iron dextran / Generic mfg. - LARVOL DELTA

Parental replacement therapy with iron dextran or ferumoxytol in patients with iron defiency (ASH 2025) - "In patients with iron deficiency, the change of the hematological parameters after replacement therapy was not statistically different between iron dextran and ferumoxytol. Our data suggests that these two formulations have similar efficacy and safety after the IV administration of a single dose of 1,020 mg."

Clinical • Hematological Disorders

Real world evidence of treatment patterns in hereditary hemorrhagic telangiectasia (ASH 2025) - "Treatment examinedincluded bevacizumab, pazopanib, pomalidomide, aminocaproate, tranexamic acid (TXA), octreotide,lanreotide, thalidomide, tacrolimus, sirolimus, tamoxifen and raloxifene...The majority of HHT patients were treated withferrous sulfate (n=910), followed by iron sucrose, ferrous gluconate, ferric carboxymaltose, iron dextran,and ferric derisomaltose...While 8% of patients treated with TXA had VTE, the data does not support a definitiveconclusion of increased VTE in patients treated with anti-fibrinolytics. To further elucidate treatmentpractices in HHT, a multi-center approach incorporating review of medical records would providevaluable insights into real-world practices."

Clinical • HEOR • Real-world • Real-world evidence • Anemia • Aplastic Anemia • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Renal Disease • Venous Thromboembolism

Cost analysis compared with efficacy shows iron dextran surpassing other intravenous iron formulations in children: A tertiary children's hospital experience (ASH 2025) - "Overall, IDx may be the preferred IVI formulation inchildren based on our center's experience. Future multi-center studies are needed to confirm our results."

Clinical • Cost-analysis • HEOR • Hematological Disorders

High versus low-cost intravenous iron in Medicare: Utilization patterns of iron infusions in traditional fee-for-service Medicare and Medicare advantage for iron deficiency anemia (ASH 2025) - "The mostcommon infusions were iron sucrose (43%), ferric carboxymaltose (23%), ferumoxytol (18%), iron dextran(8%), ferric gluconate (6%) and derisomaltose (1%). This could be due to incentivedifferences offered by various plan structures in MA relative to TM. Future research should assess thedownstream implications of these patterns overtime, on outcomes and on cost-effectiveness."

Medicare • Reimbursement • US reimbursement • Anemia • Chronic Kidney Disease • Hematological Disorders • Nephrology • Renal Disease

Safety and efficacy analysis of IV iron formulations in children: Results from a large pediatric cohort (ASH 2025) - "Statistical analysis was performed usingWilcoxon signed-rank test for paired analysis of pre/post treatment labs, Kruskal-Wallis test as well aslinear mixed model for comparison of Hgb/ferritin improvement across IVI formulations, and Chi-squareanalysis as well as logistic mixed model for comparison of adverse effects.Results Our study included 344 patients, receiving a total of 661 IVI treatments [237(35.9%) iron sucrose (IS),226(34.2%) iron dextran (IDx), 155(23.4%) ferric carboxymaltose (FCM), 41(6.2%) ferric gluconate (FG),2(0.3%) ferumoxytol (FM)]. Limitations of this study include its retrospective nature and potentialselection bias. Prospective studies in children are needed to validate our findings."

Clinical • Celiac Disease • Chronic Kidney Disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Nephrology • Pediatrics

A quality improvement project to improve the delivery rate of IV iron to patients admitted with severe gastrointestinal hemorrhage (ASH 2025) - "An increase in the proportion of IV iron dextran utilization was seen over the course of thisquality improvement project; however, the proportion of patients being treated with IV iron was relativelystable. Subsequent PDSA cycles should focus on clinical care pathways and electronic medical recordalerts to more reliably identify patients at risk of ID who could benefit from IV iron therapy prior todischarge."

Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Hematological Disorders • Renal Disease

Therapeutic effects of Tmprss6 suppression are negated by iron overload in a mouse model of beta-thalassemia (ASH 2025) - "C57BL/6 mice were either treatedwith 10 mg of i.p. iron dextran prior to the previously described Tmprss6 ASO treatment or placed on5000 ppm high iron diet throughout the duration of the Tmprss6 ASO treatment...Neither serum and tissue iron, nor CBCs were altered in thesehigh iron groups after Tmprss6 inhibition.Overall, we have demonstrated that while Tmprss6 inhibition is effective in increasing hepcidin andimproving thalassemia under usual iron-replete conditions, its effect is blunted in the presence of moresevere iron overload caused by either high ERFE concentrations or by the administration of exogenousiron. Similar factors may make patients with beta-thalassemia resistant to treatments targeting Tmprss6."

