# Real-world evaluation of an intravenous iron service for the treatment of iron deficiency with or without anemia

## TL;DR

This study evaluated the effectiveness and safety of high-dose intravenous iron in treating iron deficiency and found that many patients remained anemic after treatment, suggesting a need for better dosing.

## Contribution

The study provides real-world evidence on the use of ferric derisomaltose for iron deficiency and highlights suboptimal dosing in clinical practice.

## Key findings

- Mean hemoglobin increased by 20.9 g/L and ferritin by 188.8 µg/L after treatment.
- Only 33.4% of patients were non-anemic after treatment, and 65.1% showed a response.
- One patient experienced a serious allergic reaction, indicating a low but present safety risk.

## Abstract

Intravenous (IV) iron is a guideline-recommended treatment for iron deficiency when oral iron is contraindicated, ineffective, or not tolerated, or when rapid iron delivery is necessary. However, evidence suggests that some patients receive less IV iron than needed. This retrospective audit assessed the effectiveness and safety of ferric derisomaltose (FDI), a high-dose IV iron, in 2,468 patients. Efficacy outcomes assessed at 4–12 weeks post-infusion included changes in hemoglobin (Hb) and ferritin, proportion of courses (a course was defined as the treatment episode required to administer one total dose) after which patients were non-anemic (Hb ≥ 130 g/L [men] or ≥ 120 g/L [women]), and response rate (proportion of courses after which patients were non-anemic or Hb increased by ≥ 20 g/L). Safety was assessed through adverse events. Across 2,775 FDI courses, the mean dose was 1,244 mg, but mean estimated iron need was 1,580 mg. At follow-up, mean Hb had increased by 20.9 g/L and mean ferritin by 188.8 µg/L. Patients were non-anemic after 33.4% (n = 494/1,478) of courses and responded after 65.1% (n = 962/1,478) of courses. One patient (n = 1/2,468; 0.04%) had a serious allergic reaction. Patients remained anemic after > 65% of courses, demonstrating the need to optimize dosing based on iron need.