An infusion therapy is recommended mainly for chemotherapy, hormone therapy and during immunotherapy. It is often indicated for iron/vitamin deficiency anemia in patients who have a gastric bypass or any form of bowel inflammation that prevents the absorption of nutrients.
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Iron infusion therapy
Infusion therapy involves the administration of medications through a needle or catheter. It is prescribed when the patient’s condition is so severe that it can not be treated effectively with oral medications or in the case of iron or vitamins, which can not be absorbed or tolerated by the patient.
Typically, “infusion therapy” means that a drug is administered intravenously, but it can also refer to a situation where drugs are transmitted through other non-oral routes, such as intramuscular injections and epidural (in the surrounding membranes) spinal cord).
The diseases that affect it require infusion therapy include infections that do not respond to oral antibiotics, cancer and pain related to cancer, dehydration, gastrointestinal diseases or disorders that affect the normal functioning of the gastrointestinal system and more. Other conditions treated with infusion therapies may include cancer chemotherapy , congestive heart failure, Crohn’s disease, hemophilia, immunodeficiencies, multiple sclerosis, rheumatoid arthritis, iron / folate vitamin deficiency anemia. who had a gastric bypass in any form of inflammation of the intestinal disease that prevents the absorption of nutrients, hormonal therapy against cancer, immunotherapy and more.
Until the 1980s, patients who received infusion therapy had to stay in the hospital setting for the duration of their therapy. The greatest emphasis on cost containment in medical care, as well as advances in the clinical administration of therapy, strategies to administer infusion therapy in alternative settings. For people who require long-term therapy, hospital care is not only extremely expensive, it also prevents the person from resuming their normal lifestyle and work activities.
Iron Infusion Therapy
Oral iron supplementation is usually the first option for the treatment of iron deficiency anemia (IDA) due to its effectiveness and low cost. But unfortunately in many iron deficient conditions, oral iron is a less than ideal treatment, mainly due to adverse events related to the gastrointestinal tract, as well as the long course required to treat anemia and replenish body iron stores.
Indications of iron therapy
The first iron product for intravenous use was high molecular weight dextran iron. However, intravenous iron preparations containing dextran are associated with an increased risk of anaphylactic reactions, which makes physicians reluctant to prescribe intravenous iron in the treatment of iron deficiency anemia for many years. In 1999 and 2001, two new intravenous iron preparations (ferric gluconate and iron sucrose) were introduced as safer alternatives to iron dextran. In the last five years, three new iron dextran-free preparations have been developed intravenously and have better safety profiles than the more traditional intravenous compounds,
Iron is an essential element because it plays an important role in many vital biological processes, such as the synthesis of heme that forms the basis of hemoglobin (Hb), the oxygen transport protein of the blood, the formation of myoglobin, the metabolism energy, the production of neurotransmitters, the formation of collagen and the function of the immune system. The lack of iron is one of the main causes of anemia in the general population. It is not surprising that iron deficiency anemia (IDA) is associated with increased morbidity and mortality.
Treatment with oral iron supplements is simple, inexpensive and a relatively effective way to treat iron deficiency conditions. Ferrous iron salts (sulfate, fumarate, succinate and gluconate) are the most commonly used oral iron preparations
iron deficiency anemia
On the other hand, it is well known that oral iron is a less than ideal treatment mainly due to adverse gastrointestinal events (particularly when ferrous iron compounds are used), lack of adherence to treatment or insufficient duration of therapy for the degree of deficiency iron, duodenal malabsorption due to concomitant gastrointestinal pathologies (inflammatory bowel disease [IBD], gastric bypass surgery or any other cause of chronic inflammation, malignancy) conditions and the long course of treatment necessary to resolve the anemia (1-2 months ) and replenish the body iron stores (another 3-6 months).Failure to comply with a prescribed treatment of oral iron is common and even in docile patients, poor intestinal absorption does not compensate for the need for iron in the presence of continuous blood loss or in inflammatory conditions.
In 1999, ferric gluconate (FG) (Ferrlecit), after having been available in Europe for many years, was introduced into the US market as a safer alternative to iron dextran.
A historical review of the use of FG in Europe and iron dextrans in the United States found no deaths attributable to FG, but at least 31 to iron dextran. The authors concluded that FG was a safer therapeutic option for iron dextran and its safety was related to the lack of dextran wrap and, therefore, was associated with a lower risk of anaphylactoid reactions.
The maximum recommended dose of FG is 125 mg administered in a bolus or short infusion; It has been reported that an infusion of 250 mg administered for 1 hour is safe.
A double-blind, placebo-controlled crossover study of single-dose administration of FG in 2338 patients on hemodialysis reported only one severe allergic reaction and no deaths. They also reported that, in patients previously sensitive to iron dextran, reactions to FG were infrequent, but 7 times more frequent than those that had no prior sensitivity to iron.
