Different doses of ferric citrate found effective for iron deficiency anemia
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Patients with iron deficiency anemia and chronic kidney disease had increased hemoglobin levels with ferric citrate regardless of the dose they received, according to study findings presented at the virtual ASN Kidney Week.
“Ferric citrate (FC) is an FDA-approved oral iron replacement for adults with iron deficiency anemia (IDA) and nondialysis-dependent (NDD) CKD and as a phosphate binder in adults with dialysis-dependent CKD,” Pablo E. Pergola, MD, PhD, of Renal Associates PA in San Antonio, and colleagues wrote in a poster. “For IDA, the recommended FC starting dose is [one] tablet (1 g, contains 210 mg ferric iron) [three] times daily (TID) titrated to maintain hemoglobin (Hb) goal.”
To investigate the long-term efficacy and safety of various ferric citrate regimens, Pergola and colleagues conducted a 48-week trial in which patients were randomized to 1 g tablet three times per day (3 g/day) or two tablets twice a day (4 g/day).
“At [week] 12, if Hb was [less than] 10 g/dL or changed [less than] 0.5 g/dL from baseline (BL), dose was increased to [two] tablets TID (from one TID) or [three] tablets BID (from two BID),” the researchers wrote.
The primary endpoint was change in hemoglobin from baseline to week 24. Researchers also considered change in transferrin saturation, ferritin and phosphate.
Results showed both ferric citrate regimens increased and maintained hemoglobin levels, and patients who had lower baseline hemoglobin and iron parameters had a greater increase in hemoglobin with treatment.
Regarding safety, researchers found adverse events that occurred in at least 5% of the study population included diarrhea (13.2%), discolored stool (12.7%) and constipation (12.2%).
“Serum phosphate remained within normal range over study duration,” Pergola and colleagues wrote. “Mean changes in Hb, TSAT, ferritin, and phosphate were similar in the BID and TID and the 3 [g] and 4 g/day dosing groups. These results support the potential for FC dosing flexibility in the long-term treatment of IDA.”
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Pergola PE, et al. PO0254. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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