P131 Optimising intravenous iron therapy in hepatology patients at Kings College Hospital

<h3></h3> Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide.¹ In advanced chronic liver disease, two thirds of patients experience anaemia, with 7% having severe anaemia (Hb &lt;80).² At King’s College Hospital, ferric carboxymaltose (FCM) is used first line for IV iron replacement. However, as doses are capped, patients often require two infusions to complete treatment.³ As ferric derisomaltose (FDI) can be administered at higher doses with no dose capping, this may reduce the need for second infusions.⁴ The purpose of this study was to determine the appropriateness of IV iron dosing and to review if switching to FDI would reduce the number of infusions required to treat IDA. As FCM is associated with hypophosphataemia, this study aimed to review phosphate monitoring and the incidence of hypophosphataemia following FCM administration Hepatology admissions and associated dispensing data for FCM were retrospectively reviewed via the electronic patient record system between 01/01/24 and 31/03/24. Twenty patients were identified, and clinical records were reviewed to determine the appropriateness of dosing, the total number of infusions and phosphate levels. Equivalent FDI doses were calculated to determine the number of FDI infusions required. Of the 20 patients receiving FCM, 80% (16/20) required two infusions to complete dosing. Of those requiring a second infusion, 56% (9/16) did not receive this. When compared with equivalent dosing of FDI, 55% (11/20) of patients required two infusions to complete dosing. However, when the trust accepted underdosing of 20% was adopted, this was further reduced to 45% (9/20). Of the patients who were underdosed with FCM, 66.7% (6/9) required a singular dose of FDI to complete dosing. Of those receiving FCM, 55% (11/20) received phosphate monitoring within one month of treatment. In this group, 9% (1/11) had low phosphate post infusion. However, hypophosphataemia was reported prior to FCM administration in this patient. The use of FDI would reduce the number of patients requiring second doses of IV iron therapy. The NNT to reduce 1 patient visit is 2.86. Switching to FDI would increase clinic capacity and reduce hospital visits and associated costs. As phosphate monitoring for patients receiving FCM is suboptimal, switching to FDI would reduce the need for phosphate monitoring and patient improve safety. Although FDI has historically been contraindicated in patients with decompensated liver disease, FDI has been used off label in this patient cohort with no reported adverse outcomes. <h3>References</h3> British Society of Gastroenterology. BSG Guidelines for the Management of Iron Deficiency Anaemia in Adults [Internet]. www.bsg.org.uk. British Society of Gastroenterology (BSG); 2021 [cited 2025 Jun 2]. Available from: https://www.bsg.org.uk/clinical-resource/guidelines-iron-deficiency-anaemia-in-adults Scheiner B, Semmler G, Maurer F, Schwabl P, Bucsics TA, Paternostro R, <i>et al</i>. Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease. Liver International [Internet]. 2019 Sep 13 [cited 2025 Jun 2];40(1):194–204. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6973120/#:~:text=Anaemia%20is%20found%20in%20two,levels%20%3C8%20mg%2FdL. emc. Ferinject (ferric carboxymaltose) – Summary of Product Characteristics (SmPC) [Internet]. www.medicines.org.uk. emc; 2024 [cited 2025 Jun 2]. Available from: https://www.medicines.org.uk/emc/product/5910/smpc#gref emc. Monofer 100mg/ml solution for injection/infusion – Summary of Product Characteristics (SmPC) – (emc) [Internet]. www.medicines.org.uk. emc; 2025 [cited 2025 Jun 2]. Available from: https://www.medicines.org.uk/emc/product/5676/smpc#gref