Iron deficiency intravenous substitution in a Swiss academic primary care division: analysis of practices

Abstract

BackgroundIron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution.ObjectiveThe aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland.MethodsAll patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review.ResultsOut of 1,671 patients, 93 were treated for iron deficiency. Median patients’ age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases.ConclusionThere was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning.

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

“…The rationale for studying the complete population of patients under FCM treatment and not only some subgroups as most studies report [8, 14, 18–21] was to improve the prescription standards of the intravenous FCM in clinical practice.…”

“…This study evaluated the efficacy and tolerability of intravenous FCM treatment for the correction of iron deficiency, with or without anemia, in patients with diverse diagnoses, who were attending a hospital outpatient Immunohemotherapy clinic. The rationale for studying the complete population of patients under FCM treatment and not only some subgroups as most studies report [ 8 , 14 , 18 – 21 ] was to improve the prescription standards of the intravenous FCM in clinical practice.…”

“…To our knowledge, this is one of the first observational studies reporting the efficacy of intravenous FCM treatment in a real-world setting, across a population of patients with a considerable dimension ( n = 459) [ 5 , 8 , 13 , 14 ]. Moreover, this study presents data on a single drug formulation, prescribed to patients with diverse ages and primary diagnoses.…”

“…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 ]. Therefore, the purpose of this study was to evaluate the efficacy and tolerability of intravenous FCM treatment of iron deficiency, in patients with or without anemia, attending an outpatient hospital clinic setting.…”