Zusammenfassung
Hintergrund:
Eisenmangel und Anämie treten insbesondere bei Frauen oder als Komorbiditäten diverser chronischer Erkrankungen auf. Für die Behandlung eines Eisenmangels oder einer Anämie stehen neben oralen Präparaten auch parenterale Eisentherapien zur Verfügung. Aufgrund der zunehmenden Bedeutung und wachsenden Anzahl von parenteralen Eisenpräparaten werden die Pharmakologie und Applikation sowie die Chronologie der Zulassungen und die Eigenschaften der verschiedenen Präparate hier vergleichend dargestellt.
Methode:
Übersichtsarbeit
Ergebnisse:
Es existieren bisher drei verschiedene Generationen von parenteralen Eisenpräparaten, die sich hinsichtlich Stabilität, Sicherheit und Dosierung unterscheiden. Insbesondere die Wirkstoffe der dritten Generation, Eisencarboxymaltose, Eisenisomaltosid und Ferumoxytol zeichnen sich durch eine hohe Komplexstabilität und vergleichbare Sicherheit aus und erlauben eine schnelle Applikation hoher Eisendosen.
Schlussfolgerungen:
Hochmolekulares Eisendextran, als Vertreter der Eisenpräparate der ersten Generation, sollte möglichst nicht mehr verwendet werden, da neuere i.v. Eisenpräparate mit deutlich geringerem Risiko für schwerwiegende anaphylaktische Reaktionen verfügbar sind. Eisengluconat und Eisensucrose, als Vertreter der zweiten Generation, sind sehr effiziente Präparate, erfordern aber häufige Klinik- oder Arztbesuche, da sie aufgrund labilerer Eisenkomplexe nur in niedrigen Dosen verabreicht werden dürfen. Die drei parenteralen Eisenformulierungen der dritten Generation weisen im Alltag Vorteile in der Handhabung auf, da sie vergleichbar gute Sicherheitsprofile, eine hohe Komplexstabilität und hierdurch die Möglichkeit der schnellen Applikation hoher Eisendosen bis hin zu Gesamtdosisinfusionen bieten. Ferner sind Testdosen bei diesen Präparaten nicht erforderlich, was ihren Einsatz zusätzlich vereinfacht.
Abstract
Background:
Iron deficiency and anaemia occur in particular in women or as comorbid conditions to a variety of chronic diseases. Besides oral preparations, parenteral iron therapies are also available for the treatment of iron deficiency or anaemia. In the light of the growing importance and increasing number of parenteral iron preparations, their pharmacology and application as well as the chronology of their approvals and the characteristics of the various preparations are presented here for comparison.
Method:
Review
Results:
To date, there are three different generations of parenteral iron preparations, which differ in terms of stability, safety and dosage. In particular, the active substances of the third generation, ferric carboxymaltose, iron isomaltoside and ferumoxytol are characterised by high complex stability and comparable safety, also allowing rapid application of high doses of iron.
Conclusions:
High molecular weight iron dextran, as a representative of 1st generation iron preparations, should no longer be used if possible, as more recent i.v. iron preparations are available with considerably lower risk of serious anaphylactic reactions. Ferrous gluconate and iron sucrose, as representatives of the 2nd generation, are very efficient preparations, but they require frequent visits to the clinic or the doctor, as they may only be administered in low doses because of labile iron complexes. The three 3rd generation parenteral iron formulations have advantages in handling in everyday practice, since they offer comparably good safety profiles, high complex stability and thus the possibility of rapid application of high doses of iron up to the total cumulative dose. Furthermore, test doses are not required with these preparations, which also simplifies their use.
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Wir danken Frau Dr. Kruse, Eickhoff Kommunikation GmbH, Köln für ihre Unterstütung beim Verfassen des Textes, die über eine finanzielle Zuwendung der Firma Takeda Pharma Vertrieb GmbH & Co KG ermöglicht wurde. Allerdings wurde der Text maßgeblich von den Autoren gestaltet, und der Inhalt reflektiert allein die Ansichten der Autoren.
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Sowohl Patrick Biggar als auch Kai-Michael Hahn erhielten Berater-, Studien- und Referentenhonorare von den Firmen Medice, Fresenius Medical Care, Vifor, Takeda sowie auch Amgen.
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Biggar, P., Hahn, KM. Bedeutung der verschiedenen i.v.-Eisengenerationen für den medizinischen Alltag. MMW - Fortschritte der Medizin 155 (Suppl 2), 18–24 (2013). https://doi.org/10.1007/s15006-013-0732-4
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DOI: https://doi.org/10.1007/s15006-013-0732-4