Ferric Carboxymaltose as Treatment in Women with Iron-Deficiency Anemia

Melvin H Seid, Angelia D Butcher, Ashwin Chatwani, Melvin H Seid, Angelia D Butcher, Ashwin Chatwani

Abstract

Objective. To evaluate safety and efficacy of intravenous ferric carboxymaltose (FCM) versus standard medical care (SMC) for iron-deficiency anemia (IDA) in postpartum women and women with heavy menstrual bleeding. Study Design. This open-label, multicenter study randomized women with IDA (hemoglobin ≤ 11.0 g/dL) to single doses of FCM (15 mg/kg [maximum 1000 mg]) or SMC (this treatment was determined by the investigator and there may have been no treatment). Safety data (primary outcome) were collected for 30 days. Results. Of 2045 subjects enrolled (FCM: n = 1023; SMC: n = 1022), 996 received FCM and 1022 received SMC. At least 1 serious adverse event (AE) was reported by 0.6% and 2.2% of subjects in the FCM and SMC groups, respectively; none were considered treatment related. The difference in serious AEs was primarily due to higher rates of uterine leiomyoma, uterine hemorrhage, and menorrhagia in SMC subjects with heavy menstrual bleeding. Common AEs were generally predictable, with higher rates of infusion site reactions in FCM subjects and gastrointestinal AEs in SMC subjects. Mean hemoglobin increases were greater in the FCM group than the SMC group. Conclusion. FCM was well tolerated and effectively increased mean hemoglobin levels in postpartum women or women with heavy menstrual bleeding and IDA. This trial is registered with ClinicalTrials.gov, NCT00548860.

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References

    1. Brugnara C. Iron deficiency and erythropoiesis: new diagnostic approaches. Clinical Chemistry. 2003;49(10):1573–1578. doi: 10.1373/49.10.1573.
    1. Kassebaum N. J., Jasrasaria R., Naghavi M., et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615–624. doi: 10.1182/blood-2013-06-508325.
    1. Friedman A. J., Chen Z., Ford P., et al. Iron deficiency anemia in women across the life span. Journal of Women's Health. 2012;21(12):1282–1289. doi: 10.1089/jwh.2012.3713.
    1. Jimenez K., Kulnigg-Dabsch S., Gasche C. Management of iron deficiency anemia. Gastroenterology and Hepatology. 2015;11(4):241–250.
    1. World Health Organization. Assessing the Iron Status of Populations. Geneva, Switzerland: WHO; 2007.
    1. Bodnar L. M., Scanlon K. S., Freedman D. S., Siega-Riz A. M., Cogswell M. E. High prevalence of postpartum anemia among low-income women in the United States. American Journal of Obstetrics and Gynecology. 2001;185(2):438–443. doi: 10.1067/mob.2001.115996.
    1. Markova V., Norgaard A., Jorgensen K. J., Langhoff-Roos J. Treatment for women with postpartum iron deficiency anaemia. Cochrane Database of Systemic Reviews. 2015;8CD010861
    1. Auerbach M., Adamson J. W. How we diagnose and treat iron deficiency anemia. American Journal of Hematology. 2016;91(1):31–38. doi: 10.1002/ajh.24201.
    1. Tolkien Z., Stecher L., Mander A. P., Pereira D. I. A., Powell J. J. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS ONE. 2015;10(2) doi: 10.1371/journal.pone.0117383.e0117383
    1. Fishbane S., Ungureanu V.-D., Maesaka J. K., Kaupke C. J., Lim V., Wish J. The safety of intravenous iron dextran in hemodialysis patients. American Journal of Kidney Diseases. 1996;28(4):529–534. doi: 10.1016/S0272-6386(96)90463-1.
    1. Fishbane S. Safety in iron management. American Journal of Kidney Diseases. 2003;41(supplement 5):S18–S26. doi: 10.1016/s0272-6386(03)00373-1.
    1. Chertow G. M., Mason P. D., Vaage-Nilsen O., Ahlmén J. Update on adverse drug events associated with parenteral iron. Nephrology Dialysis Transplantation. 2006;21(2):378–382. doi: 10.1093/ndt/gfi253.
    1. Lyseng-Williamson K. A., Keating G. M. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69(6):739–756. doi: 10.2165/00003495-200969060-00007.
    1. Toblli J. E., Angerosa M. Optimizing iron delivery in the management of anemia: patient considerations and the role of ferric carboxymaltose. Drug Design, Development and Therapy. 2014;8:2475–2491. doi: 10.2147/dddt.s55499.
    1. Van Wyck D. B., Martens M. G., Seid M. H., Baker J. B., Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstetrics and Gynecology. 2007;110(2, part 1):267–278. doi: 10.1097/01.aog.0000275286.03283.18.
    1. Van Wyck D. B., Mangione A., Morrison J., Hadley P. E., Jehle J. A., Goodnough L. T. Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial. Transfusion. 2009;49(12):2719–2728. doi: 10.1111/j.1537-2995.2009.02327.x.
    1. Seid M. H., Derman R. J., Baker J. B., Banach W., Goldberg C., Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. American Journal of Obstetrics and Gynecology. 2008;199(4):435.e1–435.e7. doi: 10.1016/j.ajog.2008.07.046.
    1. Breymann C., Gliga F., Bejenariu C., Strizhova N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. International Journal of Gynecology and Obstetrics. 2008;101(1):67–73. doi: 10.1016/j.ijgo.2007.10.009.
    1. Barish C. F., Koch T., Butcher A., Morris D., Bregman D. B. Safety and efficacy of intravenous ferric carboxymaltose (750 mg) in the treatment of iron deficiency anemia: two randomized, controlled trials. Anemia. 2012;2012:9. doi: 10.1155/2012/172104.172104
    1. Wolf M., Koch T. A., Bregman D. B. Effects of iron deficiency anemia and its treatment on fibroblast growth factor 23 and phosphate homeostasis in women. Journal of Bone and Mineral Research. 2013;28(8):1793–1803. doi: 10.1002/jbmr.1923.
    1. Jüppner H., Wolf M., Salusky I. B. FGF-23: more than a regulator of renal phosphate handling? Journal of Bone and Mineral Research. 2010;25(10):2091–2097. doi: 10.1002/jbmr.170.
    1. Onken J. E., Bregman D. B., Harrington R. A., et al. A multicenter, randomized, active-controlled study to investigate the efficacy and safety of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Transfusion. 2014;54(2):306–315. doi: 10.1111/trf.12289.

Source: PubMed

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