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Piotr Ponikowski - One of the best experts on this subject based on the ideXlab platform.

  • effects of intravenous Iron Therapy in Iron deficient patients with systolic heart failure a meta analysis of randomized controlled trials
    European Journal of Heart Failure, 2016
    Co-Authors: Ewa A. Jankowska, Tomasz Suchocki, Michał Tkaczyszyn, Stephan Von Haehling, Wolfram Doehner, W. Banasiak, Marcin Drozd, Gerasimos Filippatos, Stefan D Anker, Piotr Ponikowski
    Abstract:

    Aims The aim of this study was to assess the net clinical and prognostic effects of intravenous (i.v.) Iron Therapy in patients with systolic heart failure (HF) and Iron deficiency (ID). Methods and results We performed an aggregate data meta-analysis (random effects model) of randomized controlled trials that evaluated the effects of i.v. Iron Therapy in Iron-deficient patients with systolic HF. We searched electronic databases up to September 2014. We identified five trials which fulfilled the inclusion criteria (509 patients received i.v. Iron Therapy in comparison with 342 controls). Intravenous Iron Therapy has been shown to reduce the risk of the combined endpoint of all-cause death or cardiovascular hospitalization [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.30–0.64, P < 0.0001], and the combined endpoint of cardiovascular death or hospitalization for worsening HF (OR 0.39, 95% CI 0.24–0.63, P = 0.0001). Intravenous Iron Therapy resulted in a reduction in NYHA class (data are reported as a mean net effect with 95% CIs for all continuous variables) (−0.54 class, 95% CI −0.87 to −0.21, P = 0.001); an increase in 6-min walking test distance (+31 m, 95% CI 18–43, P < 0.0001); and an improvement in quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ) score +5.5 points, 95% CI 2.8–8.3, P < 0.0001; European Quality of Life–5 Dimensions (EQ-5D) score +4.1 points, 95% CI 0.8–7.3, P = 0.01; Minnesota Living With Heart Failure Questionnaire (MLHFQ) score −19 points, 95% CI:–23 to −16, P < 0.0001; and Patient Global Assessment (PGA) +0.70 points, 95% CI 0.31–1.09, P = 0004]. Conclusion The evidence indicates that i.v. Iron Therapy in Iron-deficient patients with systolic HF improves outcomes, exercise capacity, and quality of life, and alleviates HF symptoms.

  • Effects of intravenous Iron Therapy in Iron‐deficient patients with systolic heart failure: a meta‐analysis of randomized controlled trials
    European journal of heart failure, 2016
    Co-Authors: Ewa A. Jankowska, Tomasz Suchocki, Michał Tkaczyszyn, Stephan Von Haehling, Wolfram Doehner, W. Banasiak, Marcin Drozd, Gerasimos Filippatos, Stefan D Anker, Piotr Ponikowski
    Abstract:

    Aims The aim of this study was to assess the net clinical and prognostic effects of intravenous (i.v.) Iron Therapy in patients with systolic heart failure (HF) and Iron deficiency (ID). Methods and results We performed an aggregate data meta-analysis (random effects model) of randomized controlled trials that evaluated the effects of i.v. Iron Therapy in Iron-deficient patients with systolic HF. We searched electronic databases up to September 2014. We identified five trials which fulfilled the inclusion criteria (509 patients received i.v. Iron Therapy in comparison with 342 controls). Intravenous Iron Therapy has been shown to reduce the risk of the combined endpoint of all-cause death or cardiovascular hospitalization [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.30–0.64, P < 0.0001], and the combined endpoint of cardiovascular death or hospitalization for worsening HF (OR 0.39, 95% CI 0.24–0.63, P = 0.0001). Intravenous Iron Therapy resulted in a reduction in NYHA class (data are reported as a mean net effect with 95% CIs for all continuous variables) (−0.54 class, 95% CI −0.87 to −0.21, P = 0.001); an increase in 6-min walking test distance (+31 m, 95% CI 18–43, P < 0.0001); and an improvement in quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ) score +5.5 points, 95% CI 2.8–8.3, P < 0.0001; European Quality of Life–5 Dimensions (EQ-5D) score +4.1 points, 95% CI 0.8–7.3, P = 0.01; Minnesota Living With Heart Failure Questionnaire (MLHFQ) score −19 points, 95% CI:–23 to −16, P < 0.0001; and Patient Global Assessment (PGA) +0.70 points, 95% CI 0.31–1.09, P = 0004]. Conclusion The evidence indicates that i.v. Iron Therapy in Iron-deficient patients with systolic HF improves outcomes, exercise capacity, and quality of life, and alleviates HF symptoms.

