The safety of available treatment options for iron-deficiency anemia

ABSTRACT

Introduction: Iron deficiency (ID), with or without anemia, is highly prevalent worldwide and has clinical consequences. The prevention and treatment of ID is a major public health goal. Accurate diagnosis, selection of the appropriate iron replacement therapy and addressing the underlying cause, remain as the main challenges in ID management.

Areas covered: This review aims to provide a narrative review of current available evidence on iron supplementation options regularly used to treat ID, including oral and intravenous (IV) iron formulations, with emphasis on safety issues. Analyzed safety concerns include gastrointestinal side effects (oral iron) and risks of hypotension, anaphylaxis, infection, hypophosphatemia, oxidative stress and mortality (IV iron).

Expert opinion: Low-to-moderate doses of oral iron supplementation remains as first line therapy for uncomplicated ID, but it has been scarcely discussed in the setting of inflammation. Confirmatory studies on the efficacy of newer oral iron formulations in this setting are needed. Compared with oral iron, short-term IV iron administration is more efficacious in ID correction, without significant safety concerns. However, long-term safety of IV iron maintenance therapy, head to head comparisons of IV iron preparations, pharmacological modulation of hepcidin and HIF, and extra-erythropoietic effects of iron are among the important areas of research.

KEYWORDS:

• Iron deficiency
• anaemia
• oral iron
• intravenous iron
• safety

Article highlights

• Challenges in the treatment of ID include finding and addressing the underlying cause and the selection of an iron replacement product which safely meets the needs of the patient.

• Low (e.g., 50 mg daily) or moderate doses (e.g., 100 mg every other day) of oral iron supplementation remains as first line therapy for uncomplicated ID.

• Oral iron supplementation has been scarcely discussed in the setting of inflammation, and confirmatory studies on the efficacy of newer oral iron formulations in this setting are needed.

• Compared with oral iron, short-term IV iron administration is more efficacious in ID correction, without significant safety concerns.

• IV iron formulations allowing higher dose administration are more convenient both for the patient and the health system.

• Long term safety of IV iron maintenance therapy, head to head comparisons of IVI preparations, pharmacological modulation of hepcidin and HIF, and extra-erythropoietic effects of iron are among the important areas of ongoing/future research.

This box summarizes key points contained in the article.

Declaration of interest

Industry-supplied funding for consultancies, lectures and/or travel from Pharmacosmos, Vifor Pharma, Zambon and NutraPharma, and is member of the editorial board of Revista Española de Anestesiología y Reanimación and Blood Transfusion. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript has served on advisory boards and have received consulting fees for Vifor (maker of iron sucrose and ferric carboxymaltose), speakers bureau for Daachi Sankyo (US licencee for ferric carboxymaltose). The reviewers have no other relevant financial relationships to disclose.

Additional information

Funding

This paper has not been funded.