When is high-dose intravenous iron repletion needed? Assessing new treatment options

Figures & data

Table 1 Summary of potential benefits of high-dose administrations of intravenous iron

Benefit	Reference
Single clinic visit to receive desired dose (or reduced clinic visits)	Peebles and Stanley^Citation13
	Jenkins^Citation14
	Summaries of product characteristics^Citation11,Citation12
Improved patient compliance (and convenience)	Peebles and Stanley^Citation13
	Jenkins^Citation14
Cost reduction	Peebles and Stanley^Citation13
	Besarab et al^Citation4
Preservation of venous access	Peebles and Stanley^Citation13
Reduction in number and/or volume of blood transfusions	Bastit et al^Citation48
	Auerbach^Citation44
Improved erythropoiesis-stimulating agents efficiency and/or reduced erythropoiesis-stimulating agent dose	Besarab et al^Citation4
	Fishbane et al^Citation45
	Auerbach et al^Citation46
	Henry et al^Citation47
	Bastit et al^Citation48
Improved prospect of transplant (by avoiding blood transfusions)	Agarwal^Citation16

Table 2 Maximum permitted iron dose based on mean body weight: European population

Male, mean adult weight 78.9 kg			Female, mean adult weight 65.8 kg
	Maximum dose based on body weight	Maximum dose allowed according to SPC^Citation11,Citation12		Maximum dose based on body weight	Maximum dose allowed according to SPC^Citation11,Citation12
Iron isomaltoside 1000	1578 mg*	1578 mg	Iron isomaltoside 1000	1316 mg*	1316 mg
Ferric carboxymaltose	1183 mg†	1000 mg	Ferric carboxymaltose	987 mg†	987 mg

Notes:

† based on 15 mg/kg body weight;

* based on 20 mg/kg body weight. Source of population data.⁵⁶

Abbreviation: SPC, summary of product characteristics.

Table 3 Maximum permitted iron dose based on mean body weight: US population

Male, mean adult weight, 86.8 kg			Female, mean adult weight, 74.7 kg
	Maximum dose based on body weight	Maximum dose allowed according to SPC^Citation11,Citation12		Maximum dose based on body weight	Maximum dose allowed according to SPC^Citation11,Citation12
Iron isomaltoside 1000	1736 mg*	1736 mg	Iron isomaltoside 1000	1494 mg*	1494 mg
Ferric carboxymaltose	1302 mg†	1000 mg	Ferric carboxymaltose	1121 mg†	1000 mg

Notes:

† Based on 15 mg/kg body weight;

* based on 20 mg/kg body weight; Source of population data.⁵⁷

Abbreviation: SPC, summary of product characteristics.

Table 4 Summary of comparative profiles of iron isomaltoside 1000 and ferric carboxymaltose^11,12,58,59

	Ferric carboxymaltose	Iron isomaltoside 1000
Maximum dose per kg body weight	15 mg iron/kg body weight	20 mg iron/kg body weight
Maximum dose in a single administration	1000 mg	20 mg iron/kg body weight
Minimum body weight for 1000 mg dose	67 kg	50 kg
Speed of administration	<500 mg in 6 minutes	0–5 mg/kg in 15 minutes
	500–1000 mg in 15 minutes	6–10 mg/kg in 30 minutes
		11–20 mg/kg in 60 minutes
Test dose required	No	No
Short chain carbohydrate structure	No	Yes
	Branched polysaccharides	Unbranched linear oligosaccharides

PeeblesGStanleySEvaluation of service reconfiguration for managing intravenous iron supplementation in non-hemodialysis patients with chronic renal failureJournal of Outcomes Research200481525

 Google Scholar

JenkinsAUsing iron dextran to treat iron-deficiency anemiaHospital Pharmacist2005126224225

 Google Scholar

Ferinject® [Package insert]Surrey, UKSyner-med Pharmaceutical Products Ltd2010

 Google Scholar

Monofer® [Package insert]Cambridge, MAAMAG Pharmaceuticals Inc2010

 Google Scholar

BesarabAAminNAhsanMOptimization of epoetin therapy with intravenous iron therapy in hemodialysis patientsJ Am Soc Nephrol20001153053810703677

 PubMed Web of Science ®Google Scholar

BastitLVandebroekAAltintasSRandomized, multicenter, controlled trial comparing the efficacy and safety of darbepoietin alpha administered every 3 weeks with or without intravenous iron in patients with chemotherapy-induced anemiaJ Clin Oncol200826101611161818375890

 PubMed Web of Science ®Google Scholar

AuerbachMShould intravenous iron be the standard of care in oncologyJ Clin Oncol200826101579158118375888

 PubMed Web of Science ®Google Scholar

FishbaneSFreiGLMaesakaJReduction in recombinant human erythropoietin doses by the use of chronic intravenous iron supplementationAm J Kidney Dis199526141467611266

 PubMed Web of Science ®Google Scholar

AuerbachMBallardHTroutJRIntravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy related anemia: A multicenter, open label, randomized trialJ Clin Oncol20042271301130715051778

 PubMed Web of Science ®Google Scholar

HenryDHDahlNVAuerbachMTchekmedyianSLaufmanLRIntravenous ferric gluconate improves response to epoietin alfa versus oral iron or no iron in anemic patients with cancer receiving chemotherapyOncologist200712223124217296819

 PubMed Web of Science ®Google Scholar

AgarwalRIndividualizing decision-making – resurrecting the doctor-patient relationship in the anemia debateClin J Am Soc Nephrol2010571340134620448071

 PubMed Web of Science ®Google Scholar

Special EurobarometerHealth and Food 246/Wave 643 – TNS Opinion and SocialEuropean Commission2006

 Google Scholar

PortierKTolsonJKRobertsSMBody weight distributions for risk management. (NHANES 1999–2002)Risk Anal2007271112617362397

 PubMed Web of Science ®Google Scholar

European Pharmacopoeia – Monograph. Page 1408.

 Google Scholar

Luitpold Pharmaceuticals Inc19th July 2007Methods and Compositions for Administration of Iron WO2007/081744 A2.

 Google Scholar