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LMWID and Ferumoxytol Well-Tolerated as Treatment for Adult Iron Deficiency Anemia

Treatment of iron deficiency with low molecular weight iron dextran (LMWID) or ferumoxytol was well-tolerated and led to minimal adverse events (AEs), study findings have shown.

“Iron deficiency anemia is the most common form of anemia and hematologic problem worldwide. Treatment options include oral or intravenous (IV) iron replacement. Although oral iron is commonly employed as first-line therapy, many studies suggest that IV iron is more effective and associated with better quality of life when compared to oral iron,” Arpine Khudanyan, BS, Oregon Health and Science University, Portland, and colleagues explained.

“Yet, adverse infusion reactions are possible. Several forms of IV iron are used in clinical practice, including LMWID, ferumoxytol, ferric gluconate, iron sucrose, and ferric carboxymaltose,” they continued.

Thus, Ms Khudanyan et al conducted a retrospective cohort analysis to compare the safety and efficacy of LMWID and ferumoxytol in adults with iron deficiency anemia treated with either drug between 2018 and 2019.

The investigators reviewed patient records for demographics, comorbidities, allergies, and type and frequency of iron administered. Comparisons of baseline and post-treatment hemoglobin (Hb), ferritin levels, and AEs after infusion were the main outcomes of interest.

Among 55 patients treated, 40 were given LMWID and only four (10%) received a second dose.

“Of the first LMWID infusions (dose of 1000 mg), all patients demonstrated an increase in Hb from a mean of 12.21 to 13.15 within an average of 2.75 months,” Ms Khudanyan and co-investigators said. Across an average of 3.26 months, the mean ferritin levels went from 28.34 pre-treatment to 231.14 post-treatment.

Based on history with AEs, two (5%) patients were given premedication with diphenhydramine or promethazine. Ultimately, three (7.5%) patients had documented AEs, including arm swelling, dysphagia with globus sensation, and nausea. Of note, there were no patients in the ferumoxytol infusion arm given premedication.

Across an average of 4.2 months, recipients of ferumoxytol had an increase in mean Hb from 10.25 to 12.17. Ferritin increased from baseline 75.93 to 150.33 within 3 months. Upon receiving a second infusion of ferumoxytol, AEs of diarrhea and nausea were reported in only one (6.67%) patient.

There were no reports of AEs requiring hospitalization, and no patients had severe hypersensitivity reactions, hypotension, or hypophosphatemia.

“In our retrospective cohort, LMWID or ferumoxytol for treatment of iron deficiency were well-tolerated with minimal AEs, limited to arm swelling, dysphagia and nausea in three patients. Those treated with ferumoxytol experienced similarly few AEs, with only one patient developing transient diarrhea and nausea,” Ms Khudanyan and colleagues reported.

“Hesitancy to utilize IV iron has persisted due to concerns for potential side effects including anaphylaxis. Our encouraging results provide additional evidence for the efficacy and safety of LMWID and furomoxytol, and should help to assuage fears that IV iron might be poorly tolerated or ineffective,” they concluded. —Hina Porcelli

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