Skip to main content
SpringerLink
Log in

Ferric carboxymaltose: a guide to its use in iron deficiency

  • Adis Drug Clinical Q&A
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Ferric carboxymaltose (Ferinject®, Injectafer®) is an important intravenous iron preparation option for the treatment of iron deficiency. A single high dose [up to 750 mg (USA) or 1000 mg (EU) of iron] can be administered intravenously in a short time frame (15 min). Thus, fewer doses of ferric carboxymaltose may be needed to replenish iron stores relative to some other intravenous iron preparations. Ferric carboxymaltose improved self-reported patient global assessment, New York Heart Association functional class and exercise capacity in patients with chronic heart failure and iron deficiency in the FAIR-HF and CONFIRM-HF trials. In other trials, ferric carboxymaltose replenished iron stores and corrected anaemia in various populations with iron-deficiency anaemia, including patients with chronic kidney disease, inflammatory bowel disease or heavy uterine bleeding, postpartum iron-deficiency anaemia and perioperative anaemia. Intravenous ferric carboxymaltose was generally well tolerated, with a very low risk of hypersensitivity reactions. In general, it was better tolerated than oral ferrous sulfate, mainly reflecting a lower incidence of gastrointestinal adverse effects. The higher acquisition cost of ferric carboxymaltose was offset by lower costs for other items, with the potential for cost savings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309–16.

    Article  CAS  PubMed  Google Scholar 

  2. Gasche C, Berstad A, Befrits R, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13(12):1545–53.

    Article  PubMed  Google Scholar 

  3. Breymann C, Bian X-M, Blanco-Capito LR, et al. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med. 2011;39(2):113–21.

    Article  PubMed  Google Scholar 

  4. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279–335.

  5. Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436–48.

    Article  CAS  PubMed  Google Scholar 

  6. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2014. doi:10.1093/eurheartj/ehu385.

    Google Scholar 

  7. Herrera C, Robles V, Navarro E, et al. Iron deficiency in the absence of anemia affects the perception of health-related quality of life in IBD patients in remission [abstract no. P124]. J Crohns Colitis. 2015;9(Suppl 1):S138–9.

  8. Vifor Pharma UK Limited. Ferinject (ferric carboxymaltose): UK summary of product characteristics. 2013. http://www.medicines.org.uk. Accessed 29 Jan 2015.

  9. American Regent Inc. Injectafer® (ferric carboxymaltose injection): US prescribing information. 2013. http://www.fda.gov. Accessed 29 Jan 2015.

  10. Keating GM. Ferric carboxymaltose: a review of its use in iron deficiency. Drugs. 2015;75(1):101–27.

    Article  PubMed  Google Scholar 

  11. Geisser P. The pharmacology and safety profile of ferric carboxymaltose (Ferinject®): structure/reactivity relationships of iron preparations. Port J Nephrol Hypert. 2009;23(1):11–6.

    Google Scholar 

  12. Funk F, Ryle P, Canclini C, et al. The new generation of intravenous iron: chemistry, pharmacology, and toxicology of ferric carboxymaltose. Arzneimittelforschung. 2010;60(6a):345–53.

    CAS  PubMed  Google Scholar 

  13. Macdougall IC, Bock AH, Carrera F, et al. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia. Nephrol Dial Transplant. 2014;29(11):2075–84.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Qunibi WY, Martinez C, Smith M, et al. A randomized controlled trial comparing intravenous ferric carboxymaltose with oral iron for treatment of iron deficiency anaemia of non-dialysis-dependent chronic kidney disease patients. Nephrol Dial Transplant. 2011;26(5):1599–607.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Onken JE, Bregman DB, Harrington RA, et al. Ferric carboxymaltose in patients with iron-deficiency anemia and impaired renal function: the REPAIR-IDA trial. Nephrol Dial Transplant. 2014;29(4):833–42.

    Article  CAS  PubMed  Google Scholar 

  16. Schaefer RM, Khasabov NN, Todorov NG, et al. The efficacy and safety of intravenous ferric carboxymaltose compared to iron sucrose in haemodialysis patients with iron deficiency anaemia [abstract no. MP375]. In: 45th Congress of the European Renal Association and the European Dialysis and Transplant Association. 2008.

