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Park J, Park SJ, Han SS, Park HM, Yu J, Park B, Kim YW, Kim SW. Efficacy of ferric carboxymaltose in iron deficiency anemia patients scheduled for pancreaticoduodenectomy. Ann Surg Treat Res 2023; 105:82-90. [PMID: 37564949 PMCID: PMC10409636 DOI: 10.4174/astr.2023.105.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/01/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Perioperative transfusion is reported to be an independent risk factor not only for postoperative complications but also for early recurrence of periampullary carcinoma after pancreaticoduodenectomy (PD). The purpose of this study was to evaluate the safety and efficacy of ferric carboxymaltose (FCM) in reducing the need for perioperative transfusion in iron deficiency anemia patients scheduled for PD. Methods Twenty-two male patients (hemoglobin [Hb] 7 to <13 g/dL) and 18 female patients (Hb 7 to <12 g/dL) were enrolled in the study group and administered FCM 1-3 weeks before PD. The perioperative transfusion rate was the primary endpoint; morbidity, length of postoperative hospital stay, change in hematological parameters after FCM injection, and adverse effects of FCM were also investigated. Results The perioperative transfusion rate of the study group was 22.5% (9 of 40). Hb level was significantly higher on the day of the operation compared to baseline (P < 0.001). Levels of Hb, transferrin saturation, and ferritin were higher at the follow-up compared to baseline (P = 0.008, P = 0.033, and P < 0.001, respectively). Conclusions FCM administration was associated with a reduced need for perioperative transfusion and can safely stabilize hematological parameters.
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Affiliation(s)
- Jangho Park
- Department of General Surgery, Osan Hankook Hospital, Osan, Korea
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Sang-Jae Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Sung-Sik Han
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Hyeong Min Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jihye Yu
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Sun-Whe Kim
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
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Tang GH, Hart R, Sholzberg M, Brezden-Masley C. Iron deficiency anemia in gastric cancer: a Canadian retrospective review. Eur J Gastroenterol Hepatol 2018; 30:1497-1501. [PMID: 30179903 DOI: 10.1097/meg.0000000000001251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gastric cancer is highly prevalent amongst men and women. Previous studies have described the high prevalence of iron deficiency anemia (IDA) in gastrointestinal cancer patients, but few have focused on the gastric cancer population. We aimed to determine the point prevalence of patients with gastric cancer who developed IDA and chemotherapy-induced anemia, and to identify types and frequencies of IDA therapies. PATIENTS AND METHODS A retrospective review was carried out for 126 gastric cancer patients from 2006 to 2016 at St Michael's Hospital, Toronto, Canada. Patient demographics, laboratory (ferritin, iron parameters) and clinical data regarding IDA were reviewed. IDA was defined as transferrin saturation less than 20%, ferritin less than 100 μg/l, and hemoglobin less than 130 g/l in men and less than 120 g/l in women. RESULTS Of the 126 patients with gastric cancer identified (median age 70, interquartile range: 59-77), 64.3% were men. Only 18.3% of patients had a self-reported history of IDA, 40% had IDA at the time of gastric cancer diagnosis, and 58.7% were anemic. A total of 77 patients received chemotherapy, and of these, 54.2% developed chemotherapy-induced anemia. At the final follow-up, 21.4% of patients were diagnosed with IDA along their treatment course, and 79.4% were anemic. Red blood cell transfusions were most frequently prescribed (48.4%; median: 4 U; interquartile range: 2-6), compared with oral (31.8%) or intravenous iron (16.7%) therapy. CONCLUSION The point prevalence of IDA was high in our gastric cancer patients despite inconsistent screening for IDA. Our findings indicate the need for a consistent diagnostic and therapeutic approach to IDA in this vulnerable patient population.
