An evaluation of ferric derisomaltose as a treatment for anemia

ABSTRACT

Introduction: Originally approved in Europe in 2009, ferric derisomaltose is the most recently authorized intravenous iron compound in the United States of America (2020). Ferric derisomaltose given as a rapid high-dose infusion can allow complete iron repletion in a single dose and it is now widely used in the treatment of iron deficiency.

Areas covered: The chemistry, pharmacodynamics and pharmacokinetics of ferric derisomaltose are reviewed. Results from phase II, III and IV trials regarding efficacy and safety are presented. Mechanisms behind minor infusion reactions, hypersensitivity and hypophosphatemia are discussed. The economic impact of ferric derisomaltose use is presented. Data pertaining to the use of ferric derisomaltose in iron deficiency anemia, chronic kidney disease, inflammatory bowel disease, chronic heart failure, perioperative care and other patient groups are comprehensively covered.

Expert opinion: Ferric derisomaltose is an effective intravenous iron formulation with a good safety profile, providing rapid, cost-effective iron repletion. Ferric derisomaltose releases low quantities of labile iron relative to older compounds. Anaphylaxis is extremely rare, and ‘Fishbane’ reactions are uncommon. Hypophosphatemia following ferric derisomaltose administration is infrequent in comparison to other intravenous irons such as ferric carboxymaltose. The scope of ferric derisomaltose use is growing with increasing research in these areas.

KEYWORDS:

• Anemia
• chronic kidney disease
• efficacy
• ferric derisomaltose
• hypersensitivity
• hypophosphatemia
• inflammatory bowel disease
• intravenous iron
• safety

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Ferric derisomaltose represents the most recently approved intravenous iron in the United States of America (2020).

• Ferric derisomaltose is a third-generation intravenous iron compound, and similar to other compounds in this category it is characterized by a densely packed carbohydrate core.

• Given its structure, ferric derisomaltose can be used for single administration, high-dose iron-replenishment.

• Recent observational studies and randomized controlled trials support both the efficacy and safety of ferric derisomaltose.

• Ferric derisomaltose is deemed cost-effective based on recent economic analyses.

• Ferric derisomaltose, unlike other compounds of the same group, appears to be less commonly associated with hypophosphatemia.

Declaration of interest

S Bhandari received funding from Pharmacosmos, Vifor pharma Astellas and Astrazeneca for travel expenses to attend educational meetings, honoraria for lectures and participated on advisory boards. 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.

Additional information

Funding

This paper was not funded.