Ferric carboxymaltose for iron-deficiency anemia secondary to gastrointestinal bleeding: a systematic review and meta-analysis

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This systematic review and meta-analysis assessed the efficacy and safety of ferric carboxymaltose (FCM) in treating iron-deficiency anemia secondary to gastrointestinal bleeding. A comprehensive search across multiple databases identified randomized controlled trials comparing FCM with other iron formulations. A total of 13 publications, reporting 16 trials and involving 1939 patients, were included. Pooled analyses demonstrated that FCM led to significantly greater improvements in key anemia parameters compared to alternative iron therapies, including a higher hemoglobin response rate [risk ratio = 1.24, 95% confidence interval (CI): 1.14-1.34], increased serum ferritin levels (mean difference = 293.52, 95% CI: 168.76-418.27), and greater transferrin saturation (mean difference = 9.71, 95% CI: 5.19-14.22). The overall incidence of drug-related adverse events was comparable between groups (risk ratio = 0.82, 95% CI: 0.51-1.34); however, FCM was associated with a substantially increased risk of hypophosphatemia (risk ratio = 21.00, 95% CI: 8.90-49.56). Notably, subgroup analysis confirmed that this therapeutic advantage remained consistent across both acute and chronic gastrointestinal bleeding settings. In conclusion, FCM is effective in correcting anemia in patients with gastrointestinal bleeding-related iron deficiency, despite a well documented risk of hypophosphatemia. Further research is warranted to optimize dosing strategies and identify patient subgroups most likely to benefit from FCM therapy.

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