  17. Charytan C, Bernardo MV, Koch TA, et al. Intravenous ferric carboxymaltose versus standard medical care in the treatment of iron deficiency anemia in patients with chronic kidney disease: a randomized, active-controlled, multi-center study. Nephrol Dial Transplant. 2013;28(4):953–64.

    Article  CAS  PubMed  Google Scholar 

  18. Evstatiev R, Marteau P, Iqbal T, et al. FERGIcor, a randomized controlled trial on ferric carboxymaltose for iron deficiency anemia in inflammatory bowel disease. Gastroenterology. 2011;141(3):846–53.e1–2.

  19. Kulnigg S, Stoinov S, Simanenkov V, et al. A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT®) randomized controlled trial. Am J Gastroenterol. 2008;103(5):1182–92.

    Article  CAS  PubMed  Google Scholar 

  20. Evstatiev R, Alexeeva O, Bokemeyer B, et al. Ferric carboxymaltose prevents recurrence of anemia in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013;11(3):269–77.

    Article  CAS  PubMed  Google Scholar 

  21. Breymann C, Gliga F, Bejenariu C, et al. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. Int J Gynaecol Obstet. 2008;101(1):67–73.

    Article  CAS  PubMed  Google Scholar 

  22. Seid MH, Derman RJ, Baker JB, et al. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199(4):435.e1–7.

  23. Van Wyck DB, Martens MG, Seid MH, et al. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol. 2007;110(2 Pt 1):267–78.

    Article  PubMed  Google Scholar 

  24. Van Wyck DB, Mangione A, Morrison J, et al. Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial. Transfusion (Paris). 2009;49(12):2719–28.

    Article  Google Scholar 

  25. Favrat B, Balck K, Breymann C, et al. Evaluation of a single dose of ferric carboxymaltose in fatigued, iron-deficient women: PREFER a randomized, placebo-controlled study. PLoS One. 2014;9(4):e94217.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Bisbe E, Moltó L, Arroyo R, et al. Randomized trial comparing ferric carboxymaltose vs oral ferrous glycine sulphate for postoperative anaemia after total knee arthroplasty. Br J Anaesth. 2014;113(3):402–9.

    Article  CAS  PubMed  Google Scholar 

  27. Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage—a placebo-controlled study. Aliment Pharmacol Ther. 2014;39(2):176–87.

    Article  CAS  PubMed  Google Scholar 

  28. Filippatos G, Farmakis D, Colet JC, et al. Intravenous ferric carboxymaltose in iron-deficient chronic heart failure patients with and without anaemia: a subanalysis of the FAIR-HF trial. Eur J Heart Fail. 2013;15(11):1267–76.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Comin-Colet J, Lainscak M, Dickstein K, et al. The effect of intravenous ferric carboxymaltose on health-related quality of life in patients with chronic heart failure and iron deficiency: a subanalysis of the FAIR-HF study. Eur Heart J. 2013;34(1):30–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Ponikowski P, Filippatos G, Colet JC, et al. The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study. Eur J Heart Fail. 2015;17(3):329–39.

    Article  CAS  PubMed  Google Scholar 

  31. Froessler B, Collingwood J, Hodyl NA, et al. Intravenous ferric carboxymaltose for anaemia in pregnancy. BMC Pregnancy Childbirth. 2014;14:115.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Shander A, Javidroozi M, Perelman S, et al. From bloodless surgery to patient blood management. Mt Sinai J Med. 2012;79(1):56–65.

    Article  PubMed  Google Scholar 

  33. Hedenus M, Karlsson T, Ludwig H, et al. Intravenous ferric carboxymaltose as sole anemia therapy in patients with lymphoid malignancies, chemotherapy-induced anemia and functional iron deficiency [abstract]. Blood. 2013;122(21):3439.

  34. Kulnigg-Dabsch S, Evstatiev R, Dejaco C, et al. Effect of iron therapy on platelet counts in patients with inflammatory bowel disease-associated anemia. PLoS One. 2012;7(4):e34520.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Kulnigg-Dabsch S, Schmid W, Howaldt S, et al. Iron deficiency generates secondary thrombocytosis and platelet activation in IBD: the randomized, controlled ThromboVIT trial. Inflamm Bowel Dis. 2013;19(8):1609–16.