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Affiliation(s)
| | | | - Michelle Sholzberg
- Division of Hematology/Oncology, Division of Laboratory Medicine and Pathobiology
| | - Christine Brezden-Masley
- Division of Hematology/Oncology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Kim YW, Bae JM, Park YK, Yang HK, Yu W, Yook JH, Noh SH, Han M, Ryu KW, Sohn TS, Lee HJ, Kwon OK, Ryu SY, Lee JH, Kim S, Yoon HM, Eom BW, Choi MG, Kim BS, Jeong O, Suh YS, Yoo MW, Lee IS, Jung MR, An JY, Kim HI, Kim Y, Yang H, Nam BH. Effect of Intravenous Ferric Carboxymaltose on Hemoglobin Response Among Patients With Acute Isovolemic Anemia Following Gastrectomy: The FAIRY Randomized Clinical Trial. JAMA 2017; 317:2097-2104. [PMID: 28535237 PMCID: PMC5815040 DOI: 10.1001/jama.2017.5703] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Acute isovolemic anemia occurs when blood loss is replaced with fluid. It is often observed after surgery and negatively influences short-term and long-term outcomes. OBJECTIVE To evaluate the efficacy and safety of ferric carboxymaltose to treat acute isovolemic anemia following gastrectomy. DESIGN, SETTING, AND PARTICIPANTS The FAIRY trial was a patient-blinded, randomized, phase 3, placebo-controlled, 12-week study conducted between February 4, 2013, and December 15, 2015, in 7 centers across the Republic of Korea. Patients with a serum hemoglobin level of 7 g/dL to less than 10 g/dL at 5 to 7 days following radical gastrectomy were included. INTERVENTIONS Patients were randomized to receive a 1-time or 2-time injection of 500 mg or 1000 mg of ferric carboxymaltose according to body weight (ferric carboxymaltose group, 228 patients) or normal saline (placebo group, 226 patients). MAIN OUTCOMES AND MEASURES The primary end point was the number of hemoglobin responders, defined as a hemoglobin increase of 2 g/dL or more from baseline, a hemoglobin level of 11 g/dL or more, or both at week 12. Secondary end points included changes in hemoglobin, ferritin, and transferrin saturation levels over time, percentage of patients requiring alternative anemia management (oral iron, transfusion, or both), and quality of life at weeks 3 and 12. RESULTS Among 454 patients who were randomized (mean age, 61.1 years; women, 54.8%; mean baseline hemoglobin level, 9.1 g/dL), 96.3% completed the trial. At week 12, the number of hemoglobin responders was significantly greater for ferric carboxymaltose vs placebo (92.2% [200 patients] for the ferric carboxymaltose group vs 54.0% [115 patients] for the placebo group; absolute difference, 38.2% [95% CI, 33.6%-42.8%]; P = .001). Compared with the placebo group, patients in the ferric carboxymaltose group experienced significantly greater improvements in serum ferritin level (week 12: 233.3 ng/mL for the ferric carboxymaltose group vs 53.4 ng/mL for the placebo group; absolute difference, 179.9 ng/mL [95% CI, 150.2-209.5]; P = .001) and transferrin saturation level (week 12: 35.0% for the ferric carboxymaltose group vs 19.3% for the placebo group; absolute difference, 15.7% [95% CI, 13.1%-18.3%]; P = .001); but there were no significant differences in quality of life. Patients in the ferric carboxymaltose group required less alternative anemia management than patients in the placebo group (1.4% for the ferric carboxymaltose group vs 6.9% for the placebo group; absolute difference, 5.5% [95% CI, 3.3%-7.6%]; P = .006). The total rate of adverse events was higher in the ferric carboxymaltose group (15 patients [6.8%], including injection site reactions [5 patients] and urticaria [5 patients]) than the placebo group (1 patient [0.4%]), but no severe adverse events were reported in either group. CONCLUSION AND RELEVANCE Among adults with isovolemic anemia following radical gastrectomy, the use of ferric carboxymaltose compared with placebo was more likely to result in improved hemoglobin response at 12 weeks. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01725789.
