Iron Isomaltoside Comparable to Iron Sucrose in Anemia Treatment

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A meta-analysis of four RCTs found Iron isomaltoside ferumoxytol is both effective and safe to treat iron deficiency anemia.

A recent meta-analysis of four randomized controlled trials (RCTs) found comparable efficacy between iron isomaltoside ferumoxytol and iron sucrose in the treatment of iron deficiency anemia.1

The analysis, encompassing nearly 4000 patients with anemia, revealed a single dose of intravenous iron isomaltoside ferumoxytol and repeated doses of oral iron sucrose exhibited comparable changes in hemoglobin (Hb), serum ferritin, and transferrin saturation.

“Iron isomaltoside is effective and safe to treat iron deficiency anemia and may benefit to reduce the risk of cardiovascular events,” wrote the investigative team led by Lunbo Shu, Fenghua District People’s Hospital of Ningbo.

Individuals with iron deficiency anemia may experience impaired health-related quality of life, shown by a reduced ability to work, fatigue, and diminished physical and cognitive functioning. 2Oral iron supplementation is a first-line treatment for the condition, but some individuals require intravenous iron when oral iron is neither effective nor tolerated.

Iron isomaltoside, or ferric derisomaltose, is a novel intravenous iron formulation consisting of iron and a carbohydrate moiety.1 The efficacy and safety of iron isomaltoside ferumoxytol compared with iron sucrose for iron deficiency anemia have not been well-explored in recent literature. Owing to conflated results in these studies, Shu and colleagues compared the efficacy and safety of iron isomaltoside ferumoxytol with iron sucrose on anemia.

Two investigators independently searched databases, including PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library, from inception through March 2021. The search strategy was performed using keywords: “iron isomaltoside ferumoxytol,” “iron sucrose,” and “anemia.” Selection criteria were patients diagnosed with iron deficiency anemia, intervention treatment of iron isomaltoside ferumoxytol versus iron sucrose, and an RCT study design.

From each RCT, investigators extracted data on the author, number of patients, age, female, Hb levels, and transferrin saturation. The primary outcome was a change in Hb levels, with secondary outcomes involving Hb responder, serum ferritin, transferrin saturation, serum-ferritin at week 2, and adverse events. A meta-analysis was conducted using a random-effects model.

The search initially identified 249 potentially relevant articles—98 duplicates and 142 papers were excluded after checking the titles/abstracts, and two trials were removed due to the study design. After exclusions, four RCTs were included in the meta-analysis. These four studies were published between 2015 and 2021 and included 3892 patients.

Iron isomaltoside was administered as a single 1000mg dose, and iron sucrose was administered at 100 or 200 mg dose multiple times. Upon analysis, compared with iron sucrose for anemia, iron isomaltoside exhibited similar Hb change (standard mean difference [SMD], 0.14 [95% CI, –0.07 to 0.35]; P = .18), with significant heterogeneity among the studies (P = .0001).

Secondary outcome data revealed iron isomaltoside also exhibited comparable Hb responder (SMD, 1.41 [95% CI, 0.71 to 2.81]; P = .33), serum ferritin (SMD, 15.13 [95% CI, –23.45 to 53.71]; P = .44), and transferrin saturation (SMD, 1.20 [95% CI, –1.08 to 3.47]; P = .30) as iron sucrose for anemia.

Meanwhile, iron isomaltoside was associated with significantly improved serum ferritin at week 2 compared with iron sucrose (SMD, 204.79 [95% CI, 38.23 to 371.35]; P =.02). Overall, the incidence of adverse events was similar among the two treatment groups (odds ratio [OR], 1.11 [95% CI, 0.68 to 1.82]; P = .68). Shu and colleagues indicated the safety of iron isomaltoside is now confirmed in this meta-analysis.

“The efficacy and safety of iron isomaltoside ferumoxytol is confirmed in this meta-analysis, as evidenced by no increase in adverse events compared to oral iron sucrose,” they wrote.


  1. Shi L, Zhao Y, Rao A. Comparison of iron isomaltoside ferumoxytol with iron sucrose for iron deficiency anemia: a meta-analysis of randomized controlled trials. Afr Health Sci. 2023;23(3):205-212. doi:10.4314/ahs.v23i3.25
  2. Larson LM, Phiri KS, Pasricha SR. Iron and Cognitive Development: What Is the Evidence?. Ann Nutr Metab. 2017;71 Suppl 3:25-38. doi:10.1159/000480742