Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia

Abstract

Nutritional iron deficiency anemia is the most common deficiency disorder, affecting more than two billion people worldwide. Oral iron supplementation is usually the first choice for the treatment of iron deficiency anemia, but in many conditions, oral iron is less than ideal mainly because of gastrointestinal adverse events and the long course needed to treat the disease and replenish body iron stores. Intravenous iron compounds consist of an iron oxyhydroxide core, which is surrounded by a carbohydrate shell made of polymers such as dextran, sucrose or gluconate. The first iron product for intravenous use was the high molecular weight iron dextran. However, dextran-containing intravenous iron preparations are associated with an elevated risk of anaphylactic reactions, which made physicians reluctant to use intravenous iron for the treatment of iron deficiency anemia over many years. Intravenous ferric carboxymaltose is a stable complex with the advantage of being non-dextran-containing and a very low immunogenic potential and therefore not predisposed to anaphylactic reactions. Its properties permit the administration of large doses (15 mg/kg; maximum of 1000 mg/infusion) in a single and rapid session (15-minute infusion) without the requirement of a test dose. The purpose of this review is to discuss some pertinent issues in relation to the history, pharmacology, administration, efficacy, and safety profile of ferric carboxymaltose in the treatment of patients with iron deficiency anemia.

Retrospective cohort study comparing the adverse reactions and efficacy of intravenous iron polymaltose with ferric carboxymaltose for iron deficiency anemia

“…A substantial finding was the significantly lower incidence of ADRs associated with FCM compared with iron polymaltose, inferring greater patient tolerance of FCM infusions. The incidence of ADRs for iron polymaltose and FCM found in this study were within the ranges of widely varying documented rates across published studies, from less than 3.6% to 31% for iron polymaltose and 1% to 25% for FCM, and with only rare (≤1%) incidences of anaphylaxis …”

Intravenous Iron Treatment in Pregnancy: Ferric Carboxymaltose for Correction of Iron Deficiency Anaemia

“…Ferric Carboxymaltose has been available in Europe since its approval in 2007 and in USA in 2009; it is recently marketed in over 50 countries and is also available in Bangladesh 18 .…”

Iron Deficiency Anaemia

“…For therapeutic iron supplementation, treatment with IV iron in some clinical situations could present some advantages over oral iron, such as faster and higher increases of haemoglobin (Hb) levels and body iron stores. Friedrisch et al suggest the main clinical indications for IV iron treatment, which contains post-gastrectomy/bariatric surgery, anaemia of chronic kidney disease, intestinal malabsorption syndromes, anaemia associated to inflammatory diseases, inflammatory bowel diseases, anaemia of cancer, intolerance to oral iron or non-compliance to an oral regimen, iron-refractory iron deficiency anaemias and so on [79]. [80][81][82].…”