Key result
Ferric carboxymaltose beats oral iron for improving exercise capacity in HFrEF.
Why the study?
A direct comparison between intravenous ferric carboxymaltose and oral iron supplementation for treating iron deficiency in heart failure patients was lacking.
Meta-Analysis
Supports preferring IV ferric carboxymaltose over oral iron in iron-deficient HFrEF; extends placebo-controlled data via network meta-analysis.
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.
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Sciatti et al. (2021) conducted a meta-analysis in Heart failure with reduced ejection fraction and iron deficiency. Ferric carboxymaltose vs. Oral iron replacement and placebo was evaluated on Exercise capacity (6-minute walking test). Ferric carboxymaltose demonstrated better efficacy than oral iron replacement in improving exercise capacity and showed a trend toward improved quality of life in patients with heart failure with reduced ejection fraction.
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