Comparative Efficacy of Three Forms of Parenteral Iron

Intravenous iron therapy is a useful treatment for the rapid correction of iron deficiency anaemia and can be used to avoid or reduce the requirement for allogeneic blood transfusion. Several intravenous iron preparations are available commercially which differ in cost, mode of administration and side effect profile. There are few data directly comparing the efficacy of these preparations. In this retrospective single-centre study, we present the results from two hundred and eight patients treated using three different iron preparations (iron dextran, iron sucrose and ferric carboxymaltose) and compare the effect on haemoglobin levels and other measures of iron deficiency six weeks after treatment. Within the limitations of our study design, we show a statistically and clinically significant difference in efficacy between these preparations. 1. Introduction Intravenous iron can be a useful treatment for iron-deficiency anaemia in several clinical situations, including in patients who are intolerant to or unresponsive to oral iron [1], patients undergoing elective surgery [2], and in patients in whom the severity of the anaemia requires rapid correction [3]. Intravenous iron therapy may reduce the requirement for allogeneic blood transfusion [4]. Iron deficiency is the most common cause of anaemia worldwide and in the United Kingdom; “Better Blood Transfusion” guidelines require hospitals to provide alternatives to allogeneic blood transfusion where possible, and the use of intravenous iron may be an effective way to achieve this. At the time of writing, there were three commercially available forms of intravenous iron in use in the United Kingdom. Iron sucrose (IS, Venofer, Vifor Pharma) is administered as an intravenous infusion containing 200？mg of iron over two hours, and subsequent doses may be given at 48-hour intervals until the desired dose of iron has been achieved. Iron dextran (ID, CosmoFer, Vitaline Pharma) is given as an intravenous infusion containing any dose up to 2000？mg of iron depending upon the patients’ calculated iron deficit; the rate of infusion is titrated according to patient tolerance, and, for example, a 1000？mg dose would usually be infused over a total of 5 hours. Ferric carboxymaltose (FCM, Ferinject, Vifor Pharma) has become available recently and is administered as an intravenous bolus (containing 500？mg elemental iron) or intravenous infusion over 30 minutes (containing 1？g of elemental iron) (source: British National Formulary). Although FCM has been shown to be safe and effective in the treatment of iron-deficiency