Ferric carboxymaltose in patients with restless legs syndrome and nonanemic iron deficiency: A randomized trial

Trenkwalder, Claudia; Winkelmann, Juliane; Oertel, Wolfgang H.; Virgin, Garth; Roubert, Bernard; Mezzacasa, Anna

doi:10.1002/mds.27040

Cited by 52 publications

(40 citation statements)

References 22 publications

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“…Patients who cannot tolerate oral iron supplements may be considered for iron infusion; high-dose ferric carboxymaltose or low-molecular-weight iron dextran can be used (table 1). 38 We have no strong evidence to support using iron sucrose in RLS, and it is probably not effective 39. Oral iron is also not well absorbed unless there is systemic iron deficiency; thus, counterintuitively, intravenous iron may be more indicated when the serum ferritin concentration is not very low.…”

Section: Introductionmentioning

confidence: 93%

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management

Wijemanne¹,

Ondo

2017

Pract Neurol

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Section: Introductionmentioning

confidence: 93%

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management

Wijemanne¹,

Ondo

2017

Pract Neurol

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“…A causative relationship between iron deficiency and RLS has not been established so far. 9,10 Nevertheless, a systemic analysis of iron homeostasis in RLS patients has not been performed up to now.…”

mentioning

confidence: 99%

Association of mitochondrial iron deficiency and dysfunction with idiopathic restless legs syndrome

et al. 2018

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Background Restless legs syndrome is a sensorimotor neurological disorder of the limbs that impairs quality of life and disturbs sleep. However, there has been progress in understanding the disease involving the dopaminergic system as well as iron metabolism. The exact pathophysiological mechanisms of restless legs syndrome remain elusive. We tried to elucidate the underlying mechanisms in iron metabolism in restless legs syndrome subjects on a systemic, cellular, and mitochondrial level. Methods We conducted a study prospectively recruiting 168 restless legs syndrome patients and 119 age‐matched healthy controls focusing on iron metabolism using human monocytes as surrogates. Results Evaluation of systemic iron metabolism parameters in the circulation showed no significant difference between patients and controls. We observed a significant reduction in mRNA levels of heme oxygenase 1 and mitochondrial iron genes like mitoferrin 1 and 2 in monocytes isolated from restless legs syndrome patients, indicating mitochondrial iron deficiency. Interestingly, we also observed reduced expression of iron regulatory protein 2 along with impaired activity of mitochondrial aconitase and reduced mitochondrial superoxide formation in restless legs syndrome subjects. Along this line, patients had reduced mitochondrial respiratory capacity that improved in restless legs syndrome subjects under treatment with dopaminergic drugs compared with untreated patients. Conclusions Our data suggest that restless legs syndrome is linked to mitochondrial iron deficiency and associated impairment of mitochondrial function. This is partly corrected by treatment with dopaminergic drugs compared with untreated patients, which may be linked to an effect of dopamine on cellular iron homeostasis. © 2018 International Parkinson and Movement Disorder Society

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“…Baseline TSAT and IRLS improved with FCM treatment at week 4 (r=0.37; P=0.006) and at the end of study, i.e., week 12, or if terminated earlier (r=0.28; P=0.031). Serious adverse effects were reported in two patients, one from each group who were withdrawn from the study, but there were no hypersensitivity or anaphylactoid reactions (189).…”

Section: Restless Leg Syndrome (Rls) and Limb Movementmentioning

confidence: 92%

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

Ratneswaran¹,

Sagoo²,

Steier³

2018

J. Thorac. Dis.

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Sleep medicine remains an exciting and fast-evolving field of medicine with insomnia, hypersomnia, parasomnia, sleepdisordered breathing and circadian rhythm disorders affecting significant proportions of the population. This update provides a selected overview about recent publications in the field. Sleep-disordered breathing and comorbidities The high prevalence of obstructive sleep apnoea (OSA) differs between genders, with male patients being more affected (1). In a US-nationwide study of 1,704,905 patients who had a diagnosis of OSA and 1,704,417 controls matched for age, sex and state of residence, the prevalence of co-morbidities [OR (95% CI)], such as type 2 diabetes [2.29 (2.28-2.31)], cardiac arrhythmia [3.26 (3.20-3.32)], ischaemic heart disease [2.54 (2.51-2.56)], stroke [3.51 (3.42-3.60)], hypertension [2.14 (2.13-2.15)], depression [4.99 (4.91-5.07)] and congestive heart failure [4.30 (4.21-4.39)] was increased (2). Non-communicable disease is important (3) and its link with comorbidities, predominantly its association with obesity (1), make OSA an important confounding factor that impacts on physical, social and mental health (4). Diagnostic criteria for sleep apnoea There have been ongoing discussions about the classification and diagnostic parameters of OSA. Study outcomes investigating OSA are dependent on accurate description, definition and comparisons of their patient groups. Heinzer et al. argue that the present International Classification of Sleep Disorders (ICSD-3) definition of sleep apnoea yields an unrealistically high prevalence of OSA (5), in part related to a low apnoea-hypopnoea index (AHI) threshold for normal subjects (5/h) and a high prevalence of coexisting symptoms and conditions such as fatigue, insomnia and hypertension which may not be related to the underlying OSA (6). In a group of 2,121 patients who underwent full home polysomnography (PSG) ['HypnoLaus' cohort; 48% male, median age 57, (interquartile range, IQR 49-68) years, mean body mass index (BMI) 25.6 kg/m 2 , standard deviation (SD) 4.1 kg/m 2 ], they applied the 2013 American Academy of Sleep Medicine (AASM) criteria for OSA: An apnoea was defined as ≥90% reduction in airflow from baseline, lasting for ≥10 seconds; a hypopnea was defined as ≥30% reduction in airflow from baseline, lasting for ≥10 seconds with either a ≥3% drop in oxygen saturation or an arousal (7,8). These criteria led to a diagnosis of moderate-to-severe OSA (sOSA) (AHI ≥15/h) in 23.4% (95% CI: 20.9-26.0) of women and 49.7% (95% CI: 46.6-52.8) of men (9). However, analysing the same cohort in 2016, but using the ICSD-3 criteria which are defined by an AHI ≥15/hour, or an AHI ≥5/hour associated with one or more symptoms of OSA or cardiovascular and metabolic comorbidities, the prevalence of OSA increased to 74.7% of men, and 52.1% of women (5,6,10). The authors suggested that a better definition of OSA should be sought using prospective and large cohort follow-up studies. Screening for OSA in a bariatric population OSA and obesity commonly co-exi...

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Ferric carboxymaltose in patients with restless legs syndrome and nonanemic iron deficiency: A randomized trial

Cited by 52 publications

References 22 publications

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management

Association of mitochondrial iron deficiency and dysfunction with idiopathic restless legs syndrome

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

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