  • EFFECTS OF INTRAVENOUS Iron Therapy IN Iron DEFICIENT PATIENTS WITH SYSTOLIC HEART FAILURE: META-ANALYSIS OF RANDOMIZED CONTROL TRIALS
    Journal of the American College of Cardiology, 2015
    Co-Authors: Ewa A. Jankowska, Tomasz Suchocki, Michał Tkaczyszyn, Stephan Von Haehling, Wolfram Doehner, W. Banasiak, Stefan Anker, Piotr Ponikowski
    Abstract:

    Iron deficiency (ID) is an ominous co-morbidity commonly found in patients with systolic heart failure (HF), and Iron Therapy is presumed to bring clinical benefits. We performed a meta-analysis of all randomized control trials that compared the effects of intravenous Iron Therapy with either no

Ewa A. Jankowska - One of the best experts on this subject based on the ideXlab platform.

  • effects of intravenous Iron Therapy in Iron deficient patients with systolic heart failure a meta analysis of randomized controlled trials
    European Journal of Heart Failure, 2016
    Co-Authors: Ewa A. Jankowska, Tomasz Suchocki, Michał Tkaczyszyn, Stephan Von Haehling, Wolfram Doehner, W. Banasiak, Marcin Drozd, Gerasimos Filippatos, Stefan D Anker, Piotr Ponikowski
    Abstract:

    Aims The aim of this study was to assess the net clinical and prognostic effects of intravenous (i.v.) Iron Therapy in patients with systolic heart failure (HF) and Iron deficiency (ID). Methods and results We performed an aggregate data meta-analysis (random effects model) of randomized controlled trials that evaluated the effects of i.v. Iron Therapy in Iron-deficient patients with systolic HF. We searched electronic databases up to September 2014. We identified five trials which fulfilled the inclusion criteria (509 patients received i.v. Iron Therapy in comparison with 342 controls). Intravenous Iron Therapy has been shown to reduce the risk of the combined endpoint of all-cause death or cardiovascular hospitalization [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.30–0.64, P < 0.0001], and the combined endpoint of cardiovascular death or hospitalization for worsening HF (OR 0.39, 95% CI 0.24–0.63, P = 0.0001). Intravenous Iron Therapy resulted in a reduction in NYHA class (data are reported as a mean net effect with 95% CIs for all continuous variables) (−0.54 class, 95% CI −0.87 to −0.21, P = 0.001); an increase in 6-min walking test distance (+31 m, 95% CI 18–43, P < 0.0001); and an improvement in quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ) score +5.5 points, 95% CI 2.8–8.3, P < 0.0001; European Quality of Life–5 Dimensions (EQ-5D) score +4.1 points, 95% CI 0.8–7.3, P = 0.01; Minnesota Living With Heart Failure Questionnaire (MLHFQ) score −19 points, 95% CI:–23 to −16, P < 0.0001; and Patient Global Assessment (PGA) +0.70 points, 95% CI 0.31–1.09, P = 0004]. Conclusion The evidence indicates that i.v. Iron Therapy in Iron-deficient patients with systolic HF improves outcomes, exercise capacity, and quality of life, and alleviates HF symptoms.

  • Effects of intravenous Iron Therapy in Iron‐deficient patients with systolic heart failure: a meta‐analysis of randomized controlled trials
    European journal of heart failure, 2016
    Co-Authors: Ewa A. Jankowska, Tomasz Suchocki, Michał Tkaczyszyn, Stephan Von Haehling, Wolfram Doehner, W. Banasiak, Marcin Drozd, Gerasimos Filippatos, Stefan D Anker, Piotr Ponikowski
    Abstract:

