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      Intravenous ferric derisomaltose versus saccharated ferric oxide for iron deficiency anemia associated with menorrhagia: a randomized, open-label, active-controlled, noninferiority study

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          Abstract

          A multicenter, randomized, open-label, phase III study was conducted to compare the efficacy and safety of intravenous ferric derisomaltose (FDI) versus saccharated ferric oxide (SFO) in Japanese patients with iron deficiency anemia associated with menorrhagia. FDI can be administered as a single dose up to 1000 mg, whereas SFO has a maximum single dose of 120 mg. The primary endpoint, which was the maximum change in hemoglobin concentration from baseline, was noninferior for the FDI group compared with the SFO group. The incidence of treatment-emergent adverse events was lower in the FDI group (66.2%) than in the SFO group (90.8%). Notably, the incidence of serum phosphorus level < 2.0 mg/dL was significantly lower in the FDI group (8.4%) than in the SFO group (83.2%), and severe hypophosphatemia (≤ 1.0 mg/dL) occurred in 6.7% of SFO‑treated patients compared with none in the FDI group. The percentage of patients who achieved the cumulative total iron dose during the 8-week treatment period was higher in the FDI group (92.8%) than in the SFO group (43.2%). The study met its primary endpoint, and also demonstrated the tolerability of a high dose of FDI per infusion, with a lower incidence of hypophosphatemia.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s12185-022-03401-0.

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          Iron-deficiency anemia.

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            Iron deficiency

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              Hepcidin and iron homeostasis.

              Despite fluctuations in dietary iron intake and intermittent losses through bleeding, the plasma iron concentrations in humans remain stable at 10-30 μM. While most of the iron entering blood plasma comes from recycling, appropriate amount of iron is absorbed from the diet to compensate for losses and maintain nontoxic amounts in stores. Plasma iron concentration and iron distribution are similarly regulated in laboratory rodents. The hepatic peptide hepcidin was identified as the systemic iron-regulatory hormone. In the efferent arc, hepcidin regulates intestinal iron absorption, plasma iron concentrations, and tissue iron distribution by inducing degradation of its receptor, the cellular iron exporter ferroportin. Ferroportin exports iron into plasma from absorptive enterocytes, from macrophages that recycle the iron of senescent erythrocytes, and from hepatocytes that store iron. In the more complex and less well understood afferent arc, hepatic hepcidin synthesis is transcriptionally regulated by extracellular and intracellular iron concentrations through a molecular complex of bone morphogenetic protein receptors and their iron-specific ligands, modulators and iron sensors. Through as yet undefined pathways, hepcidin is also homeostatically regulated by the iron requirements of erythroid precursors for hemoglobin synthesis. In accordance with the role of hepcidin-mediated iron redistribution in host defense, hepcidin production is regulated by inflammation as well. Increased hepcidin concentrations in plasma are pathogenic in iron-restrictive anemias including anemias associated with inflammation, chronic kidney disease and some cancers. Hepcidin deficiency causes iron overload in hereditary hemochromatosis and ineffective erythropoiesis. Hepcidin, ferroportin and their regulators represent potential targets for the diagnosis and treatment of iron disorders and anemias. This article is part of a Special Issue entitled: Cell Biology of Metals. Copyright © 2012 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                hkawabat@kuhp.kyoto-u.ac.jp
                Journal
                Int J Hematol
                Int J Hematol
                International Journal of Hematology
                Springer Nature Singapore (Singapore )
                0925-5710
                1865-3774
                6 July 2022
                6 July 2022
                2022
                : 116
                : 5
                : 647-658
                Affiliations
                [1 ]GRID grid.410835.b, Department of Hematology, , National Hospital Organization Kyoto Medical Center, ; Kyoto, Japan
                [2 ]GRID grid.420045.7, ISNI 0000 0004 0466 9828, Clinical Development Department, , Nippon Shinyaku Co., Ltd, ; Kyoto, Japan
                [3 ]GRID grid.420045.7, ISNI 0000 0004 0466 9828, Data Science Department, , Nippon Shinyaku Co., Ltd, ; Kyoto, Japan
                [4 ]GRID grid.505613.4, ISNI 0000 0000 8937 6696, Department of Obstetrics, Gynecology and Family Medicine, , Hamamatsu University School of Medicine, ; Hamamatsu, Shizuoka Japan
                Author information
                http://orcid.org/0000-0002-1918-8635
                Article
                3401
                10.1007/s12185-022-03401-0
                9588477
                35790696
                0fcfd4f1-aced-4f38-ac8b-3da7d87c3e08
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 23 February 2022
                : 2 June 2022
                : 3 June 2022
                Funding
                Funded by: Nippon Shinyaku Co., Ltd.
                Categories
                Original Article
                Custom metadata
                © Japanese Society of Hematology 2022

                Hematology
                ferric derisomaltose,iron deficiency anemia,intravenous iron preparation,hypophosphatemia

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