Ferumoxytol versus other intravenous iron therapies for anemia

Anemia, particularly iron deficiency anemia, is a common complication in patients with end stage chronic kidney disease (CKD, stage disease and those on dialysis). CKD patients have a deficiency in endogenous erythropoietin (a hormone that stimulates the production of red blood cells) often requiring supplementation with erythropoiesis-stimulating agents (ESA), which results in increased utilization of iron, depleting iron stores. Additionally CKD patients have reduced iron intake, compromised gastrointestinal iron absorption and bleeding (including blood loss during the dialysis process). Evidence suggests that intravenous (IV) iron is preferred to oral for patients receiving ESA therapy and undergoing dialysis. For non-dialysis patients there is insufficient evidence to suggest the preferential use of IV formulations, therefore oral therapy should be tried first and IV iron used if there is an inadequate response or the patient cannot tolerate oral therapy. Ferumoxytol (Feraheme) is an intravenous iron formulation available in Canada for the treatment of iron deficiency anemia (IDA) in adults with CKD. This report will review the comparative efficacy, safety and cost-effectiveness data of ferumoxytol relative to the alternative IV iron preparations available in Canada. It will also review evidence based guidelines for the use of ferumoxytol.