https://doi.org/10.4081/monaldi.2021.1703
Indirect comparison between ferric carboxymaltose and oral iron replacement in heart failure with reduced ejection fraction: a network meta-analysis
Submitted: November 26, 2020
Accepted: January 26, 2021
Published: March 31, 2021
Accepted: January 26, 2021
Abstract Views: 4622
PDF: 867
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Treatment of iron deficiency (ID) in patients with heart failure (HF) has improved symptoms, quality of life, exercise capacity and has reduced hospitalizations in randomized controlled trials (RCTs) and meta-analyses. Intravenous ferric carboxymaltose (FCM) provided convincing results in this field, while oral iron supplementation failed. However, FCM and oral iron were compared to placebo, and a comparison between the two strategies is still lacking. We aimed to fill this gap of knowledge with an indirect comparison between them by means of a network meta-analysis of RCTs. Five studies measuring exercise capacity (i.e. 6-minute walking test) and quality of life (i.e. Kansas City Cardiomyopathy Questionnaire) were eligible to be included in our review. Given the limitations of a network meta-analysis, our findings support the better efficacy of FCM than oral iron as regards exercise capacity, with a trend towards an improvement in quality of life, suggesting that FCM seems to be strategy of choice to correct ID in HF patients.
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975.
DOI: https://doi.org/10.1002/ejhf.592
Metra M, Teerlink JR. Heart failure. Lancet 2017;390:1981-95.
DOI: https://doi.org/10.1016/S0140-6736(17)31071-1
van Deursen VM, Urso R, Laroche C, et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail 2014;16:103-11.
DOI: https://doi.org/10.1002/ejhf.30
Jankowska EA, Rozentryt P, Witkowska A, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010;31:1872-80.
DOI: https://doi.org/10.1093/eurheartj/ehq158
Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361:2436-48.
DOI: https://doi.org/10.1056/NEJMoa0908355
Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J 2015;36:657-68.
DOI: https://doi.org/10.1093/eurheartj/ehu385
Jankowska EA, Tkaczyszyn M, Suchocki T, et al. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail 2016;18:786-95.
DOI: https://doi.org/10.1002/ejhf.473
Anker SD, Kirwan BA, van Veldhuisen DJ, et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 2018;20:125-33.
DOI: https://doi.org/10.1002/ejhf.823
van Veldhuisen DJ, Ponikowski P, van der Meer P, et al. Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency. Circulation 2017;136:1374-83.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.027497
Dhoot S, Mittal S, Singh SP, et al. Effect of ferric-carboxy maltose on oxygen kinetics and functional status in heart failure patients with iron deficiency. Future Sci OA 2020;6:FSO467.
DOI: https://doi.org/10.2144/fsoa-2019-0156
Lewis GD, Malhotra R, Hernandez AF, et al. Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: The IRONOUT HF randomized clinical trial. JAMA 2017;317:1958-66.
DOI: https://doi.org/10.1001/jama.2017.5427
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 2009;6:e1000097.
DOI: https://doi.org/10.1371/journal.pmed.1000097
Equator Network [Internet]. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. Accessed: 2020 Oct 20. Available from: https://www.equator-network.org/reporting-guidelines/meta-analysis-of-observational-studies-in-epidemiology-a-proposal-for-reporting-meta-analysis-of-observational-studies-in-epidemiology-moose-group/
Reken S, Sturtz S, Kiefer C, et al. Assumptions of mixed treatment comparisons in health technology assessments: challenges and possible steps for practical application. PLoS One 2016;11:e0160712.
DOI: https://doi.org/10.1371/journal.pone.0160712
Jansen JP, Naci H. Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers. BMC Med 2013;11:159.
DOI: https://doi.org/10.1186/1741-7015-11-159
Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Methods 2012;3:80-97.
DOI: https://doi.org/10.1002/jrsm.1037
Veroniki AA, Vasiliadis HS, Higgins JP, Salanti G. Evaluation of inconsistency in networks of interventions. Int J Epidemiol 2013;42:332-45.
DOI: https://doi.org/10.1093/ije/dys222
Tonin FS, Rotta I, Mendes AM, Pontarolo R. Network meta-analysis: a technique to gather evidence from direct and indirect comparisons. Pharm Pract (Granada) 2017;15:943.
DOI: https://doi.org/10.18549/PharmPract.2017.01.943
Ioannidis JP, Cappelleri JC, Lau J. Issues in comparisons between meta-analyses and large trials. JAMA 1998;279:1089-93.
DOI: https://doi.org/10.1001/jama.279.14.1089
White IR. Network meta-analysis. Stata J 2015;15:951-85.
DOI: https://doi.org/10.1177/1536867X1501500403
Pereira TV, Horwitz RI, Ioannidis JP. Empirical evaluation of very large treatment effects of medical interventions. JAMA 2012;308:1676-84.
DOI: https://doi.org/10.1001/jama.2012.13444
Jansen JP, Fleurence R, Devine B, et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health 2011;14:417-28.
DOI: https://doi.org/10.1016/j.jval.2011.04.002
Jankowska EA, Malyszko J, Ardehali H, et al. Iron status in patients with chronic heart failure. Eur Heart J 2013;34:827-34.
DOI: https://doi.org/10.1093/eurheartj/ehs377
Melenovsky V, Petrak J, Mracek T, et al. Myocardial iron content and mitochondrial function in human heart failure: a direct tissue analysis. Eur J Heart Fail 2017;19:522-30.
DOI: https://doi.org/10.1002/ejhf.640
Stugiewicz M, Tkaczyszyn M, Kasztura M, et al. The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications. Eur J Heart Fail 2016;18:762-73.
DOI: https://doi.org/10.1002/ejhf.467
von Haehling S, Jankowska EA, van Veldhuisen DJ, et al. Iron deficiency and cardiovascular disease. Nat Rev Cardiol 2015;12:659-69.
DOI: https://doi.org/10.1038/nrcardio.2015.109
Núñez J, Comín-Colet J, Miñana G, et al. Iron deficiency and risk of early readmission following a hospitalization for acute heart failure. Eur J Heart Fail 2016;18:798-802.
DOI: https://doi.org/10.1002/ejhf.513
Ponikowski P, Kirwan B-A, Anker SD, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet 2020;396:1895-904.
DOI: https://doi.org/10.1016/S0140-6736(20)32339-4
European Medicines Agency [Internet]. Reflection paper on the data requirements for intravenous iron-based nano-colloidal products developed with reference to an innovator medicinal product. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-data-requirements-intravenous-iron-based-nano-colloidal-products-developed_en.pdf
Martin-Malo A, Borchard G, Flühmann B, et al. Differences between intravenous iron products: focus on treatment of iron deficiency in chronic heart failure patients. ESC Heart Fail 2019;6:241-53.
DOI: https://doi.org/10.1002/ehf2.12400
Supporting Agencies
Ethos s.r.l., via Berna 9 Sc, A Int, 1, 00144 Rome, ItalyHow to Cite
Sciatti, Edoardo, Ugo Nesti, and Andrea Di Lenarda. 2021. “Indirect Comparison Between Ferric Carboxymaltose and Oral Iron Replacement in Heart Failure With Reduced Ejection Fraction: A Network Meta-Analysis”. Monaldi Archives for Chest Disease 91 (3). https://doi.org/10.4081/monaldi.2021.1703.
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
