Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe.

This post-authorisation safety study estimated the risk of anaphylaxis in patients receiving intravenous (IV) iron in Europe, with interest in iron dextran and iron non-dextrans. Studies conducted in the United States have reported risk of anaphylaxis to IV iron ranging from 2.0 to 6.8 per 10 000 first treatments. Cohort study of IV iron new users, captured mostly through pharmacy ambulatory dispensing, from populations covered by health and administrative data sources in five European countries from 1999 to 2017. Anaphylaxis events were identified through an algorithm that used parenteral penicillin as a positive control. A total of 304 210 patients with a first IV iron treatment (6367 iron dextran), among whom 13-16 anaphylaxis cases were identified and reported as a range to comply with data protection regulations. The pooled unadjusted incidence proportion (IP) ranged from 0.4 (95% confidence interval [CI], 0.2-0.9) to 0.5 (95% CI, 0.3-1.0) per 10 000 first treatments. No events were identified at first dextran treatments. There were 231 294 first penicillin treatments with 30 potential cases of anaphylaxis (IP = 1.2; 95% CI, 0.8-1.7 per 10 000 treatments). We found an IP of anaphylaxis from 0.4 to 0.5 per 10 000 first IV iron treatments. The study captured only a fraction of IV iron treatments administered in hospitals, where most first treatments are likely to happen. Due to this limitation, the study could not exclude a differential risk of anaphylaxis between iron dextran and iron non-dextrans. The IP of anaphylaxis in users of penicillin was consistent with incidences reported in the literature. © 2021 Vifor (International) AG. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Citation

Joan Fortuny, Gero von Gersdorff, Régis Lassalle, Marie Linder, Jetty Overbeek, Jonas Reinold, Gunnar Toft, Antje Timmer, Jochen Dress, Patrick Blin, Cécile Droz-Perroteau, Vera Ehrenstein, Carla Franzoni, Ron Herings, Bianca Kollhorst, Nicholas Moore, Ingvild Odsbu, Susana Perez-Gutthann, Tania Schink, Katherine Rascher, Lawrence Rasouliyan, Kenneth J Rothman, Nuria Saigi-Morgui, Mathias Schaller, Elisabeth Smits, Michael Forstner, Intravenous Iron Consortium, Jacques Bénichou, Andreas J Bircher, Edeltraut Garbe, David S Rampton, Lia Gutierrez. Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe. Pharmacoepidemiology and drug safety. 2021 Oct;30(10):1447-1457

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PMID: 34181291

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