    Aims The aim of this study was to assess the net clinical and prognostic effects of intravenous (i.v.) Iron Therapy in patients with systolic heart failure (HF) and Iron deficiency (ID). Methods and results We performed an aggregate data meta-analysis (random effects model) of randomized controlled trials that evaluated the effects of i.v. Iron Therapy in Iron-deficient patients with systolic HF. We searched electronic databases up to September 2014. We identified five trials which fulfilled the inclusion criteria (509 patients received i.v. Iron Therapy in comparison with 342 controls). Intravenous Iron Therapy has been shown to reduce the risk of the combined endpoint of all-cause death or cardiovascular hospitalization [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.30–0.64, P < 0.0001], and the combined endpoint of cardiovascular death or hospitalization for worsening HF (OR 0.39, 95% CI 0.24–0.63, P = 0.0001). Intravenous Iron Therapy resulted in a reduction in NYHA class (data are reported as a mean net effect with 95% CIs for all continuous variables) (−0.54 class, 95% CI −0.87 to −0.21, P = 0.001); an increase in 6-min walking test distance (+31 m, 95% CI 18–43, P < 0.0001); and an improvement in quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ) score +5.5 points, 95% CI 2.8–8.3, P < 0.0001; European Quality of Life–5 Dimensions (EQ-5D) score +4.1 points, 95% CI 0.8–7.3, P = 0.01; Minnesota Living With Heart Failure Questionnaire (MLHFQ) score −19 points, 95% CI:–23 to −16, P < 0.0001; and Patient Global Assessment (PGA) +0.70 points, 95% CI 0.31–1.09, P = 0004]. Conclusion The evidence indicates that i.v. Iron Therapy in Iron-deficient patients with systolic HF improves outcomes, exercise capacity, and quality of life, and alleviates HF symptoms.

  • EFFECTS OF INTRAVENOUS Iron Therapy IN Iron DEFICIENT PATIENTS WITH SYSTOLIC HEART FAILURE: META-ANALYSIS OF RANDOMIZED CONTROL TRIALS
    Journal of the American College of Cardiology, 2015
    Co-Authors: Ewa A. Jankowska, Tomasz Suchocki, Michał Tkaczyszyn, Stephan Von Haehling, Wolfram Doehner, W. Banasiak, Stefan Anker, Piotr Ponikowski
    Abstract:

    Iron deficiency (ID) is an ominous co-morbidity commonly found in patients with systolic heart failure (HF), and Iron Therapy is presumed to bring clinical benefits. We performed a meta-analysis of all randomized control trials that compared the effects of intravenous Iron Therapy with either no

George M. Rodgers - One of the best experts on this subject based on the ideXlab platform.

  • Continuing Education Article Intravenous Iron Therapy: A Summary of Treatment Options and Review of Guidelines
    2016
    Co-Authors: Scott B. Silverstein, Jeffrey A. Gilreath, George M. Rodgers
    Abstract:

    By the end of the article, the reader should be able to: 1. Describe the differences in pharmacology between parenteral Iron products 2. List the adverse consequences of Iron overload 3. Discuss how parenteral Iron Therapy may benefit chronic kidney disease and oncology patients receiving ESAs 4. Understand the limitations that Iron studies have in diagnosing and treating absolute and functional Iron-deficiency anemia Iron replacement for Iron-deficiency anemia has his-torically been accomplished with the use of oral Iron Therapy. Although oral Iron is appropriate for most Iron-deficiency anemia patients, many patients do not respond to or may be intolerant of oral Iron, or may experience bleeding of sufficient magnitude to require higher Iron doses than that achievable with oral Iron. Intravenous Iron Therapy is a useful option for these latter patients. Three intravenous Iron products are recommended: low-molecular weight Iron dextran (INFeD), ferric gluconate (Ferrlecit), and Iron sucrose (Venofer). These intravenous Iron products have superior safety profiles compared to high-molecular weight Iron dextran. The Food and Drug Administration’s approval of erythropoietic-stimulating agents to treat cer-tain types of anemia has increased usage of intravenous Iron for functional Iron deficiency. This review sum-marizes the current status of intravenous Iron products and discusses their advantages and disadvantages in treat-ing both absolute and functional Iron deficiency

  • Intravenous Iron Therapy: A Summary of Treatment Options and Review of Guidelines
    Journal of Pharmacy Practice, 2008
    Co-Authors: Scott B. Silverstein, Jeffrey A. Gilreath, George M. Rodgers
    Abstract:

    Iron replacement for Iron-deficiency anemia has historically been accomplished with the use of oral Iron Therapy. Although oral Iron is appropriate for most Iron-deficiency anemia patients, many patients do not respond to or may be intolerant of oral Iron, or may experience bleeding of sufficient magnitude to require higher Iron doses than that achievable with oral Iron. Intravenous Iron Therapy is a useful option for these latter patients. Three intravenous Iron products are recommended: low-molecular weight Iron dextran (INFeD), ferric gluconate (Ferrlecit), and Iron sucrose (Venofer). These intravenous Iron products have superior safety profiles compared to high-molecular weight Iron dextran. The Food and Drug Administration's approval of erythropoietic-stimulating agents to treat certain types of anemia has increased usage of intravenous Iron for functional Iron deficiency. This review summarizes the current status of intravenous Iron products and discusses their advantages and disadvantages in treati...

