Parental replacement therapy with iron dextran or ferumoxytol in patients with iron defiency

Abstract Background: Replacement therapy in patients with iron deficiency can be administered via oral or parenteral route. Two intravenous (IV) formulations commonly used in clinical practice are iron dextran and ferumoxytol, which can be administered at a fixed dose of 1,020 mg. We studied the changes in hematological parameters after a single IV infusion of either iron dextran or ferumoxytol. Methods: We conducted a retrospective review of 246 consecutive patients with iron deficiency seen at our institution in 2023 and 2024. Laboratory data were collected both at baseline and at 2-3 months after replacement therapy with 1,020 mg of either iron dextran (145 patients) or ferumoxytol (101 patients). Results: In the entire group of 246 patients, the median age was 55 years (range, 18-96 years), and 191 (78%) patients were females. The median hemoglobin (Hb) and ferritin levels at baseline and at 2-3 months after iron dextran were 9.7 (95% CI, 9.4-10.0) g/dL and 18 (95% CI, 24-35) mg/dL, and 11.9 (95% CI, 11.5-12.2) g/dL (p<0.0001) and 170 (95% CI, 144-195) mg/dL (p<0.0001), respectively. The median Hb and ferritin levels at baseline and at 3 months after ferumoxytol were 10.4 (95% CI, 10.1-10.8) g/dL and 36 (95% CI, 28-43) mg/dL, and 12.4 (95% CI, 12.1-12.8) g/dL (p<0.0001) and 189 (95% CI, 151-226) mg/dL (p<0.0001), respectively. No statistically significant difference was observed between iron dextran and ferumoxytol in change of Hb levels, ferritin, transferrin saturation, mean corpuscular volume (MCV), and red cell distribution width (RDW). Transfusion reactions with iron dextran and ferumoxytol were observed in 2 (1.4%) and 3 (3%) patients, respectively (p=0.65). Conclusion: In patients with iron deficiency, the change of the hematological parameters after replacement therapy was not statistically different between iron dextran and ferumoxytol. Our data suggests that these two formulations have similar efficacy and safety after the IV administration of a single dose of 1,020 mg.