    PubMed  Google Scholar 

  36. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13.

    Article  PubMed  Google Scholar 

  37. Hussain I, Bhoyroo J, Butcher A, et al. Direct comparison of the safety and efficacy of ferric carboxymaltose versus iron dextran in patients with iron deficiency anemia. Anemia. 2013;2013:169107.

    Article  PubMed Central  PubMed  Google Scholar 

  38. European Medicines Agency. New recommendations to manage risk of allergic reactions with intravenous iron-containing medicines. 2013. http://www.ema.europa.eu. Accessed 6 Mar 2015.

  39. Blazevic A, Hunze J, Boots JMM. Severe hypophosphataemia after intravenous iron administration. Neth J Med. 2014;72(1):49–53.

    CAS  PubMed  Google Scholar 

  40. Christoph P, Schuller C, Studer H, et al. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. iron sucrose. J Perinat Med. 2012;40(5):469–74.

    Article  CAS  PubMed  Google Scholar 

  41. Data on file, Vifor Inc, 2014.

  42. Wilson PD, Hutchings A, Jeans A, et al. An analysis of the health service efficiency and patient experience with two different intravenous iron preparations in a UK anaemia clinic. J Med Econ. 2013;16(1):108–14.

    Article  PubMed  Google Scholar 

  43. Fragoulakis V, Kourlaba G, Goumenos D, et al. Economic evaluation of intravenous iron treatments in the management of anemia patients in Greece. Clinicoeconom Out Res. 2012;4:127–34.

    Google Scholar 

  44. Calvet X, Ruíz MA, Dosal A, et al. Cost-minimization analysis favours intravenous ferric carboxymaltose over ferric sucrose for the ambulatory treatment of severe iron deficiency. PLoS One. 2012;7(9):e45604.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Bager P, Dahlerup JF. The health care cost of intravenous iron treatment in IBD patients depends on the economic evaluation perspective. J Crohns Colitis. 2010;4(4):427–30.

    Article  PubMed  Google Scholar 

  46. Gutzwiller FS, Schwenkglenks M, Blank PR, et al. Health economic assessment of ferric carboxymaltose in patients with iron deficiency and chronic heart failure based on the FAIR-HF trial: an analysis for the UK. Eur J Heart Fail. 2012;14(7):782–90.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Blank PR, Schwenkglenks M, Szucs TD. Cost-effectiveness of ferric carboxymaltose in patients with chronic heart failure: an analysis from the FAIR-HF trial [abstract no. P1437]. Eur Heart J. 2010;31(Suppl 1):225.

    Google Scholar 

  48. Lim E-A, Sohn H-S, Lee H, et al. Cost-utility of ferric carboxymaltose (Ferinject®) for iron-deficiency anemia patients with chronic heart failure in South Korea. Cost Eff Resour Alloc. 2014;12:19.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Comin-Colet J, Rubio-Rodriguez D, Rubio-Terres C, et al. A cost-effectiveness analysis of ferric carboxymaltose in patients with iron deficiency and chronic heart failure in Spain. Rev Esp Cardiol (Engl Ed). 2015. doi:10.1016/j.rec.2014.10.010.

    PubMed  Google Scholar 

Download references

Acknowledgments

The manuscript was reviewed by: E. Bisbe, Department of Anaesthesia, Hospital Mar-Esperança, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain; B. Bokemeyer, Gastroenterology Practice, Minden, Germany.

Disclosure

This article was adapted from Drugs 2015;75(1):101–27 [10] by a salaried employee of Adis/Springer and was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes resulting from comments received were made by the authors on the basis of scientific merit.

Author information

Authors and Affiliations

  1. Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand

    Gillian M. Keating

Authors
  1. Gillian M. Keating
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gillian M. Keating.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keating, G.M. Ferric carboxymaltose: a guide to its use in iron deficiency. Drugs Ther Perspect 31, 143–149 (2015). https://doi.org/10.1007/s40267-015-0203-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-015-0203-3

Keywords

Search

Navigation