Preclinical • Anemia • Beta-Thalassemia • Genetic Disorders • Hematological Disorders • ERFE • HAMP • TMPRSS6

Raising the bar in maternofetal hematology: Cost-effectiveness of iron deficiency screening in pregnancy across ferritin-based thresholds (ASH 2025) - "If found to be iron deficient, patientswere treated with a single dose of 1g intravenous iron dextran... The identification and treatment of ID beginning in the second trimester at a ferritinthreshold of <30µg/L is the cost-effective intervention, in comparison to a threshold of <15µg/L or noscreening. These results fill a critical gap in maternofetal medicine and may help inform the forthcomingAmerican Society of Hematology Clinical Practice Guidelines on the Diagnosis and Treatment of IronDeficiency."

Cost effectiveness • HEOR • Hematological Disorders • Postpartum Hemorrhage

Implementation of a multidisciplinary quality improvement project standardizing an approach to screening and treating iron deficiency in pregnancy (ASH 2025) - "ID in pregnancy is underrecognized and undertreated. Through a multidisciplinary QIinitiative, screening for ID improved from 10% to over 60% of pregnancies within one year of projectinitiation. Over the same period, there was a 20-fold increase in the number of IV iron dextran infusionsresulting in an increase in median hemoglobin by over 1 g/dL and a signal for decreased transfusionrequirements."

Anesthesia • Hematological Disorders • Obstetrics

Additional intramuscular iron injections tended to improve post-weaning growth when administered at weaning, but not at day seven of life. (PubMed, Transl Anim Sci) - "A total of 440 mixed sex pigs were used in this experiment in three treatment groups: control: only receiving iron dextran two days after birth; day 7: receiving iron injections at days two and seven after birth; Weaning iron: receiving iron dextran injections on day two and at weaning (20.1 days)...Plasma hepcidin anti-microbial peptide, was elevated in the weaning iron group after injection, possibly impairing enteric iron absorption. An additional injection at weaning showed potential for improved growth in the post-weaning period and has practical advantages for producers."

Journal • Hematological Disorders

Economic evaluation of intravenous iron formulations for patients with iron deficiency anemia: a systematic review. (PubMed, Front Health Serv) - "Six studies compared ferric carboxymaltose (FCM) with iron sucrose (IS); two studies compared FCM, ferric derisomaltose (FDI), and IS; one study compared FCM, iron dextran (ID), and IS; one study compared FCM, IS, ID, and FDI at three dose levels; one study obtained an economic ranking for FCM, ID, IS, and ferrous gluconate (FG); five studies compared FDI and FCM; and one study compared FDI with IS...Current evidence suggests that the efficacy of FDI is better than IS, and the economic ranking of the four intravenous iron formulations can be summarized as FCM, ID, IS, and FG. Further research is needed to justify the economic comparison between FCM and FDI."

HEOR • Journal • Review • Anemia • Hematological Disorders

DIVI: Darbe Plus IV Iron to Decrease Transfusions While Maintaining Iron Sufficiency in Preterm Infants (clinicaltrials.gov) - P2 | N=120 | Recruiting | Sponsor: University of Washington | Trial completion date: Dec 2027 ➔ Jun 2027 | Trial primary completion date: Dec 2025 ➔ Oct 2026

Trial completion date • Trial primary completion date • Anemia • Hematological Disorders

Iron dextran nanoparticles interacting with micrometric crosslinked protein scaffolds: Theoretical, computational and experimental results to design formulations for iron deficiency. (PubMed, Int J Biol Macromol) - "This is the first time that theoretical, computational and experimental studies were applied to IDN, multiple IDN and interactions with MCGS. These tools could be used for other protein scaffolds to predict drug encapsulation and delivery."

Journal • Hematological Disorders

Administration of green tea polyphenols mitigates iron-overload-induced bone loss in a β-thalassemia mouse model. (PubMed, NPJ Sci Food) - "This study assessed the effects of GTE on bone health in β-thalassemia knockout mice subjected to 4 weeks of iron dextran injections, followed by 2 months of daily oral treatment with deionized water, deferiprone (50 mg/kg), GTE (50 mg EGCG/kg), the combination of deferiprone and GTE, EGCG (50 mg/kg), or vitamin D3 (0.5 μg/kg ). GTE treatment reduced systemic iron burden, malondialdehyde, alkaline phosphatase, and parathyroid hormone, while improving femoral microarchitecture, bone mineral density, plasma calcium, and bone morphogenetic protein expression. These findings suggest GTE protects against iron-induced bone loss through combined chelation and antioxidation, supporting its potential as a therapeutic strategy."

