New Guidelines Issued by a Number of Global Medical Committees Prioritise Management of Iron Deficiency to Improve Patient Outcomes
Lundi 17 septembre 2012, ↓ accès direct au téléchargement
The new Kidney Disease Guideline: Improving Global Outcomes Clinical Practice Guideline for Anaemia in Chronic Kidney Disease (hereafter referred to as the KDIGO Anaemia Guideline 2012)1 emphasises the importance of recognising and treating iron deficiency first in the treatment of anaemia.
The new European Society of Cardiology Heart Failure Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 (hereafter referred to as the ESC Guidelines HF 2012)2 recognise, for the first time, iron deficiency as a co-morbidity of heart failure (HF) and include evidence from the FAIR-HF study3, demonstrating the benefit of ferric carboxymaltose in chronic HF (CHF) patients with iron deficiency.
The recently updated version of the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Cancer- and Chemotherapy-Induced Anaemia (hereafter referred to as the NCCN Guidelines CIA 2012)4 recommend the use of intravenous (i.v.) iron in cancer patients to treat iron deficiency. The NCCN Guidelines CIA 2012 acknowledge that i.v. iron has improved efficacy to the more commonly used oral iron, and should be considered in combination with ESA supplementation.
Vifor Pharma welcomes the publication of the new KDIGO Anaemia Guideline 2012 on the management of anaemia in chronic kidney disease (CKD)1. The new Guideline highlights iron therapy as a cornerstone in the treatment of anaemia, emphasising the importance of recognising and treating iron deficiency in CKD patients. A key component of the KDIGO Anaemia Guideline 2012 is the recommendation to address all correctable causes of anaemia, including iron deficiency, before initiating treatment with erythropoiesis-stimulating agents (ESAs). Treatment with i.v. iron is noted as a way to treat iron deficiency anaemia, which can avoid or reduce the use of ESAs, avoid or minimise blood transfusions, and help treat anaemia-related conditions, potentially through enhancing erythropoiesis and raising haemoglobin levels1.
The KDIGO Anaemia Guideline 2012 is the latest in a series of recommendations across a range of therapeutic areas that address the importance of treating iron deficiency. The recent ESC Guidelines HF 2012 recognised, for the first time, iron deficiency as a co-morbidity of heart failure (HF) in its own right, rather than only as a cause of anaemia2. The ESC Guidelines HF 2012 emphasise the importance of identifying and managing iron deficiency in HF patients since this condition is associated with poorer outcomes for patients with CHF. These include worse symptoms, decreased quality of life, impaired exercise capacity, greater risk of hospitalisation and reduced survival5,6. Assessment and monitoring of iron status is recommended for the first time as standard haematological tests in patients with suspected HF to optimise the management of iron deficiency.
The ESC Guidelines HF 2012 include evidence from the FAIR-HF study, designed to evaluate the use of i.v. iron (ferric carboxymaltose) in patients with CHF and iron deficiency3. Over 6 months of treatment, ferric carboxymaltose was found to significantly improve patient global assessment, New York Heart Association functional class, 6-minute walk test distance and health-related quality of life, which, together, demonstrate the benefit of i.v. ferric carboxymaltose in CHF patients with iron deficiency3.
“Iron deficiency is a debilitating condition that places a substantial burden on patients and negatively impacts their symptoms, exercise capacity and quality of life. The inclusion of ferric carboxymaltose as a treatment option within the ESC Guidelines HF 2012 is a significant development to help ensure that the management of iron deficiency is optimised. The widespread recognition by several new guidelines reinforces the importance of identifying and managing effectively iron deficiency in a number of disease areas, and ensuring that the appropriate treatment reflects the individual patient’s circumstances,” commented Iain Macdougall, Consultant Nephrologist and Professor of Clinical Nephrology at King's College Hospital in London, UK.
