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Ferric derisomaltose increases hemoglobin and ferritin levels, but most patients remain anemic due to underdosing relative to their estimated iron need.
A large retrospective audit has raised concerns about underdosing in intravenous (IV) iron therapy, despite guideline recommendations. The study by Roel Fijn et al. determined the real-world safety and efficiency of ferric derisomaltose (FDI), a high-dose IV iron formulation, in 2,468 people receiving 2,775 treatment courses.
IV iron is typically indicated when oral iron is poorly tolerated, ineffective, or when rapid replenishment is needed. However, this audit revealed that patients often receive less iron than clinically required. While the mean estimated iron requirement per patient was 1,580 mg, the actual mean dose administered was only 1,244 mg per course.
Clinical outcomes were estimated between 4 and 12 weeks after treatment. Hemoglobin (Hb) levels raised by an average of 20.9 g/L, and ferritin rose by 188.8 µg/L. Despite these improvements, only 33.4% of treatment courses led to patients becoming non-anemic (Hb ≥ 130 g/L in men or ≥ 120 g/L in women), while 65.1% exhibited a response (either achieving non-anemic status or an Hb rise of at least 20 g/L).
Regarding safety profile, adverse events were rare. Only 1 serious allergic reaction was reported (0.04%, 1 out of 2,468 patients), reaffirming the favorable safety profile of FDI. However, the finding that more than 65% of patients remained anemic post-treatment underscores the importance of individualized dosing. The authors stress that iron dosing must align more closely with calculated iron needs to attain optimal outcomes. To sum up, ferric derisomaltose is effective and well-tolerated, but underdosing remains common in clinical practice—limiting its potential to fully correct iron deficiency anemia.
Scientific Reports
Real-world evaluation of an intravenous iron service for the treatment of iron deficiency with or without anemia
Roel Fijn et al.
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