Iron Sucrose: A Wealth of Experience in Treating Iron Deficiency

Abstract

Iron deficiency and iron-deficiency anemia are associated with increased morbidity and mortality in a wide range of conditions. In many patient populations, this can be treated effectively with oral iron supplementation; but in patients who are unable to take or who do not respond to oral iron therapy, intravenous iron administration is recommended. Furthermore, in certain conditions, such as end-stage kidney disease, chronic heart failure, and inflammatory bowel disease, intravenous iron administration has become first-line treatment. One of the first available intravenous iron preparations is iron sucrose (Venofer ® ), a nanomedicine that has been used clinically since 1949. Treatment with iron sucrose is particularly beneficial owing to its ability to rapidly increase hemoglobin, ferritin, and transferrin saturation levels, with an acceptable safety profile. Recently, important new data relating to the use of iron sucrose, including the findings from the landmark PIVOTAL trial in patients with end-stage kidney disease, have been reported. Several years ago, a number of iron sucrose similars became available, although there have been concerns about the clinical appropriateness of substituting the original iron sucrose with an iron sucrose similar because of differences in efficacy and safety. This is a result of the complex and unique physicochemical properties of nanomedicines such as iron sucrose, which make copying the molecule difficult and problematic. In this review, we summarize the evidence accumulated during 70 years of clinical experience with iron sucrose in terms of efficacy, safety, and cost-effectiveness.

Criticality of Surface Characteristics of Intravenous Iron–Carbohydrate Nanoparticle Complexes: Implications for Pharmacokinetics and Pharmacodynamics

“…Iron deficiency is a global health problem that is associated with a wide breadth of underlying conditions including chronic kidney disease, heart failure, underlying inflammatory conditions, cancer, and bariatric surgery, as well as menorrhagia and post-partum bleeding [1]. Iron is not only the key driver for erythropoiesis and formation of red blood cells [2].…”

Current Status of Renal Anemia Pharmacotherapy—What Can We Offer Today

“…FPC has been proven effective in Hb maintaining and decreasing ESA needs [ 134 ]. Iv iron agents have comparable efficacy in improving Hb, ferritin, and TSAT and reducing the use of ESAs or blood transfusions [ 135 ]. However, some data show that iron sucrose similars have decreased efficacy and safety compared with parent iron sucrose [ 135 ].…”

“…Iv iron agents have comparable efficacy in improving Hb, ferritin, and TSAT and reducing the use of ESAs or blood transfusions [ 135 ]. However, some data show that iron sucrose similars have decreased efficacy and safety compared with parent iron sucrose [ 135 ]. Kalra et al [ 136 ] studied 351 iron-deficient ND-CKD patients and randomized them 2:1 to either IV iron isomaltoside 1000 or iron sulphate (100 mg of elemental oral iron twice daily for 8 weeks).…”

Intravenous iron: do we adequately understand the short‐ and long‐term risks in clinical practice?

“…There have been concerns that biosimilars may differ in efficacy and safety despite having the same iron core and carbohydrate shell. 6,10,11 At present, due to inadequate information on biosimilars, they are not considered to be interchangeable by the EMA and the information in this review refers to the original products in Table I.…”

“…This study been criticized for the accuracy of the analysis. 11 Subsequent trials have not confirmed those findings. Yen et al 71 studied 1 410 patients who had a first infection in the 1Á5 years after staring haemodialysis.…”