  • Intravenous Iron Therapy: a summary of treatment options and review of guidelines
    2008
    Co-Authors: Scott B. Silverstein, Jeffrey A. Gilreath, George M. Rodgers
    Abstract:

    Iron replacement for Iron-deficiency anemia has his-torically been accomplished with the use of oral Iron Therapy. Although oral Iron is appropriate for most Iron-deficiency anemia patients, many patients do not respond to or may be intolerant of oral Iron, or may experience bleeding of sufficient magnitude to require higher Iron doses than that achievable with oral Iron. Intravenous Iron Therapy is a useful option for these latter patients. Three intravenous Iron products are recom-mended: low-molecular weight Iron dextran (INFeD), ferric gluconate (Ferrlecit), and Iron sucrose (Venofer). These intravenous Iron products have superior safety profiles compared to high-molecular weight Iron dextran. The Food and Drug Administration’s approval of erythropoietic-stimulating agents to treat certain types of anemia has increased usage of intravenous Iron for functional Iron deficiency. This review summarizes the current status of intravenous Iron products and dis-cusses their advantages and disadvantages in treating both absolute and functional Iron deficiency

  • Parenteral Iron Therapy: A Single Institution's Experience Over a 5-Year Period
    Journal of the National Comprehensive Cancer Network : JNCCN, 2005
    Co-Authors: Christopher A. Laman, Scott B. Silverstein, George M. Rodgers
    Abstract:

    Many patients require parenteral Iron Therapy for optimal correction of anemia, including cancer patients who require erythropoietic drugs. Available parenteral Iron Therapy options include Iron dextran, Iron gluconate, and Iron sucrose. The purpose of this study is to summarize our institution's experience with parenteral Iron Therapy over a 5-year period, with a focus on comparative safety profiles. All patients receiving parenteral Iron Therapy over this period were included in the analysis. Chi-squared test and Fisher's exact test were used to compare the adverse event rates of each product. A total of 121 patients received 444 infusions of parenteral Iron over this period. Iron dextran was the most commonly used product (85 patients) and Iron sucrose was the least used (2 patients). Iron gluconate was used by 34 patients. Overall adverse event rates per patient with Iron dextran and Iron gluconate were 16.5% and 5.8%, respectively (P = .024). Premedication with diphenhydramine and acetaminophen before infusions of Iron dextran reduced adverse event rates per infusion from 12.3% to 4.4% (P = .054). Test doses of Iron dextran were used 88% of the time for initial infusions of Iron dextran. All adverse events for all parenteral Iron products were mild or moderate. There were no serious adverse events and no anaphylaxis was observed. Our results suggest that, if test doses and premedications are used, Iron dextran is an acceptable product to treat Iron deficiency.

  • Parenteral Iron Therapy options.
    American journal of hematology, 2004
    Co-Authors: Scott B. Silverstein, George M. Rodgers
    Abstract:

    Parenteral Iron Therapy is occasionally necessary for patients intolerant or unresponsive to oral Iron Therapy, for receiving recombinant erythropoietin Therapy, or for use in treating functional Iron deficiency. There are now three parenteral Iron products available: Iron dextran, ferric gluconate, and Iron sucrose. We summarize the advantages and disadvantages of each product, including risk of anaphylaxis and hypersensitivity, dosage regimens, and costs. The increased availability of multiple parenteral Iron preparations should decrease the need to use red cell transfusions in patients with Iron-deficiency anemia.

Iain C. Macdougall - One of the best experts on this subject based on the ideXlab platform.

  • Intravenous Iron Therapy in patients with chronic kidney disease: recent evidence and future directions.
    Clinical kidney journal, 2017
    Co-Authors: Iain C. Macdougall
    Abstract:

    Current recommendations for the use of intravenous Iron Therapy in the management of anaemia in patients with chronic kidney disease (CKD) are based on limited clinical evidence. Since the publication of the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anaemia in Chronic Kidney Disease in 2012, a number of randomized clinical trials [notably, the Ferinject Assessment in Patients with Iron Deficiency Anaemia (FIND-CKD) and Randomized Trial to Evaluate IV and Oral Iron in Chronic Kidney Disease (REVOKE) trials] and observational studies have been completed, and a further large clinical trial-Proactive IV Iron Therapy in Dialysis Patients (PIVOTAL)-is currently underway. In this article, the implications of the findings from these recent studies are discussed and the critical evidence gaps that remain to be addressed are highlighted.

