Efficacy and Safety of Intravenous Ferric Carboxymaltose in Geriatric Inpatients at a German Tertiary University Teaching Hospital: A Retrospective Observational Cohort Study of Clinical Practice.

Matthias Bach,Juergen Stein,Julia Martin,Garth Virgin,Bettina Schulze,Tabea Geisel,Roland Schaefer

doi:10.1155/2015/647930

Abstract

Current iron supplementation practice in geriatric patients is erratic and lacks evidence-based recommendations. Despite potential benefits in this population, intravenous iron supplementation is often withheld due to concerns regarding pharmacy expense, perceived safety issues, and doubts regarding efficacy in elderly patients. This retrospective, observational cohort study aimed to evaluate the safety and efficacy of intravenous ferric carboxymaltose (FCM, Ferinject) in patients aged >75 years with iron deficiency anaemia (IDA). Within a twelve-month data extraction period, the charts of 405 hospitalised patients aged 65–101 years were retrospectively analysed for IDA, defined according to WHO criteria for anaemia (haemoglobin: <13.0 g/dL (m)/<12.0 g/dL (f)) in conjunction with transferrin saturation <20%. Of 128 IDA patients screened, 51 (39.8%) received intravenous iron. 38 patient charts were analysed. Mean cumulative dose of intravenous FCM was 784.4 ± 271.7 mg iron (1–3 infusions). 18 patients (47%) fulfilled treatment response criteria (≥1.0 g/dL increase in haemoglobin between baseline and hospital discharge). AEs were mild/moderate, most commonly transient increases of liver enzymes (n = 5/13.2%). AE incidence was comparable with that observed in patients <75 years. No serious AEs were observed. Ferric carboxymaltose was well tolerated and effective for correction of Hb levels and iron stores in this cohort of IDA patients aged over 75 years.

Highlights

Iron deficiency is one of the most common nutritional deficiencies in the elderly population as a whole, with a prevalence of approximately 10–15% in persons aged 65 and older and 35% in those aged 85 and above [1, 2]
Geisel et al reported 66% prevalence of anaemia in geriatric inpatients. 65% of cases were associated with iron deficiency (ID), mostly due to chronic infection, or ID combined with anaemia of inflammation (IDA/Anaemia caused by inflammation (AI), 21.4%) [3]
Data for analysis were extracted from the charts of elderly persons who had been admitted to the rehabilitation unit and treated according to the medical needs of their underlying disease in accordance with therapy requirements published in the German Physician’s Circular (GPC)

Summary

Introduction

Iron deficiency is one of the most common nutritional deficiencies in the elderly population as a whole, with a prevalence of approximately 10–15% in persons aged 65 and older and 35% in those aged 85 and above [1, 2]. Major causes are reduced iron absorption as a result of drug interactions, diseases of the digestive tract, and/or chronic inflammation. Depletion of iron stores may occur as a consequence of (mostly chronic) bleeding [5, 6]. Anaemia is usually a result of iron deficiency, either absolute or functional (i.e., insufficient supply of iron to the Anemia erythroid marrow despite adequate iron stores) [7]. 65% of cases were associated with iron deficiency (ID), mostly due to chronic infection, or ID combined with anaemia of inflammation (IDA/AI, 21.4%) [3]. While comorbidities and polypharmacy may be contributory factors, nutrition played only a limited role [2]

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Discussion

Conclusion