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Meta-Analysis
. 2020 Dec;7(6):3392-3400.
doi: 10.1002/ehf2.13146.

Ferric carboxymaltose for the treatment of iron-deficient heart failure patients: a systematic review and meta-analysis

Muhammad Shahzeb Khan  1 , Muhammad Shariq Usman  2 , Stephan von Haehling  3   4 , Wolfram Doehner  5   6 , Andrew J Stewart Coats  7   8
Affiliations
Meta-Analysis

Ferric carboxymaltose for the treatment of iron-deficient heart failure patients: a systematic review and meta-analysis

Muhammad Shahzeb Khan et al. ESC Heart Fail. 2020 Dec.

Abstract

Aims: Intravenous ferric carboxymaltose (FCM) has been shown to improve functional capacity and quality of life in iron deficient heart failure patients. However, FCM's effect on hospitalizations and mortality remains unclear as previous randomized controlled trials (RCTs) and their meta-analyses have been underpowered to detect significant differences. We sought to conduct an updated meta-analysis using recently published RCT data.

Methods and results: Online databases were searched from inception until November 2020 for RCTs evaluating the effects of FCM on clinical outcomes in iron-deficient heart failure patients. Outcomes of interest included heart failure hospitalizations, all-cause mortality, and cardiovascular mortality. Meta-analysis was performed using a fixed-effect model and estimates were reported as odds ratios (ORs), hazard ratios, or rate ratios (RRs) along with corresponding 95% confidence intervals (CIs). A total of 1947 patients (n = 1062 in the FCM group; n = 885 in the placebo group) were included. FCM, compared with placebo, significantly reduced the risk of the composite endpoint of time to first heart failure hospitalization or cardiovascular death (hazard ratio = 0.76; 95% CI = 0.63-0.90; I2 = 55%). FCM also significantly reduced the risk of recurrent heart failure hospitalizations (RR = 0.68; 95% CI = 0.54-0.85; I2 = 71%) and recurrent cardiovascular hospitalizations (RR = 0.71; 95% CI = 0.59-0.86; I2 = 56%). However, FCM had no significant effect on the risk of all-cause (OR = 0.97; 95% CI = 0.73-1.28; I2 = 0%) or cardiovascular mortality (OR = 0.93; 95% CI = 0.69-1.27; I2 = 0%).

Conclusions: Ferric carboxymaltose reduces heart failure hospitalizations and cardiovascular hospitalizations with no beneficial effect on all-cause and cardiovascular mortality in iron-deficient heart failure patients. These findings reinforce the role of FCM as a therapeutic option in heart failure patients.

Keywords: Heart failure; Iron deficiency; Iron therapy; Meta‐analysis.

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Conflict of interest statement

WD reports speaker fees and advisory honoraria from Aimediq, Bayer, Boehringer Ingelheim, Lilly, Medtronic, Pfizer, Sanofi‐Aventis, Sphingotec, Vifor Pharma. WD reports research support from EU (Horizon2020), German ministry of Education and Research, German Center for Cardiovascular Research, Vifor Pharma, ZS Pharma.

Figures

Figure 1
Figure 1
PRISMA flow chart. This figure summarizes the literature search and study selection process.
Figure 2
Figure 2
Forest plot for dichotomous outcomes: (A) number of patients experiencing the composite endpoint of cardiovascular death or heart failure hospitalization; (B) number of patients who experienced heart failure hospitalizations during follow‐up; (C) all‐cause death; (D) cardiovascular death. M–H, Mantel–Haenszel; CI, confidence interval.
Figure 3
Figure 3
Forest plot for recurrent outcomes: (A) composite of recurrent heart failure hospitalization and cardiovascular death; (B) total heart failure hospitalizations; (C) total cardiovascular hospitalizations; (D) composite endpoint of recurrent cardiovascular hospitalizations and cardiovascular mortality. IV, inverse variance; CI, confidence interval; SE, standard error.
Figure 4
Figure 4
Forest plot for time‐to‐even outcomes: (A) time to first heart failure hospitalizations or cardiovascular death; (B) time to cardiovascular death. IV, inverse variance; CI, confidence interval; SE, standard error.
See this image and copyright information in PMC

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