Efficacy of Intravenous Ferric Carboxymaltose in Heart Failure Patients with Iron Deficiency Anemia: A Meta-analysis of 6271 Patients.

IF 2.9 3区医学 Q2 PHARMACOLOGY & PHARMACY Clinical Drug Investigation Pub Date : 2024-11-11 DOI:10.1007/s40261-024-01401-y

Amira Mohamed Taha, Ahmed Saad Elsaeidy, Sarah A Nada, Sadish Sharma, Mohamed M Ghonaim, Areeba Ahsan, Marina Ramzy Mourid, Khaled Abouelmagd

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Abstract

Background: Iron deficiency is prevalent among heart failure patients and is associated with worse clinical outcomes, including decreased quality of life and functional capacity. This condition often results in a higher incidence of hospitalization and mortality. Iron supplementation, particularly with intravenous ferric carboxymaltose (FCM), has shown potential benefits as an adjunct therapy in heart failure management. This study aims to evaluate the efficacy of FCM in the treatment of patients with heart failure and iron deficiency anemia, with a focus on its impact on mortality and hospitalization rates.

Methods: A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases from their inception until 1st December 2023. Meta-analysis was performed using RevMan 5.4, employing a random-model effect. The results were reported as risk ratios (RRs), standard mean differences (SMDs), and 95 % confidence intervals (CIs).

Results: The meta-analysis included 13 studies with a total of 6271 patients. Ferric carboxymaltose administration resulted in a significant improvement in the 6-minute walk distance (SMD: 1.45; 95 % CI: 0.55, 2.36; p = 0.002), quality of life, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) (SMD: 1.49; 95 % CI: 0.87, 2.11; p < 0.00001), the rate of first hospitalization for heart failure or cardiovascular death (RR: 0.91; 95 % CI: 0.84, 0.98; p = 0.02). However, FCM did not show a significant impact on the risk of cardiovascular death (RR: 0.90; 95 % CI: 0.77, 1.05; p = 0.17), the need for intervention due to worsening heart failure (RR: 0.41; 95 % CI: 0.04, 4.51; p = 0.47), or all-cause mortality rates (RR: 0.89; 95 % CI: 0.69, 1.16; p = 0.28).

Conclusion: While FCM treatment in patients with heart failure and iron deficiency anemia significantly improves functional capacity and quality of life, it has no notable effect on mortality rates or the likelihood of hospitalization. These findings highlight the need for further research to explore comprehensive treatment strategies that address both the symptomatic and survival aspects of heart failure management in this patient population.

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缺铁性贫血心衰患者静脉注射羧甲基铁的疗效：对 6271 例患者的 Meta 分析。

背景：铁缺乏症在心力衰竭患者中很普遍，并与较差的临床结果有关，包括生活质量和功能能力下降。这种情况往往导致更高的住院率和死亡率。铁补充剂，尤其是静脉注射羧甲基铁（FCM）作为心衰治疗的辅助疗法，已显示出潜在的益处。本研究旨在评估 FCM 在治疗心力衰竭合并缺铁性贫血患者中的疗效，重点关注其对死亡率和住院率的影响：方法：在 PubMed、Web of Science 和 Scopus 数据库中进行了全面检索，检索时间从开始到 2023 年 12 月 1 日。使用 RevMan 5.4 进行元分析，采用随机模型效应。结果以风险比（RRs）、标准平均差（SMDs）和95%置信区间（CIs）的形式报告：荟萃分析包括 13 项研究，共涉及 6271 名患者。服用羧甲基铁可显著改善 6 分钟步行距离（SMD：1.45；95 % CI：0.55, 2.36；P = 0.002）、堪萨斯城心肌病问卷（KCCQ）评估的生活质量（SMD：1.49; 95 % CI: 0.87, 2.11; p < 0.00001）、因心力衰竭或心血管死亡首次住院率（RR: 0.91; 95 % CI: 0.84, 0.98; p = 0.02）。然而，FCM 对心血管死亡风险（RR：0.90；95 % CI：0.77，1.05；P = 0.17）、心衰恶化导致的干预需求（RR：0.41；95 % CI：0.04，4.51；P = 0.47）或全因死亡率（RR：0.89；95 % CI：0.69，1.16；P = 0.28）并无显著影响：心力衰竭合并缺铁性贫血患者接受 FCM 治疗后，功能和生活质量均有明显改善，但对死亡率或住院的可能性却没有明显影响。这些发现凸显了进一步研究的必要性，以探索综合治疗策略，从症状和生存两方面治疗心衰患者。

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来源期刊

Clinical Drug Investigation 医学-药学

CiteScore

5.90

自引率

3.10%

发文量

108

审稿时长

6-12 weeks

期刊介绍： Clinical Drug Investigation provides rapid publication of original research covering all phases of clinical drug development and therapeutic use of drugs. The Journal includes: -Clinical trials, outcomes research, clinical pharmacoeconomic studies and pharmacoepidemiology studies with a strong link to optimum prescribing practice for a drug or group of drugs. -Clinical pharmacodynamic and clinical pharmacokinetic studies with a strong link to clinical practice. -Pharmacodynamic and pharmacokinetic studies in healthy volunteers in which significant implications for clinical prescribing are discussed. -Studies focusing on the application of drug delivery technology in healthcare. -Short communications and case study reports that meet the above criteria will also be considered. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Clinical Drug Investigation may be accompanied by plain language summaries to assist readers who have some knowledge, but non in-depth expertise in, the area to understand important medical advances.