The following is a summary of “Effectiveness of Intravenous Iron Treatment Versus Standard Care in Patients With Heart Failure and Iron Deficiency – IRONMAN,” published in the March 2024 issue of Cardiology by Kumbhani et al.
Ferric derisomaltose is an intravenous iron formulation used to treat iron deficiency anemia. In a single dose, it effectively delivers iron with rapid infusion.
Researchers conducted a prospective study evaluating the safety and efficacy of ferric derisomaltose in treating iron deficiency (ID) in patients with heart failure (HF).
They randomized patients to receive either ferric derisomaltose (n=569) or usual care (n=568) based on body weight and hemoglobin levels. Patients with <50 kg received 20 mg/kg IV ferric derisomaltose. Within the 50-70 kg group, it was 1,000 mg if hemoglobin was ≥10 g/dL, or 20 mg/kg if hemoglobin <10 g/dL. Patients with ≥ 70 kg weight received more IV ferric derisomaltose at 20 mg/kg up to 1,500 mg if hemoglobin was ≥ 10 g/dL or 2,000 mg if hemoglobin was 10 g/dL. Infusions were based on low ferritin (<100µg/L or ≤400 µg/L) and transferrin saturation (<25%).
The results showed that 771 (68%) patients were anemic, where 348 had mild anemia and 423 had moderate anemia. Minnesota Living with Heart Failure (MLwHF) questionnaire at 4 months was 36.9 vs. 40.2 (P=0.05) with a mean difference of -7 (95% CI: -13 to -2). The difference was lesser for mild anemia (-3 [-9 to +3]) and for patients without anemia (+1 [-5 to +6]) (P=0.14). The increase in hemoglobin in patients with serum ferritin ≤30 µg/L receiving ferric derisomaltose (P=0.028) was noticed with no difference on MLwHF by serum ferritin category (P=1.0). In general, ferric derisomaltose was slightly better than usual for HF, 22.4 vs. 27.5 events/100 patient-years (P=0.07). For HF hospitalization (16.7 vs. 20.9/100 patient-years, P=0.085) and cardiovascular death (21% vs. 24%, P=0.23), ferric derisomaltose performed more effectively than the usual care. Also, in all-cause mortality and hospitalization due to infection (11.7% vs. 14.2% )(P=0.16), ferric derisomaltose edged higher.
Investigators found intravenous ferric derisomaltose offered no significant advantage over patients with HF having ID, though further studies may be needed to identify subgroups who might benefit. The trial adds to the mixed data on iron therapy in HF, where ferric carboxymaltose has been the focus of most prior research.
Source: acc.org/Latest-in-Cardiology/Clinical-Trials/2022/11/04/14/19/ironman