Venofer
In November 2000, Iron sucrose (IS) (Venofer) was approved in the United States, although it had also been used for a long time in Europe. By far, the greatest experience in published literature is with this formulation.
The SI can be safely administered as a 15-30 minute infusion in doses of 200-300 mg; the maximum weekly dose should not exceed 600 mg. If doses higher than those recommended are not infused, adverse events are rarely observed.
IS is a dextran-free formulation with a safety profile similar to FG. The efficacy and safety of IV IS has been demonstrated in the treatment of anemia even in patients with CKD on hemodialysis. (34,35) In addition, IS is also effective in the treatment of patients with ADI combined with IBD, while the oral iron is potentially harmful to the intestinal epithelium. It has been shown that IS is an important alternative option for blood transfusion in a variety of surgical settings that lead to a significant reduction in blood transfusion requirements.
The incidence of severe anaphylaxis with IS is 0.002%. When doses higher than 250 mg of FG or 300 mg of IS are administered, reactions to the infusion probably occur due to the release of free iron from less bound carbohydrate carriers. Black box warnings do not appear in the FG or IS instructions for use and a trial dose is not required.
Based on the current state of knowledge, FG and IS widely replaced the use of iron dextrans in American patients.
Despite being the IV iron compound used most frequently in published studies, the main disadvantage of SI is the need for multiple infusions since the maximum weekly dose should not exceed 600 mg (200 mg IV, 1-3 times/week).
These restrictive and time-consuming management requirements may contribute to underutilization of IV iron in the treatment of ADI. Consequently, there was a clear need for cost-effective IV iron therapy with a favorable administration regimen that could help increase its use and improve results.
Ferumoxytol (FeraHeme ® )
This formulation was approved by the FDA in 2009 for the replacement of iron in patients with CKD with IDA. It can be administered as a relatively large dose (maximum 510 mg) in a rapid session (<20 seconds) without the need for a trial dose.
However, this product is not currently approved in Europe and the FDA continues to evaluate Ferumoxytol due to reports of cardiac errors. In addition, the administration of ferumoxytol can interfere transiently with the diagnostic capacity of MRI that is frequently used for the diagnosis and monitoring of inflammatory bowel disease, IBD; consequently, this does not appear to be an IV iron compound suitable for patients with IBD.
Oral iron supplements are an economical and effective way to treat patients with IDA and its administration, without significant blood loss or blood loss, can correct anemia.
Oral iron is a less than ideal treatment due to the high rate of gastrointestinal adverse events, particularly when ferrous iron compounds are used; a course of prolonged treatment is needed to resolve the anemia and achieve the replacement of the body reserves of iron.
In cases where oral iron is not effective, iron compounds are associated with adverse events or cannot be used. IV child treatment options.
IV iron therapy is clearly better and has several advantages over oral iron treatment.
Given the proven effectiveness and safety profile of IV iron, particularly SI in a broad spectrum of diseases associated with IDA, the current paradigm that oral iron is first-line therapy should be reconsidered.
Based on the prevalence of published evidence, with the exception of high molecular weight iron dextran, the differences in the safety profile between iron IV products are small when administered in the recommended doses and respecting the infusion time Right.
Clinical trials in nephrology, gynecology, gastroenterology, oncology, and hematology are needed to evaluate the faster administration of higher doses of iron. Therefore, until there is reliable comparative data available, a product can not, and should not, be considered superior in terms of safety profile.
Intravenous iron is safe and probably much safer than most doctors know. The proper use of this important therapeutic modality offers important clinical benefits by reducing the morbidity and mortality of many pathological conditions associated with iron deficiency.
At Hematology & Oncology Consults of Florida, the infusions are made in the privacy and harmony of our suites in the place.
Infusion on the site has been a safe and effective alternative to hospital care for many disease states and therapies. For many patients, receiving treatment in an outpatient infusion room setting is preferable to inpatient care. Our infusion therapy suites that are ideal for patient therapy situations.
The infusion patient care approach at the site offers numerous advantages, such as the use of medications for convenience, efficacy, safety, and compliance, taking into account accessibility and cost; a collaborative approach to on-site infusion that involves the patient, the oncologist, and other health care providers; and a focus on improving health outcomes
The information in this document does not replace a medical consultation. It is only for personal guide use. We recommend that patients ask what types of medications are needed for their type and stage of the disease.
Sources:
- American Cancer Society
- The National Cancer Institute
- National Comprehensive Cancer Network
- American Academy of Gastroenterology
- National Institute of Health
- MD Anderson Cancer Center
- Memorial Sloan Kettering Cancer Center
- American Academy of Hematology
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