Железодефицитные новости

[Dr.Vad]

Оценка безопасности в/в пр-тов железа (монофер против феринджекта) на примере лечения 2 тысяч пациенток - гипофосфатемия развивалась у каждой третьей на фоне феринджекта:

This randomized, multicenter, double-blind clinical trial compared the safety and efficacy of ferumoxytol versus ferric carboxymaltose (FCM), focusing on rates of hypersensitivity reactions and hypotension as the primary end point. Patients with iron deficiency anemia of any etiology in whom oral iron was unsatisfactory or intolerable received ferumoxytol (n = 997) or FCM (n = 1000) intravenously over ≥15 minutes on days 1 and 8 or 9 for total respective doses of 1.02 g and 1.50 g. Composite incidences of moderate-to-severe hypersensitivity reactions, including anaphylaxis, or moderate-to-severe hypotension from baseline to week 5 (primary safety end point) were 0.6% and 0.7% in the ferumoxytol and FCM groups, respectively, with ferumoxytol noninferior to FCM. No anaphylaxis was reported in either group. The secondary safety end point of incidences of moderate-to-severe hypersensitivity reactions, including anaphylaxis, serious cardiovascular events, and death from baseline to week 5 were 1.3% and 2.0% in the ferumoxytol and FCM groups, respectively (noninferiority test P < .0001). Least-squares mean changes in hemoglobin at week 5 were 1.4 g/dL and 1.6 g/dL in the ferumoxytol and FCM groups, respectively (noninferiority test P < .0001). Incidence of hypophosphatemia was 0.4% for ferumoxytol and 38.7% for FCM.
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Am J Hematol. 2018 Feb 8.
Comparative safety of intravenous ferumoxytol vs ferric carboxymaltose in iron deficiency anemia: A randomized trial.

[Dr.Vad]

Железо в лечении синдрома беспокойных ног - рекомендации международного консенсуса:

Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children.
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Sleep Med. 2018 Jan;41:27-44.
Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report.
Allen RP & International Restless Legs Syndrome Study Group (IRLSSG).

[Dr.Vad]

Итальянские доктора показали, что у недоношенных детей (менее 32 недель) назначение железа бисглицината в дозе 0.75 мг/кг было эквивалентным 3 мг/кг сульфата по лечению ЖДА вместе с эритропоэтином:
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Curr Pediatr Rev. 2018 Jan 23.
Iron supplementation with iron sulfate versus iron bisglycinate chelate in preterm newborns.

[Dr.Vad]

Iron status among vegetarians is likely a result of several factors:
1) The bulk of iron consumed by vegetarians is in its less bioavailable form, non-heme iron.
2) Plant foods contain potent iron-absorption inhibitors, including phytates, oxalates, and phenolic compounds.
3) Although iron intake among vegetarians is often higher than among non-vegetarians, iron requirements for vegetarians is about 1.8 times higher compared to non-vegetarians. Thus, iron intake among vegetarians falls short of their needs.
Although vitamin C enhances iron absorption, relatively high intake of vitamin C among vegetarians does not guarantee adequate iron status. It would be prudent for vegetarians to utilize iron-fortified products. They may also benefit from periodic use of iron supplements.
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Iron Status of Vegetarian Children: A Review of Literature
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

В/в железо в дозе 500 мг похоже недостаточная доза для лечения с-ма беспокойных ног: отличия в сравнении с плацебо были статистически незначимы и только у 22% пролеченных феринджектом не было необходимости в лечении СБН в течение 30 недель после введения.

This study did not show significant benefit from a single 500 mg FCM treatment for RLS symptoms. The two previous, well-controlled, trials of 1000 mg FCM showed significant treatment benefits which suggested that there may have been a clinically relevant total dose required to achieve a clinical response.
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Sleep Med. 2018 Feb;42:7-12.
Efficacy of ferric carboxymaltose (FCM) 500 mg dose for the treatment of Restless Legs Syndrome.

[Dr.Vad]

Длительное наблюдение за лечением СБН препаратом железа при обнаружении его дефицита, как причины: у 60% симптоматика сохранялась на протяжении 2-3 лет, персистирование симптомов ассоциировалась с возрастом и длительностью болезни, раннее обнаружение ЖД и лечение может повысить шансы на успешную ремиссию:

Over the observation period of 2.5±1.4 years, 15 patients reported no RLS symptom whereas 24 patients still complained of RLS symptoms. The remission rate of RLS with iron replacement was 38.5%. The relative risk of symptom persistence was increased by the duration of RLS symptoms (OR: 1.88, 95% CI: 1.01-3.49) or by the age at RLS diagnosis (OR: 1.25, 95% CI: 1.01-1.56).
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Psychiatry Investig. 2018 Feb 28.
Symptom Persistence after Iron Normalization in Women with Restless Legs Syndrome.
Bang YR и соавт.

[Dr.Vad]

весьма интересная работа проделана австралийскими медиками - они проанализировали соотношение ферритина и множества эритроцитарных показателей крови у детей/подростков и посмотрели на каком уровне ферритина эти показатели перестают повышаться (достигают плато), чтобы определить минимальное значение для разграничения между дефицитом железа и его достаточностью с точки зрения гемопоэза: результат оказался примерно таким, какими цифрами мы уже пользуемся на форуме для детей -

до 5 лет - ферритин 26-27 мг/л
5-13 лет - ферритин 30 мг/л
13-18 лет - ферритин 39 мг/л
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Br J Haematol. 2018 Feb 21.
Ferritin as a functional biomarker of iron status in children and young adults.
Markus C и соавторы, полный текст
[Ссылки доступны только зарегистрированным пользователям ]