Ferric Carboxymaltose and Erythropoiesis-Stimulating Agent Treatment Reduces the Rate of Blood Transfusion in Refractory Anemia

Abstract

Background: Erythropoiesis-stimulating agents (ESAs) are used to treat refractory anemia (RA). Guidelines suggest iron supplementation for unresponsive patients, regardless of iron deficiency. The primary aim of this study was to evaluate the effect of iron supplementation with ferric carboxymaltose (FCM) on the reduction of red blood cell transfusion (RBCT) rate in transfusion-dependent RA patients. Methods: This was a prospective quasi-randomized study, wherein patients were randomly assigned into three groups: (A) ESAs alone, (B) ferric gluconate (FG) and ESAs, and (C) FCM and ESAs. Hemoglobin and ferritin levels, as well as the number of RBCTs at 4 and 28 weeks were compared. Economic evaluation was also performed. Results: A total of 113 RA patients were enrolled. In total, 43 were treated with intravenous FG and ESAs, 38 with FCM and ESAs, and 32 with ESAs alone. At both follow-ups, erythropoietic response was increased in those receiving iron as compared with those with ESAs alone (p = 0.001), regardless of the type of iron. At one month, ferritin levels were higher in the FCM and ESA groups (p = 0.001). RBCTs were lower in both iron groups. The less costly treatment strategy was FCM, followed by FG, and lastly ESAs. Conclusion: Addition of iron to ESAs in RA reduced RBCT requirement and improved hemoglobin values.

How can sodium–glucose cotransporter 2 inhibitors stimulate erythrocytosis in patients who are iron‐deficient? Implications for understanding iron homeostasis in heart failure

“…10 These findings are surprising since the depletion of systemic iron stores typically blunts the response to erythropoietin mimetics, thus necessitating intravenous iron supplementation to minimize the development of hyporesponsiveness or resistance to these drugs. 11,12 Furthermore, treatment of patients with heart failure with SGLT2 inhibitors typically aggravates conventional metrics of iron deficiency, as these drugs act to lower both serum ferritin and transferrin saturation. In a large-scale trial, SGLT2 inhibition increased the risk of patients fulfilling conventional criteria for iron deficiency by 70% after 12 months of therapy.…”