Iron deficiency and anaemia are also prevalent in cancer, with 30–90% of cancer patients experiencing anaemia7. Half of all patients present with anaemia following the fourth cycle of chemotherapy, resulting in a loss of quality of life, energy and physical function8. It is therefore important to ensure that this condition is managed effectively. “There is an increasing awareness of the need to manage iron deficiency in cancer patients, and a recent review9 recommends the reliable diagnosis and treatment of iron deficiency as key steps in modern cancer patient management” said Iain Macdougall.
In addition, the recently published NCCN Guidelines CIA 2012 recommend that, for patients receiving chemotherapy, i.v. iron products alone should be used for iron repletion in cancer patients with absolute iron deficiency. They also recommend that ESAs should be used in addition to i.v. iron to increase haematological response in patients with functional iron deficiency4. Further, these guidelines acknowledge that i.v. iron has improved efficacy to the more commonly used oral iron, and should be considered for ESA supplementation4.
Together, these guidelines represent a significant step towards broadening awareness among the medical community of the potential value of correcting iron deficiency with intravenous iron.
Vifor Pharma, une entreprise du Groupe Galenica, est l’un des leaders mondiaux en matière de découverte, développement, fabrication et commercialisation de produits pharmaceutiques utilisés dans le traitement de la carence en fer. La société propose également un portefeuille diversifié de produits de prescription et de produits délivrés sans ordonnance (OTC). Vifor Pharma, dont le siège est à Zurich (Suisse), étend sans cesse sa présence mondiale et dispose d’un vaste réseau de filiales et de partenaires dans le monde.
Ferinject® is an innovative non-dextran intravenous (i.v.) iron replacement therapy discovered and developed by Vifor Pharma, a company of the Galenica Group. Ferric carboxymaltose is the active pharmaceutical ingredient of Ferinject®. To date, Ferinject® has gained marketing authorisation in 40 countries worldwide for the treatment of iron deficiency where oral iron is ineffective or cannot be used. In many countries, intravenous iron replacement products are primarily used to treat dialysis patients. However, iron deficiency is also a complication of many other illnesses. Vifor Pharma is evaluating new opportunities in the treatment of iron deficiency with Ferinject® in different therapeutic areas. Further clinical trials with Ferinject® in chronic kidney disease (CKD), oncology (anaemia in cancer patients), cardiology (chronic heart failure), patient blood management and women’s health are ongoing.
Venofer®, the originator iron sucrose, is an intravenous iron therapy developed by Vifor Pharma. Venofer® is authorized worldwide in more than 80 countries for the treatment of iron deficiency and iron deficiency anaemia where there is a clinical need for a rapid iron supply or when oral iron is ineffective, not tolerated or patient non-compliance is an issue. To date over 5,000 patients have been documented in clinical studies. In many countries, intravenous (i.v.) iron therapies are primarily used to treat dialysis patients, and with an efficacy and safety profile distinct from iron sucrose similar therapies, Venofer® has become the most widely used i.v. iron product in hemodialysis patients.
1. Kidney Disease: Improving Global Outcomes (KDIGO) Anaemia Work Group. KDIGO Clinical Practice Guideline for Anaemia in Chronic Kidney Disease. Kidney Int Suppl 2012;2:279–335.
2. McMurray JJ, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;33:1787–1847.
3. Anker SD, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009;361:2436–2448.
4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Cancer- and Chemotherapy-Induced Anaemia. Version 1.2013. Available at: http://www.nccn.org
5. Jankowska EA, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010;31:1872–1880.
6. Okonko DO, et al. Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anaemia, exercise capacity, and survival. J Am Coll Cardiol 2011;58:1241–1251.
7. Knight K, et al. Prevalence and outcomes of anaemia in cancer: a systematic review of the literature. Am J Med 2004;116 Suppl 7A:11S–26S.
8. Ludwig H, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 2004;40:2293–2306.
9. Aapro M, et al. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol 2012;23:1954–1962.
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Head of Global Communications & Public Affairs