Journal article

Publication year: 2021

Pages: 981-988

Journal: Proceedings of the American Thoracic Society

Volume number: 18

Issue number: 6

ISSN: 1546-3222

eISSN: 2325-6621

Open access status: Hybrid

DOI Link: https://doi.org/10.1513/AnnalsATS.202009-1131OC

Publisher: American Thoracic Society

Abstract: 

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 mu g/L or iron <10.3 mu mol/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.

Harvard Citation style: Howard, L., He, J., Watson, G., Huang, L., Wharton, J., Luo, Q., et al. (2021) Supplementation with Iron in Pulmonary Arterial Hypertension Two Randomized Crossover Trials, Proceedings of the American Thoracic Society, 18(6), pp. 981-988. https://doi.org/10.1513/AnnalsATS.202009-1131OC

APA Citation style: Howard, L., He, J., Watson, G., Huang, L., Wharton, J., Luo, Q., Kiely, D., Condliffe, R., Pepke-Zaba, J., Morrell, N., Sheares, K., Ulrich, A., Quan, R., Zhao, Z., Jing, X., An, C., Liu, Z., Xiong, C., Robbins, P., ...Wilkins, M. (2021). Supplementation with Iron in Pulmonary Arterial Hypertension Two Randomized Crossover Trials. Proceedings of the American Thoracic Society. 18(6), 981-988. https://doi.org/10.1513/AnnalsATS.202009-1131OC