Journal • Preclinical • Beta-Thalassemia • Genetic Disorders • Hematological Disorders • Osteoporosis • Rheumatology

Infusion Reactions with Alternative Therapies during the National Shortage of Iron Dextran (ASH 2023) - "The most common infusion formulation associated with a reaction was iron sucrose at its higher recommended dose of 500mg, compared with iron dextran and sodium ferric gluconate/sucrose. Providers should be aware of these associated adverse reactions with the different doses of alternative formulations when recommending infusions for patients, and the need for preemptive intervention."

Correction of Anemia with Intravenous Iron Mitigates Adverse Maternal Outcomes in Pregnancy (ASH 2023) - " We performed a cohort study of pregnant individuals (age ≥18 years) who received at least one IV infusion of an iron formulation (iron sucrose (IS), low molecular weight iron dextran (LMWID), or ferric carboxymaltose (FCM)) during their pregnancy at a single center from 2011-2022... Anemia status, regardless of severity, is associated with higher rates of maternal composite morbidity. Anemia on admission to L&D was less likely in those who received IV LMWID compared to those who received IV IS. The total dose of iron received was lower, on average, in those prescribed IS (despite the need for more infusion visits)."

Adverse events • Anemia • Cardiovascular • Gynecology • Hematological Disorders • Hypertension • Infectious Disease • Obstetrics • Postpartum Hemorrhage

Iron Deficiency Anemia: The Impact of Intravenous Iron Replacement Treatment on Health Care Costs (ASH 2023) - "Cohorts were classified based on index date treatment: FCM patients received ferric carboxymaltose; low-dose IV iron patients were treated with iron sucrose, iron dextran, or sodium ferric gluconate complex in sucrose. Despite the higher drug acquisition cost of FCM relative to low-dose IV iron, the drug price differential was offset by lower inpatient cost incurred in the FCM group. This resulted in similar all-cause total health care costs between FCM and low-dose IV iron in cancer and heart failure patients and lower total cost for FCM compared to low-dose IV iron in CKD patients. These results were more pronounced when comparing FCM with iron sucrose; the FCM group consistently had statistically lower total costs than iron sucrose in patients with cancer, HF and CKD."

HEOR • Anemia • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Hematological Disorders • Nephrology • Renal Disease

E-Iron: An Asynchronous Telemedicine Referral Platform for Management of Anemic Pregnant Patients and the Expediting of Treatment with Intravenous Iron (ASH 2023) - "Treatment consisted of 'single dose infusion' in 88% of infused patients, either using iron dextran 1g, - the Georgetown regimen - (68%), or iron carboxymaltose 750 mgs (19%)... E-IRON represents a successful implementation of an electronic, asynchronous, telemedicine protocol, that facilitates rapid triage and treatment of anemic pregnant patients requiring IVI. We have shown that the earlier infusion is administered, the greater the increment in Hb, which underscores the value of a protocol that minimizes the time interval between referral and infusion. The speed of IVI administration since implementation of e-IRON is unprecedented at our institution."

Clinical • Anemia • Hematological Disorders • Postpartum Hemorrhage

Intracellular Iron Controls HSC Metabolism By Affecting Mitochondrial Fitness (ASH 2023) - "To demonstrate a direct effect of iron on mitochondrial fitness in HSCs, we treated wt mice with iron dextran...Remarkably, MitoQ rescued the quiescence and self-renewal ability of th3 HSCs, as shown by superior chimerism in secondary transplantation of HSCs from MitoQ-treated th3 donors in lethally irradiated recipients (th3 HSC+MitoQ 81.7±1.6 vs. untreated th3 HSC 34.9±14.6 vs. % of chimerism, p<0.05), thus indicating that IO-derived ROS impair HSC function by affecting mitochondrial fitness and bioenergetics...Since mitochondria are defective, IO HSCs are unable to produce appropriate levels of ATP through OXPHOS and rely on glycolysis, despite their active cycling activity. Finally, the rescue of mitochondrial activity can restore the functional defects of th3 HSCs."

Anemia • Beta-Thalassemia • Genetic Disorders • Hematological Disorders • Metabolic Disorders • Sickle Cell Disease • GAPDH

Rker-216 Reversed Microcytic Anemia in a Mouse Model of Iron Refractory Iron Deficiency Anemia (ASH 2023) - "For IV iron, KO mice were given a single dose of iron dextran at 100 mg/kg and evaluated on day 9...In fact, Hb and MCV of the 3 mg/kg-m216 cohort were restored to the levels of WT mice, indicating that microcytic anemia was fully resolved in this group. Conclusion These data suggest that m216 inhibited the BMP pathway to increase iron absorption via hepcidin suppression and was able to provide similar effects as iron infusion in reversing microcytic anemia in a mouse model of IRIDA."

