Efficacy and Safety of Ferric Carboxymaltose and Other Formulations in Iron-Deficient Patients: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials

Abstract

BackgroundIron deficiency is very common in a number of medical conditions. Ferric carboxymaltose is a new stable iron preparation that can be administered in single infusions over short periods of time. The aim of this study was to conduct a systematic review of randomised controlled trials (RCTs) regarding the efficacy and safety of the novel complex compared with other iron formulations. In addition, the feasibility of a network meta-analysis for indirect comparisons was investigated.MethodsA systematic literature review was performed for published RCTs on the use of ferric carboxymaltose in iron deficiency between July and October 2014. Indirect comparisons were also addressed using terms referring to competing iron formulations. We further supported the qualitative results of the systematic review by a network meta-analysis that allows pooling the evidence around different intervention outcomes in the absence of trials involving a direct comparison.ResultsThe initial search yielded 1027 citations, which was decreased to 21 studies eligible for inclusion in the review. Studies were heterogeneous in the number of patients randomised, iron deficiency-related conditions addressed, trial inclusion criteria, time horizon, treatment dosage and outcomes assessed. Six studies with the same time horizon (i.e. 6 weeks) were included in the network meta-analysis. Considering the differences between final and initial outcome values for each iron formulation, the mean difference of these differences (delta) was estimated for each couple of treatments involving ferric carboxymaltose. Significant improvements in serum ferritin (µg/l) were obtained with ferric carboxymaltose compared to oral iron (delta 172.8; 95 % CI 66.7–234.4) and in haemoglobin (g/dl) with respect to ferric gluconate (delta 0.6; 95 % CI 0.2–0.9), oral iron (delta 0.8; 95 % CI 0.6–0.9) and placebo (delta 2.1; 95 % CI 1.2–3.0).ConclusionsAll currently available intravenous iron preparations appear to be safe and effective, but ferric carboxymaltose seems to provide a better and quicker correction of haemoglobin and serum ferritin levels in iron-deficient patients.

Sustainability of Endovenous Iron Deficiency Anaemia Treatment: Hospital-Based Health Technology Assessment in IBD Patients

“…Nevertheless, a recently published network meta-analysis highlights that ferric carboxymaltose may provide better and faster correction of Hb and serum ferritin levels in iron-deficient patients, with good tolerability and a minimal risk of adverse events (AEs) [29]. Only one study has supported the use of ferric carboxymaltose in IBD patients, suggesting that this regimen had a significantly higher treatment response than IV iron sucrose.…”

“…Despite this limiting factor, the literature indicates that intravenous iron preparations are safe and effective, with the most recent evidence [29] suggesting a favourable effect of ferric carboxymaltose for a better and faster correction of Hb and serum ferritin levels in iron-deficient patients.…”

Efficacy and Tolerability of Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency at a Hospital Outpatient Clinic: A Retrospective Cohort Study of Real-World Clinical Practice

“…Administration of FCM was also well-tolerated by patients, with most drug-related adverse events considered to be mild to moderate in severity [4, 10, 12]. However, real-world data on the efficacy of intravenous FCM therapeutics in current clinical practice are still scarce [5, 8, 13, 14].…”

Post-Operative Iron Carboxymaltose May Have an Effect on Haemoglobin Levels in Cardiothoracic Surgical Patients on the ICU - an Observational Pilot Study about Anaemia Treatment with Intravenous Iron

“…There is a high level of evidence, that intravenous iron (IVI) is an effective treatment of pre-operative anaemia [1,2]. In cardiothoracic surgery, however, pre-operative treatment is often not feasible due to logistics or emergencies, while bleeding and major surgery leads to iron deficiency.…”