Ferric Carboxymaltose Outperforms Iron Sucrose in Treating Iron Deficiency Anemia

A recent study has revealed that ferric carboxymaltose (FCM) exhibits an advantage over iron sucrose (IS) in treating iron deficiency anemia (IDA) in adults, particularly in the form of a statistically significant improvement in hemoglobin (Hb) levels comparatively.1

IDA, recognized as the most common nutritional deficiency in the world, affects 30% of the global population. Given that iron is required for a range of cellular functions including oxygen transport, mitochondrial energy generation, and DNA synthesis, the symptoms of IDA can vary greatly. Reduced blood oxygen levels can cause compensatory decreases in intestinal blood flow, which can in turn trigger motility disorder and malabsorption.2

FCM and IS are 2 of the most widely utilized intravenous iron therapies for IDA. Previous studies have investigated the comparative efficacy and safety of FCM and IS; however, these studies often display varying results. This spectrum of outcomes indicates the inherent variability in the impacts of FCM and IS across different patient populations.1

“To date, there have been no systematic reviews comparing FCM and IS in the management of IDA regardless of etiology,” wrote Lokman Hekim Tanrıverdi, MD, PhD, Inonu University Department of Medical Pharmacology, and colleagues. “Given the need for more conclusive evidence, we conducted a systematic review and meta-analysis of [randomized controlled trials (RCTs)] to compare the efficacy and safety of FCM and IS in the treatment of IDA.”1

Tanrıverdi and colleagues initially identified a total of 688 records; of these, a total of 14 RCTs involving 4757 patients were included in the study. The primary efficacy outcome of the study was change in Hb level during follow-up, while the primary safety outcome was risk of serious or severe adverse events.1

The 14 RCTs were subsequently categorized based on underlying IDA causes; 3 studies investigated IDA resulting from gynecological disorders, 3 for impaired iron absorption, 3 for impaired renal function, 2 for postpartum anemia, 1 for pregnancy-related IDA, and 2 involving patients with mixed etiologies.1

Of these, 12 RCTs, involving 4734 patients, saw FCM result in a significant increase in Hb levels during follow-up compared to IS (mean difference [MD], .45 g/dL; 95% CI, .08 to .83, I2: 97%, P = .02). Stratification by etiology of anemia also indicated a substantial improvement in Hb levels due to FCM in patients with postpartum anemia (MD, 1.04 g/dL; 95% CI, .75-1.33, P <.01), but inverse results were obtained for hemodialysis patients (MD, -.24 g/dL; 95% CI, -.53 to .04, P <.01) compared to IS.1

A significant difference in favor of postpartum anemia for FCM was also noted when studies were classified based on impaired iron absorption (MD: .17 g/dL; 95% CI, -.34 to .69), impaired renal function (MD: -.09 g/dL; 95% CI, -.46 to .28), gynecological disorders (MD, .26 g/dL; 95% CI, -.62 to 1.14), postpartum anemia (MD: 1.04 g/dL; 95% CI, .75 to 1.33), and mixed etiology (MD: 1.1 g/dL; 95% CI, -.36 to 2.56).1

The team also noted that the pooled risk for severe adverse events was comparable between FCM and IS (RR, 1.03; 95% CI, .88 to 1.21, P = .7). This suggests that both FCM and IS have acceptable safety profiles without clinically meaningful differences in serious adverse events.1

Tanriverdi and colleagues wrote that this study demonstrates the potential advantage of FCM over IS in improving both Hb and ferritin levels in patients with IDA. However, they caution some degree of skepticism, as not all trials utilized in the study reported on adverse events.1

“This systematic review and meta-analysis has demonstrated the potential advantage of FCM over IS in improving Hb and ferritin levels, particularly among patients with gynecological disorders underlying IDA,” Tanrıverdi and colleagues wrote. “While the two iron preparations demonstrated comparable efficacy in the general population, the findings of this review underscore the important of considering the specific etiology of anemia when choosing between these treatments.”1

References

1. Tanrıverdi LH, Sarıcı A. Efficacy, Safety, and Tolerability of Ferric Carboxymaltose and Iron Sucrose in Iron-Deficiency Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Turk J Haematol. 2025;42(2):119-135. doi:10.4274/tjh.galenos.2025.2025.0034

2. Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol. 2022;9(1):e000759. doi:10.1136/bmjgast-2021-000759