Efficacy and Safety of Intravenous Ferric Carboxymaltose in Geriatric Inpatients at a German Tertiary University Teaching Hospital: A Retrospective Observational Cohort Study of Clinical Practice

Abstract

Current iron supplementation practice in geriatric patients is erratic and lacks evidence-based recommendations. Despite potential benefits in this population, intravenous iron supplementation is often withheld due to concerns regarding pharmacy expense, perceived safety issues, and doubts regarding efficacy in elderly patients. This retrospective, observational cohort study aimed to evaluate the safety and efficacy of intravenous ferric carboxymaltose (FCM, Ferinject) in patients aged >75 years with iron deficiency anaemia (IDA). Within a twelve-month data extraction period, the charts of 405 hospitalised patients aged 65–101 years were retrospectively analysed for IDA, defined according to WHO criteria for anaemia (haemoglobin: <13.0 g/dL (m)/<12.0 g/dL (f)) in conjunction with transferrin saturation <20%. Of 128 IDA patients screened, 51 (39.8%) received intravenous iron. 38 patient charts were analysed. Mean cumulative dose of intravenous FCM was 784.4 ± 271.7 mg iron (1–3 infusions). 18 patients (47%) fulfilled treatment response criteria (≥1.0 g/dL increase in haemoglobin between baseline and hospital discharge). AEs were mild/moderate, most commonly transient increases of liver enzymes (n = 5/13.2%). AE incidence was comparable with that observed in patients <75 years. No serious AEs were observed. Ferric carboxymaltose was well tolerated and effective for correction of Hb levels and iron stores in this cohort of IDA patients aged over 75 years.

Anemia in the frail, elderly patient

“… 60 Several recent studies have shown that intravenous iron application is also safe in geriatric patients with chronic inflammation-associated anemia. 66 – 68 Oral iron substitution is usually recommended in case of absolute iron deficiency. 69 Results of a recent meta-analysis of oral iron substitution in older patients indirectly confirms this recommendation by revealing an increase of Hb after 4–6 weeks of oral iron substitution.…”

Iron deficiency anemia in older adults: A review

“…23 The absence of a significant response to oral iron supplementation can be attributed to a IDA misdiagnosis, malabsorption or persistent chronic blood loss that exceeds the amount of iron that can be absorbed from an oral supplement. 24,65,[72][73][74][75] The results of iron therapy for indications other than absolute IDA, such as cancer-related anemia, chronic kidney disease, chronic heart failure, inflammatory anemia and postoperative anemia, are not discussed here. 23,24,26,53,71 Several parenteral iron preparations are available, and the most commonly prescribed preparations are iron sucrose, ferric carboxymaltose and iron dextran.…”

“…There is insufficient evidence that one iron preparation is superior over another, and the efficacy and safety of parenteral ferric carboxymaltose has been shown in heterogeneous groups of older patients. 24,65,[72][73][74][75] The results of iron therapy for indications other than absolute IDA, such as cancer-related anemia, chronic kidney disease, chronic heart failure, inflammatory anemia and postoperative anemia, are not discussed here. There are insufficient data to decide whether iron deficiency (low serum ferritin level with normal hemoglobin value) in older adults should be treated with iron.…”

Seven-Year Single-Center Experience of the Efficacy and Safety of Ferric Carboxymaltose in Cancer Patients with Iron-Deficiency Anemia

“…There was no difference between the geriatric and non-geriatric groups in terms of both ∆ hemoglobin and response rate. In a retrospective study investigating the efficacy of treatment in the hospitalized geriatric population over the age of 75, where oncology patients are underrepresented, the response rate was determined by similar criteria, and the response was observed in 18 of 38 patients (47.7%) [28]. The reason for reporting lower response rates in this study may be attributed to the inclusion of fewer patients, being in an older age group, or the fact that the patients were inpatients, a more vulnerable group.…”