Relationship Between Initial Parenteral Iron Therapy Dosing and Treatment Effectiveness: A Real-World Retrospective Analysis

Abstract

Purpose Replacement iron is the main treatment for iron deficiency, but the relationship between initial intravenous (IV) dose and need for additional treatment is unclear. This study explored patterns of IV iron dosing in US clinical practice. Methods Patient records were obtained for adults who received IV iron for anemia between 2015 and 2017. Patients were classified into four groups: those who received <1500 mg and ≥1500 mg IV iron and those received ≤1000 mg and >1000 mg within 3 weeks of their first dose. The proportion of patients requiring additional IV iron after 30 days of the initial dose was evaluated. Results Data were obtained for 2959 patients receiving iron sucrose (44.2%), ferric carboxymaltose injection (FCM) (25.8%), and ferumoxytol (FM) (14.3%). Overall, 567 patients (19%) received ≥1500 mg of IV iron and 942 (32%) received >1000 mg of IV iron within the first 21 days. Mean (SD) baseline iron deficit was 1001 mg (312). Patients who received ≥1500 mg had a 32% lower probability of receiving additional IV iron than those who received <1500 mg (adjusted hazard ratio [HR]: 0.68 [95% confidence interval (CI); 0.58, 0.81]) and incurred significantly fewer outpatient visits for all causes (p < 0.001) and IV iron treatment (p < 0.001). Patients who received an initial dose of >1000 mg had a 41% lower probability of receiving additional IV iron than those who received ≤1000 mg (adjusted HR: 0.59 [95% CI; 0.52, 0.67]) and had significantly fewer outpatient visits for all causes (p < 0.001) and IV iron treatment (p < 0.001). Patients receiving FCM required fewer outpatient visits than those receiving FM and other treatments, including a subgroup of patients who initially received >1000 mg IV iron. Conclusion Higher doses of IV iron within 3 weeks of first dose may reduce further IV iron treatment needs and outpatient visits.

Effect of Ferric Carboxymaltose Versus Low-Dose Intravenous Iron Therapy and Iron Sucrose on the Total Cost of Care in Patients with Iron Deficiency Anemia: A US Claims Database Analysis

“…This hypothesis is supported by the results of two real-world analyses that showed that higher-dose iron formulations can be more effective in managing anemia. LaVallee et al found that use of high-dose IV iron formulations for the initial course of treatment resulted in fewer outpatient visits and fewer retreatments [ 13 ]. In a retrospective analysis of integrated electronic health records and claims data in the USA, 77% of patients had an iron deficit of > 750 mg.…”

“…In addition to addressing the underlying causes of IDA, intravenous (IV) iron therapy is often required for patients with IDA who have chronic diseases and those who are not responsive to or who cannot tolerate oral iron [ 4 , 5 , 8 , 10 ]. Current IV iron therapies available in the USA include high-dose IV iron formulations such as ferric carboxymaltose (FCM), ferumoxytol, and ferric derisomaltose, and low-dose IV iron (LDI) formulations such as iron sucrose, iron dextran, and sodium ferric gluconate complex in sucrose [ 13 ]. High-dose IV iron formulations allow patients to receive more iron with fewer infusions than LDI and have been shown to allow more patients to achieve normal serum Hgb levels than LDI [ 1 ].…”

Characteristics and key differences between patient populations receiving imaging modalities for coronary artery disease diagnosis in the US

“…The repository represents more than 98% of US payers and is nationally representative of the US, including patients from all geographic regions. The database has been applied in multiple peer-reviewed real-world retrospective analyses [ 22 – 25 ].…”

Clinical management of iron deficiency anemia in Japan: iron prescription patterns, treatment effectiveness, and assessments

“…However, the iron prescription pattern and whether adequate iron dose is prescribed in the actual clinical practice in Japan has not been clarified, and a survey of the current practice is warranted. In the U.S., the pattern of IV iron dosing, including FCM, has already been surveyed, showing that a higher total cumulative dose of iron was associated with improved Hb levels and reduced needs for further iron therapy [11]. However, because the types and dosages of available iron preparations in Japan differ from the U.S., a survey using Japanese data is needed.…”