Supplementation with Iron in Pulmonary Arterial Hypertension. Two Randomized Crossover Trials.
Luke S G E HowardJianguo HeGeoffrey M J WatsonLi HuangJohn WhartonQin LuoDavid G KielyRobin CondliffeJoanna Pepke-ZabaNicholas W MorrellKaren K ShearesAnna UlrichRuilin QuanZhihui ZhaoXiaoli JingChenhong AnZhihong LiuChangming XiongPeter A RobbinsTimothy DawesAntonio de MarvaoChristopher J RhodesManuel J RichterHenning GallHossein A GhofraniLan ZhaoLes HusonMartin R WilkinsPublished in: Annals of the American Thoracic Society (2021)
Rationale: Iron deficiency, in the absence of anemia, is common in patients with idiopathic and heritable pulmonary arterial hypertension (PAH) and is associated with a worse clinical outcome. Oral iron absorption may be impeded by elevated circulating hepcidin concentrations. The safety and benefit of parenteral iron replacement in this patient population is unclear. Objectives: To evaluate the safety and efficacy of parenteral iron replacement in PAH. Methods: In two randomized, double-blind, placebo-controlled 12-week crossover studies, 39 patients in Europe received a single infusion of ferric carboxymaltose (Ferinject) (1,000 mg or 15 mg/kg if weight <66.7 kg) or saline as placebo, and 17 patients in China received iron dextran (Cosmofer) (20 mg iron/kg body weight) or saline placebo. All patients had idiopathic or heritable PAH and iron deficiency at entry as defined by a serum ferritin <37 μg/L or iron <10.3 μmol/L or transferrin saturations <16.4%. Results: Both iron treatments were well tolerated and improved iron status. Analyzed separately and combined, there was no effect on any measure of exercise capacity (using cardiopulmonary exercise testing or 6-minute walk test) or cardiopulmonary hemodynamics, as assessed by right heart catheterization, cardiac magnetic resonance, or plasma NT-proBNP (N-terminal-pro hormone brain natriuretic peptide) at 12 weeks. Conclusions: Iron repletion by administration of a slow-release iron preparation as a single infusion to patients with PAH with iron deficiency without overt anemia was well tolerated but provided no significant clinical benefit at 12 weeks. Clinical trial registered with ClinicalTrials.gov (NCT01447628).
Keyphrases
- iron deficiency
- double blind
- placebo controlled
- pulmonary arterial hypertension
- clinical trial
- end stage renal disease
- phase iii
- magnetic resonance
- ejection fraction
- open label
- newly diagnosed
- phase ii
- peritoneal dialysis
- physical activity
- study protocol
- body mass index
- pulmonary artery
- prognostic factors
- low dose
- magnetic resonance imaging
- case report
- polycyclic aromatic hydrocarbons
- computed tomography
- body composition
- atrial fibrillation
- radiation therapy
- locally advanced
- anti inflammatory
- subarachnoid hemorrhage