Pharmacokinetics, safety and tolerability of intravenous ferric carboxymaltose: a dose-escalation study in volunteers with mild iron-deficiency anaemia

Abstract

Iron-deficiency anaemia (IDA) represents a major burden to public health worldwide. The therapeutic aim for patients with IDA is to return iron stores and haemoglobin (Hb) levels to within the normal range using supplemental iron therapy and erythropoiesis-stimulating agents. Oral and previous intravenous (i.v.) iron formulations have a number of disadvantages, including immunogenic reactions, oxidative stress, low dosages, long administration times and the requirement for a test dose. Ferric carboxymaltose (FCM, Ferinject) is a novel, next-generation i.v. iron formulation with the potential to overcome these limitations. In this single-centre, randomized, double-blind, placebo-controlled study, the pharmacokinetics (PK), pharmacodynamics (PD), safety and tolerability of single, escalating doses of FCM were investigated. Four ascending doses were investigated in a total of 24 patients with mild IDA (defined as serum ferritin < 20 microg/l and transferrin saturation [TfS] < 16%): 100 mg iron as FCM given as an i.v. bolus injection, and 500, 800 and 1000 mg iron as FCM given as an i.v. infusion over 15 min. At each dose level six patients received FCM and two received placebo. The decision to escalate to the next dose was based on evaluation of safety and tolerability data from the previous dose. The maximum duration of the study was 5 weeks from screening to final assessment. Assessments were made of PK iron-status parameters up to 168 h post-dose. Safety assessments included incidence of adverse events (AEs), clinical laboratory parameters and vital signs. PK and PD parameters were analysed using descriptive statistics. All analyses were performed on the safety population, which included all patients who received > or = 1 dose of study medication. Seventy-seven patients were screened and, of these, 32 male and female patients with pre-study Hb between 9.2 and 11.9 g/dl and serum ferritin < 20 microg/l were included in the study. Two patients had TfS > 16% (19.2% and 17.2%); both patients were considered by the investigator to be eligible for inclusion. Compared with placebo, a rapid, dose-dependent increase in total serum iron was observed across all dose groups. Mean (standard deviation) maximum total serum iron levels ranged between 36.9 (4.4) and 317.9 (42.3) microg/ml in the 100 and 1000 mg groups. Concentration-time curves of total serum iron continuously declined for up to 24 and 72 h post-dose in the 100 and 500-1000 mg groups, respectively. Non-compartmental analysis of PK parameters was truncated at 24 h (100 mg) and 72 h (500-1000 mg doses). A dose-dependent, but not dose-linear, increase in serum ferritin was seen in all treatment groups compared with placebo, with peak levels of a 23-210-fold increase above baseline occurring 48-120 h postdose. Iron-binding capacity was transiently almost fully utilized after doses of 500, 800 and 1000 mg (TfS > 95%). No meaningful changes in serum transferrin or serum transferrin receptor concentrations were observed during this study. The elimination pattern for FCM...

Safety and efficacy of high-dose intravenous iron carboxymaltose vs. iron sucrose for treatment of postpartum anemia

“…The recommended treatment for mild IDA (Hb > 95 g/L) consists in oral administration of 80 -200 mg of iron (II) salts or iron (III) polymaltose, with the alternative of intravenous (IV) treatment in case of bad compliance or gastrointestinal intolerance. For more severe IDA (Hb < 95 g/L), parenteral administration of iron is recommended [4,18,25,32] .…”

Ferric Carboxymaltose

“…Peak serum ferritin levels occurred at 48 to 120 hours post infusion. 3 The volume of distribution is about 3 L. 1 Levels declined over 24 to 72 hours; total serum iron levels were below the limit of quantification in the majority of patients within 60 to 96 hours post dose. 3 Ferric carboxymaltose has a terminal elimination half-life of 7.4 to 12.1 hours.…”

“…Mean maximum total serum iron levels were 36.9 mcg/mL following a 100 mg IV dose, 154.1 mcg/mL following a 500 mg IV dose, and 306.4 to 317.9 mcg/mL following a 1,000 mg IV dose. 3,4 Iron administered as ferric carboxymaltose is rapidly distributed to the bone marrow, liver, and spleen. Peak serum ferritin levels occurred at 48 to 120 hours post infusion.…”

The Effectiveness of Ferric Carboxymaltose on the Improvement of Chronic Iron Deficiency Anemia in Patients With Colon Cancer: A Controlled Randomized Clinical Trial

“…The molecular structure of ferric carboxymaltose is designed in such a way that it causes the entrapment of iron in macrophages of the reticuloendothelial system in the liver, spleen and bone marrow; therefore, iron is available for the transferrin protein. This process prevents releasing large amounts of iron ions into the serum (10)(11)(12)(13).…”