Gidaro Antonio, Delitala Alessandro Palmerio, Berzuini Alessandra, Soloski Mark J, Manca Pietro, Castro Dante, Salvi Emanuele, Manetti Roberto, Lambertenghi Deliliers Giorgio, Castelli Roberto
Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi N° 74, 20157 Milan, Italy.
Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro N° 8, 07100 Sassari, Italy.
J Clin Med. 2022 Aug 14;11(16):4744. doi: 10.3390/jcm11164744.
: Erythropoiesis-stimulating agents (ESAs) are used to treat refractory anemia (RA). Guidelines suggest iron supplementation for unresponsive patients, regardless of iron deficiency. The primary aim of this study was to evaluate the effect of iron supplementation with ferric carboxymaltose (FCM) on the reduction of red blood cell transfusion (RBCT) rate in transfusion-dependent RA patients. : This was a prospective quasi-randomized study, wherein patients were randomly assigned into three groups: (A) ESAs alone, (B) ferric gluconate (FG) and ESAs, and (C) FCM and ESAs. Hemoglobin and ferritin levels, as well as the number of RBCTs at 4 and 28 weeks were compared. Economic evaluation was also performed. : A total of 113 RA patients were enrolled. In total, 43 were treated with intravenous FG and ESAs, 38 with FCM and ESAs, and 32 with ESAs alone. At both follow-ups, erythropoietic response was increased in those receiving iron as compared with those with ESAs alone ( = 0.001), regardless of the type of iron. At one month, ferritin levels were higher in the FCM and ESA groups ( = 0.001). RBCTs were lower in both iron groups. The less costly treatment strategy was FCM, followed by FG, and lastly ESAs. : Addition of iron to ESAs in RA reduced RBCT requirement and improved hemoglobin values.
促红细胞生成素（ESAs）用于治疗难治性贫血（RA）。指南建议，无论是否缺铁，对无反应的患者补充铁剂。本研究的主要目的是评估羧基麦芽糖铁（FCM）补充铁剂对减少输血依赖型RA患者红细胞输注（RBCT）率的效果。
这是一项前瞻性半随机研究，患者被随机分为三组：（A）单独使用ESAs，（B）葡萄糖酸铁（FG）和ESAs，（C）FCM和ESAs。比较血红蛋白和铁蛋白水平，以及4周和28周时的RBCT数量。还进行了经济学评估。
共纳入113例RA患者。其中，43例接受静脉注射FG和ESAs治疗，38例接受FCM和ESAs治疗，32例仅接受ESAs治疗。在两次随访中，与仅接受ESAs治疗的患者相比，接受铁剂治疗的患者红细胞生成反应增加（P = 0.001），与铁剂类型无关。在1个月时，FCM和ESA组的铁蛋白水平更高（P = 0.001）。两个铁剂组的RBCT数量均较低。成本较低的治疗策略是FCM，其次是FG，最后是ESAs。
在RA患者中，ESAs联合铁剂可减少RBCT需求并改善血红蛋白值。
