Date Published: 
Friday, 10 October, 2014

An update on intravenous iron sucrose for the treatment of iron deficiency and iron deficiency anaemia

Dr Yves Beguin

Iron sucrose is a frequently used intravenous iron compound for the treatment of iron deficiency and iron deficiency anemia in a broad range of therapeutic areas, including in patients with conditions such as chronic kidney disease, inflammatory bowel disease, pregnancy (second and third trimester), postpartum period, heavy menstrual bleeding and cancer.

Intravenous iron may be considered in patients with: 1) functional iron deficiency, where iron stores are present (normal ferritin) but not available (transferrin saturation decreased), and impaired iron absorption due to chronic inflammatory conditions; or 2) in those with absolute iron deficiency, where there are no iron stores (low ferritin and low transferrin saturation), and rapid resolution of iron deficit is necessary. Oral iron is often used as first-line treatment in patients with absolute iron deficiency, if resolution of iron deficiency is not time critical.

Intravenous iron is often administered to patients with impaired iron absorption, such as those with chronic inflammatory conditions. There is a common misconception that intravenous iron is trapped in macrophages in inflammatory conditions. However, iron release from macrophages is only reduced in this state, rather than completely blocked. Therefore, intravenous iron may be administered to individuals with inflammation and confirmed absolute iron deficiency (serum ferritin <100 ng/ml or transferrin saturation <20%).

Iron therapy is also commonly administered to patients with impaired iron absorption and rapidly increasing iron requirements, such as anaemic cancer patients being treated with erythropoietin stimulating agents (ESAs). Intravenous iron may enhance response to and substantially reduce dose of ESAs, which can result in improved overall cost-effectiveness of ESA treatment in this patient population.

Iron sucrose has an extensive safety record in a wide range of patients with iron deficiency. The most commonly reported adverse event is taste disturbance and the incidence of serious drug-related adverse events is low. Three analyses of surveillance data covering the period from 1997 to 2009 confirmed iron sucrose was well-tolerated, even in patients with prior intolerance to iron dextran or iron gluconate. No patient with intolerance to iron dextran or iron gluconate had an anaphylactic reaction to iron sucrose.

There is no evidence for an increased rate of infections or a risk of tumour progression with intravenous iron used according to the label. However, this area of research requires further investigation. Intravenous iron should not be used in patients with active infection. 

Administration of oral or intravenous iron formulations, such as iron sucrose, is the recommended treatment for iron deficiency anaemia and has proven efficacy in many patient populations. However, further research is required to better understand suboptimal treatment in specific patients groups, such as those with pre-operative anaemia and those with active infection.