Safety and tolerability of intravenous ferric carboxymaltose in the oldest old patients: a prospective cohort study in a University Italian Geriatrics Department

Abstract

Background & aims. Anemia is common in older adults and it is associated with relevant complications. Although anemia is often multifactorial in origin and iron deficiency is considered a key relevant causative factor. The first therapeutic option is oral iron supplementation, but it is frequently characterized by adverse effects and overall poor efficacy. So far, intravenous (i.v.) iron formulations may serve as alternative treatment options and, in particular, Ferric carboxymaltose (FCM), showed to be safe and effective in older patients. We aimed to assess the safety and tolerability of FCM in real world hospitalized frail oldest old patients. Methods.This is an observational prospective study on 25 old age patients with iron deficiency anemia (IDA), admitted between July 2019 and November 2019 to the Geriatric Clinical ward of the IRCCS Policlinico San Martino, Genoa, Italy and treated with i.v. FCM. The incidence, probability and severity of adverse drug reactions (ADR) were reported along with the clinical response in term of mean Haemoglobin (Hb) increase after one week from the drug administration. Results. 72% of patients were oldest old with IDA and the clinical phenotype was characterized by multimorbidity and disability. The mean dose of i.v. FCM was 1160.0 ± 313.6 mg. FCM resulted safe therapeutic option with overall good tolerability. Additionally, a significant clinical improvement in the mean Hb level was observed. Conclusions. These findings moved a step in the recommendation of i.v. iron supplementation as a preferable route in oldest old, serving as a potential platform for future randomized clinical studies.