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

BACKGROUND: To compare the effectiveness and safety of intravenous iron (VI) formulations used to treat iron deficiency in children. STUDY DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.