Preclinical • Anemia • Genetic Disorders • Hematological Disorders • Inflammation • TMPRSS6

Ironing out the Wrinkles: Low Molecular Weight Iron Dextran and Premedications (ASH 2023) - "Serious infusion reactions with LMW ID were rare (n=2, 2.1%), and neither patient required epinephrine administration nor hospitalization...The incidence of AEs was compared with individual premedication, and lower incidences were seen in 64 (66.7%) patients with diphenhydramine (3.1% vs 18.8%, χ2 = 6.82; P =0.015), 50 (52.1%) with methylprednisolone (2.0% vs 15.2%, χ2 = 5.48; P =0.022), and 46 (47.9%) with acetaminophen (0.0% vs 16%, χ2 = 8.03; P =0.004)...By contrast, there was no significant difference in patients receiving famotidine, suggesting that while acetaminophen may be a useful premedication, famotidine may not be beneficial...Both our study and the prior multi-center study noted an increased incidence of infusion reactions in patients with a history of allergies, and both demonstrated the rarity of serious reactions. Based on these results and the prior studies indicating the increased cost of other IV iron formulations, consideration of reinstitution of LMW..."

Hematological Disorders • Hypotension • Immunology

Contemporary Intravenous Iron Usage and Safety Patterns (ASH 2023) - "While all formulations are considered safe, those with iron dextran (ID) are reported to have a relatively higher incidence of anaphylaxis, often prompting a test-dose prior to full administration...Serious adverse events (SAEs) were defined as those events requiring epinephrine administration, anaphylaxis, hypotension, tachycardia, or an allergic reaction (hives, rash, chest tightness, eye swelling) within 24 hours of IV iron infusion... A total of 49,310 infusions were administered during the analyzed period and included the use of five formulations: ID, iron sucrose (IS), ferumoxytol (FM), ferric carboxymaltose (FC), and ferric gluconate (FG)... While ID was found to have a relatively higher incidence of AEs, all IV iron formulations were found to be safe. The most frequently used formulation was IS, which had a low incidence of AEs even at higher doses, suggesting feasibility for minimizing the number of infusions required to achieve therapeutic levels. Although all..."

Clinical • Cardiovascular • Dermatology • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypotension • Nephrology • Obstetrics • Urticaria

Endothelial Hemoglobin Alpha Mediates Iron Regulation of Endothelial Nitric Oxide (ASH 2023) - "To restore vascular iron stores, a subset of IDA mice received a single i.p. injection of iron dextran (FeDex; 20 mg/kg) at 12 weeks...Lack of endothelial Hbα did not prevent the increased response to L-NAME in IDA mice, but did prevent the rescue by FeDex. These data suggest a model in which endothelial Hbα participates in regulating NO in response to iron, but not the increased NO in IDA."

Anemia • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Hematological Disorders • Inflammation • Nephrology • Renal Disease • CDH5 • FTL

Hematology Electronic Consultation As a Means for Effective Management of Iron Deficiency Anemia (ASH 2023) - "The most common IV iron formulations were low molecular weight iron dextran (43%) and ferumoxytol (30%), and adverse reactions were rare occurring in only 3.3% of patients. The results from this analysis demonstrate that e-consults permit efficient and safe management of iron deficiency, improve access to hematology care, and generate cost savings for the healthcare system. With the growing utilization of e-consults for iron deficiency evaluation and management, wait times to initial hematology evaluation may improve while access to care is simultaneously increased. Future quality improvement efforts, such as standardizing note templates to document suspected etiology and automating follow-up labs at the time of iron infusion, should be considered to expedite appropriate workup, reduce risk of incomplete repletion and recurrence of iron deficiency, and optimize educational opportunities for ordering providers."

Anemia • Hematological Disorders

Tranexamic Acid Reduces Large Traumatic Bleeding and Mortality in Murine Iron Deficiency Anemia By Mechanisms Beyond Control of Fibrinolysis (ASH 2023) - "Materials and Methods Severe IDA was generated in C57BL/6J mice by starting an iron-deficient diet in 3-week-old mice for 8 weeks (+/- 1 mg intraperitoneal iron dextran 2 weeks before trauma). This suggests that bleed and mortality rescue in IDA were less dependent on the anti-fibrinolytic effects of TXA, and more dependent on anti-inflammatory effects, which are poorly understood. These observations open new avenues to study pharmacodynamic effects of TXA beyond fibrinolysis inhibition, which may be particularly impactful for trauma rescue in the setting of anemia."

Preclinical • Anemia • Hematological Disorders • Hepatology • Liver Failure • IL10 • IL1B • IL2 • IL6 • TNFA