Real-world evaluation of an intravenous iron service for the treatment of iron deficiency with or without anemia

Abstract

Intravenous (IV) iron is a guideline-recommended treatment for iron deficiency when oral iron is contraindicated, ineffective, or not tolerated, or when rapid iron delivery is necessary. However, evidence suggests that some patients receive less IV iron than needed. This retrospective audit assessed the effectiveness and safety of ferric derisomaltose (FDI), a high-dose IV iron, in 2,468 patients. Efficacy outcomes assessed at 4-12 weeks post-infusion included changes in hemoglobin (Hb) and ferritin, proportion of courses (a course was defined as the treatment episode required to administer one total dose) after which patients were non-anemic (Hb ≥ 130 g/L [men] or ≥ 120 g/L [women]), and response rate (proportion of courses after which patients were non-anemic or Hb increased by ≥ 20 g/L). Safety was assessed through adverse events. Across 2,775 FDI courses, the mean dose was 1,244 mg, but mean estimated iron need was 1,580 mg. At follow-up, mean Hb had increased by 20.9 g/L and mean ferritin by 188.8 µg/L. Patients were non-anemic after 33.4% (n = 494/1,478) of courses and responded after 65.1% (n = 962/1,478) of courses. One patient (n = 1/2,468; 0.04%) had a serious allergic reaction. Patients remained anemic after > 65% of courses, demonstrating the need to optimize dosing based on iron need.

Fig. 1

Proportion of FDI courses after which patients were non-anemic or responded at follow-up. Patients were non-anemic at baseline for 5.7% of courses (n = 168/2,954). Non-anemic status was defined as Hb ≥ 130 g/L (men) and ≥ 120 g/L (women). Response rate was defined as the proportion of courses after which patients were non-anemic as per WHO definition or after which patients experienced an Hb increase of ≥ 20 g/L from baseline. Mean time to follow-up was 44 days. FDI ferric derisomaltose, Hb hemoglobin, WHO World Health Organization.

Fig. 2

Proportion of FDI courses after which patients were non-anemic at follow-up, according to actual dose of iron administered. Non-anemic status was defined as Hb ≥ 130 g/L (men) and ≥ 120 g/L (women). Mean time to follow-up was 41 days for patients who received less than their total iron need, 44 days for patients who received their total iron need, and 48 days for patients who received more than their total iron need. FDI ferric derisomaltose, Hb hemoglobin.