant erythropoietin treatment, number of red blood cells and presence of any signs of PRCA development. If a confirmed or suspected diagnosis of PRCA is made, the date of diagnosis will also be recorded. Patients who develop PRCA will be offered the opportunity to enroll into another study specifically designed to follow PRCA patients for treatment, outcome and recovery. Additionally, blood samples will be collected at study entry and every 3 months for the purpose of screening/monitoring for antibodies to erythropoietin. If a patient's physician suspects PRCA or loss of effectiveness to erythropoietins at any other time during the study, an additional blood sample will be taken. Patients whose blood tests positive for antibodies to erythropoietin at any time will have blood sampled monthly until the tests are negative, at which time blood samples will be taken every 3 months until the completion of the study. Patients who discontinue erythropoietin will be followed only for an additional 12 months from the time erythropoietin is discontinued. All information will be collected in a confidential manner and identity of the patients will be protected. The results of this study will be combined with a similar study that does not collect blood samples to observe the number of patients who develop antibodies to erythropoietin. This study will initially enroll only patients with chronic renal disease who are being treated with a recombinant erythropoietin marketed by any of the Johnson and Johnson family of companies but may be expanded to enroll patients with other diseases and who have taken other recombinant erythropoietins. The study hypothesis is that the study will provide a framework for companion studies designed to investigate disease progression and population subgroup differences in further detail.

Since the study is purely an observation of patients who may develop PRCA, no treatment will be required by the Sponsor and no medication will be supplied by the Sponsor. Patients will receive standard-of-care treatment for their chronic renal (or other) disease from their individual physicians.

Inclusion Criteria:

• Male or female patients of legal age to give consent according to local standards
• Patients must be receiving or about to receive treatment with an erythropoietin as part of a pre-existing treatment plan for their chronic renal (or other) disease
• Physicians treating the patients must agree in advance to document any appearance of pure red cell aplasia (PRCA) such that information and details of the case may be reported to regulatory agencies (with patient identification protected)
• If required by local ethics committees, patients must give consent to permit the collection of de-identified personal data for the specific purpose of this study and to collect blood samples for tests for antibodies to erythropoietin

Exclusion Criteria:

• Patients who are unable to complete future follow-up visits
• Patients who when entering the study have any of the following symptoms of pure red cell aplasia (PRCA): Loss of effectiveness of erythropoietin or low number of immature red blood cells while on erythropoietin as shown by a blood test or bone marrow examination
• Patients with a history of PRCA or loss of effectiveness with erythropoietin at the time of enrollment into the study
• Patients whose anemia did not respond to previous treatment with an erythropoietin
• Patients with a history of antibodies to erythropoietin prior to entering the study