A systemic review and meta-analysis on the efficacy and safety of ferumoxytol for anemia in chronic kidney disease patients

Abstract

Purpose: To evaluate the efficacy of ferumoxytol, relative to conventional iron supplement formulations, on hemoglobin levels, ferritin level, and adverse event incidence in chronic kidney disease patients.

Methods: We performed a systematic search of six academic databases (EMBASE, CENTRAL, Scopus, PubMed, Web of sciences, and MEDLINE), adhering to PRISMA guidelines. We performed a meta-analysis on relevant studies to evaluate the overall influence of ferumoxytol, relative to conventional iron supplement formulations, on hemoglobin levels, ferritin level, and treatment related treatment emergent adverse events (TEAEs) incidence in chronic kidney disease patients.

Results: Seven eligible studies were identified from a total of 1397 studies. These studies contained data on 3315 participants with chronic kidney disease (mean age: 59.2 ± 4.6 years). A meta-analysis revealed that ferumoxytol administration had positive effects on hemoglobin levels (Hedge's g statistic: 0.51) and ferritin level (0.88), transferrin saturation (0.39). Besides, we also report reduced incidence of treatment related TEAEs (-0.24) for patients consuming ferumoxytol as compared conventional iron supplement formulations.

Conclusions: This meta-analysis provides preliminary evidence that ferumoxytol use exerts beneficial effects on the overall hematological outcomes in patients with chronic kidney disease. This study also reports improved treatment related safety profile for ferumoxytol when compared with conventional iron formulations. The findings from this study can have direct implications in forming best practice guidelines for managing anemia in patients with chronic kidney disease.

Keywords: Chronic kidney disease; adverse event; ferritin; hemodialysis; hemoglobin.

Figure 1.

PRISMA flowchart detailing study identification and inclusion.

Figure 2.

Bias risk for included trials based on the Cochrane risk of bias assessment.

Figure 3.

Publication bias determined using the Duval & Tweedy’s trim and fill method.

Figure 4.

Forest plot for studies evaluating hemoglobin levels in chronic kidney disease patients receiving either ferumoxytol or iron supplements. The overall effect size is presented as black boxes while 95% confidence intervals are presented as whiskers. A negative effect size represents higher hemoglobin levels for patients administered iron supplements, while a positive effect size represents higher hemoglobin levels for patients administered ferumoxytol. (ND: Non-dialysis; HD: Hemodialysis).

Figure 5.

Forest plot for studies evaluating ferritin levels in chronic kidney disease patients receiving either ferumoxytol or iron supplements. The overall effect size is presented as black boxes while 95% confidence intervals are presented as whiskers. A negative effect size represents higher ferritin levels for patients administered iron supplements, while a positive effect size represents higher ferritin levels for patients administered ferumoxytol. (ND: Non-dialysis; HD: Hemodialysis).

Figure 6.

Forest plot for studies evaluating transferrin saturation in chronic kidney disease patients receiving either ferumoxytol or iron supplements. The overall effect size is presented as black boxes while 95% confidence intervals are presented as whiskers. A negative effect size represents higher transferrin saturation for patients administered iron supplements, while a positive effect size represents higher transferrin saturation for patients administered ferumoxytol. (ND: Non-dialysis; HD: Hemodialysis).

Figure 7.

Forest plot for studies evaluating adverse event incidence in chronic kidney disease patients receiving either ferumoxytol or iron supplements. The overall effect size is presented as black boxes while 95% confidence intervals are presented as whiskers. A negative effect size represents more adverse events for patients administered iron supplements, while a positive effect size represents more adverse events for patients administered ferumoxytol.