Effectiveness and Safety of Intravenous Iron Formulations in Children with Iron Deficiency

To compare the effectiveness and safety of intravenous iron (VI) formulations used to treat iron deficiency in children.

This retrospective study included patients aged 0-21 years who received IVI with low molecular weight iron dextran (LMWID), iron sucrose, ferric gluconate, or ferric carboxymaltose (FCM). Demographics, number of doses per treatment course, underlying diagnoses, pre- and post-treatment hemoglobin (Hgb) and ferritin levels, adverse effects, and post-FCM phosphorous levels were collected. Changes in Hgb and ferritin were statistically analyzed for comparing effectiveness across formulations, and adverse effects requiring medication were analyzed to assess safety.

A total of 342 patients received 659 treatment courses with 833 total doses. LMWID was given as 1-2 doses, FCM as 1-3, iron sucrose as 1-6, and ferric gluconate as 1-8 doses per course. Most patients were female (n=232; 67.8%) and adolescent (n=258; 75.4%). The most common diagnoses were inflammatory bowel disease and heavy menstrual bleeding. Hgb and ferritin increased across all formulations; Hgb rose the most with LMWID (P<0.001), whereas ferritin rose the most with FCM (P<0.001) when compared with IS. Adverse effects occurred in 4.9% of doses, with LMWID associated with a higher number of reactions requiring medication (P=0.02). Hypophosphatemia occurred in 9 out of 20 FCM courses with post-treatment phosphorous levels measured.

IVI was effective and well-tolerated in this pediatric cohort. Formulation-specific benefits should be weighed against the risk of increased adverse effects with LMWID and hypophosphatemia with FCM.