  • Iron Therapy for the treatment of Iron deficiency in chronic heart failure intravenous or oral
    European Journal of Heart Failure, 2015
    Co-Authors: Theresa Mcdonagh, Iain C. Macdougall
    Abstract:

    This article considers the use and modality of Iron Therapy to treat Iron deficiency in patients with heart failure, an aspect of care which has received relatively little attention compared with the wider topic of anaemia management. Iron deficiency affects up to 50% of heart failure patients, and is associated with poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. The European Society of Cardiology Guidelines for heart failure 2012 recommend a diagnostic work-up for Iron deficiency in patients with suspected heart failure. Iron absorption from oral Iron preparations is generally poor, with slow and often inefficient Iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in heart failure due to decreased gastrointestinal absorption and poor compliance due to pill burden. Evidence for clinical benefits using oral Iron is lacking. I.v. Iron sucrose has consistently been shown to improve exercise capacity, cardiac function, symptom severity, and quality of life. Similar findings were observed recently for i.v. ferric carboxymaltose in patients with systolic heart failure and impaired LVEF in the double-blind, placebo-controlled FAIR-HF and CONFIRM-HF trials. I.v. Iron Therapy may be better tolerated than oral Iron, although confirmation in longer clinical trials is awaited. Routine diagnosis and management of Iron deficiency in patients with symptomatic heart failure regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using i.v. Iron Therapy should now be considered.

Hakan Ozdogu - One of the best experts on this subject based on the ideXlab platform.

  • Safety, therapeutic effectiveness, and cost of parenteral Iron Therapy
    International Journal of Hematology, 2009
    Co-Authors: Suheyl Asma, Can Boga, Hakan Ozdogu
    Abstract:

    Patients have to discontinue the use of oral Iron Therapy due to the development of side effects and lack of long-term adherence to medication for Iron deficiency anemia. This study aimed to evaluate the therapeutic effectiveness, safety, and cost of intravenous Iron sucrose Therapy. The computerized database and medical records of 453 patients diagnosed with Iron deficiency anemia who received intravenous Iron sucrose Therapy for Iron deficiency anemia between 2004 and 2008 were reviewed. The improvement of hematologic parameters and cost of Therapy were evaluated 4 weeks after Therapy. 453 patients (443 females, 10 males; age: 44.2 ± 12.3 years) received Iron sucrose Therapy. Mean hemoglobin, hematocrit, and mean corpuscular volume values were 8.2 ± 1.4 g/dL, 26.9 ± 3.8%, and 66.1 ± 7.8 fL, respectively, before Therapy and 11.5 ± 1.0 g/dL, 35.8 ± 2.5%, 76.5 ± 6.1 fL, respectively, after Therapy ( P < 0.001). A mean ferritin level of 3.4 ± 2.4 ng/mL before Therapy increased to 65.9 ± 40.6 ng/mL after Therapy ( P < 0.001). All patients responded to intravenous Iron Therapy (transferrin saturation values of the patients were >50%). The mean cost of Therapy was 143.07 ± 29.13 US dollars. The Therapy was well tolerated. Although the cost of intravenous Iron sucrose Therapy may seem high, a lack of adherence to Therapy and side effects including gastrointestinal irritation during oral Iron Therapy were not experienced during intravenous Therapy.

  • Safety, therapeutic effectiveness, and cost of parenteral Iron Therapy
    International journal of hematology, 2009
    Co-Authors: Suheyl Asma, Can Boga, Hakan Ozdogu
    Abstract:

    Patients have to discontinue the use of oral Iron Therapy due to the development of side effects and lack of long-term adherence to medication for Iron deficiency anemia. This study aimed to evaluate the therapeutic effectiveness, safety, and cost of intravenous Iron sucrose Therapy. The computerized database and medical records of 453 patients diagnosed with Iron deficiency anemia who received intravenous Iron sucrose Therapy for Iron deficiency anemia between 2004 and 2008 were reviewed. The improvement of hematologic parameters and cost of Therapy were evaluated 4 weeks after Therapy. 453 patients (443 females, 10 males; age: 44.2 ± 12.3 years) received Iron sucrose Therapy. Mean hemoglobin, hematocrit, and mean corpuscular volume values were 8.2 ± 1.4 g/dL, 26.9 ± 3.8%, and 66.1 ± 7.8 fL, respectively, before Therapy and 11.5 ± 1.0 g/dL, 35.8 ± 2.5%, 76.5 ± 6.1 fL, respectively, after Therapy (P 50%). The mean cost of Therapy was 143.07 ± 29.13 US dollars. The Therapy was well tolerated. Although the cost of intravenous Iron sucrose Therapy may seem high, a lack of adherence to Therapy and side effects including gastrointestinal irritation during oral Iron Therapy were not experienced during intravenous Therapy.