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Affiliation(s)
- Young-Woo Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jae-Moon Bae
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Kyu Park
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wansik Yu
- Center for Gastric Cancer, Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Jeong Hwan Yook
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Gastrointestinal Surgery, Yonsei University Health System, Seoul, Republic of Korea
| | - Mira Han
- Cancer Registration and Biostatistics Branch, Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Tae Sung Sohn
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Oh Kyoung Kwon
- Center for Gastric Cancer, Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Seung Yeob Ryu
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Jun-Ho Lee
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Min-Gew Choi
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Beom Su Kim
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Oh Jeong
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon-Won Yoo
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In Seob Lee
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Ran Jung
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Ji Yeong An
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Gastrointestinal Surgery, Yonsei University Health System, Seoul, Republic of Korea
| | - Youngsook Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hannah Yang
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Byung-Ho Nam
- Cancer Registration and Biostatistics Branch, Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea
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Montano-Pedroso JC, Garcia EB, Novo NF, Veiga DF, Ferreira LM. Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial. Trials 2016; 17:196. [PMID: 27068478 PMCID: PMC4828756 DOI: 10.1186/s13063-016-1300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/17/2016] [Indexed: 12/13/2022] Open
Abstract
Background Anaemia and iron deficiency are common complications following post-bariatric abdominoplasty. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that postoperative intravenously administered iron supplementation could be used to treat anaemia and to prevent the development of iron deficiency in these patients. Methods/Design In this multicentre open-label randomised clinical trial, 56 adult women undergoing post-bariatric anchor-line abdominoplasty will be allocated at a ratio of 1:1 for postoperative supplementation with two intravenously administered applications of 200 mg of iron saccharate or postoperative supplementation with 100 mg of iron polymaltose complex administered orally, twice a day for 8 weeks. The primary outcome is the difference in mean haemoglobin levels between the two groups at eight postoperative weeks. Secondary outcomes evaluated at one, four and eight postoperative weeks include iron profile, reticulocyte count, overall quality of life measured using the Short-Form 36 Health Survey (SF-36) questionnaire, fatigue measured using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), adverse effects and postoperative complications. Discussion This randomised clinical trial aims to evaluate the haematopoietic effectiveness of intravenously administered iron supplementation in patients undergoing post-bariatric abdominoplasty. A more effective recovery of haemoglobin levels could help improve the patients’ quality of life and could provide an improved haematological status in preparation for the subsequent and frequent plastic surgeries these patients undergo. Trial registration Clinicaltrials.gov Identifier: NCT01857011 (8 May 2013), Universal Trial Number U111-1169-6223, Brazilian Clinical Trials Registry (REBEC): RBR-2JGRKQ.
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Affiliation(s)
- Juan Carlos Montano-Pedroso
- Division of Plastic Surgery, Graduate Program in Translational Surgery, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil.
| | - Elvio Bueno Garcia
- Division of Plastic Surgery, Graduate Program in Translational Surgery, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
| | - Neil Ferreira Novo
- Division of Plastic Surgery, Graduate Program in Translational Surgery, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
| | - Daniela Francescato Veiga
- Division of Plastic Surgery, Graduate Program in Translational Surgery, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Graduate Program in Translational Surgery, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
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Toblli JE, Angerosa M. Optimizing iron delivery in the management of anemia: patient considerations and the role of ferric carboxymaltose. Drug Des Devel Ther 2014; 8:2475-91. [PMID: 25525337 PMCID: PMC4266270 DOI: 10.2147/dddt.s55499] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
With the challenge of optimizing iron delivery, new intravenous (iv) iron-carbohydrate complexes have been developed in the last few years. A good example of these new compounds is ferric carboxymaltose (FCM), which has recently been approved by the US Food and Drug Administration for the treatment of iron deficiency anemia in adult patients who are intolerant to oral iron or present an unsatisfactory response to oral iron, and in adult patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). FCM is a robust and stable complex similar to ferritin, which minimizes the release of labile iron during administration, allowing higher doses to be administered in a single application and with a favorable cost-effective rate. Cumulative information from randomized, controlled, multicenter trials on a diverse range of indications, including patients with chronic heart failure, postpartum anemia/abnormal uterine bleeding, inflammatory bowel disease, NDD-CKD, and those undergoing hemodialysis, supports the efficacy of FCM for iron replacement in patients with iron deficiency and iron-deficiency anemia. Furthermore, as FCM is a dextran-free iron-carbohydrate complex (which has a very low risk for hypersensitivity reactions) with a small proportion of the reported adverse effects in a large number of subjects who received FCM, it may be considered a safe drug. Therefore, FCM appears as an interesting option to apply high doses of iron as a single infusion in a few minutes in order to obtain the quick replacement of iron stores. The present review on FCM summarizes diverse aspects such as pharmacology characteristics and analyzes trials on the efficacy/safety of FCM versus oral iron and different iv iron compounds in multiple clinical scenarios. Additionally, the information on cost effectiveness and data on change in quality of life are also discussed.
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Affiliation(s)
- Jorge Eduardo Toblli
- Nephrology Section, Department of Internal Medicine, Hospital Alemán, School of Medicine, University of Buenos Aires, Argentina
| | - Margarita Angerosa
- Nephrology Section, Department of Internal Medicine, Hospital Alemán, School of Medicine, University of Buenos Aires, Argentina
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