Evaluation of the reported rates of hypersensitivity reactions associated with iron dextran and ferric carboxymaltose based on global data from VigiBase™ and IQVIA™ MIDAS® over a ten-year period from 2008 to 2017

It is hypothesized that the risk of hypersensitivity reactions (HSRs) may be lower with ferric carboxymaltose than iron dextran because of its non-dextran carbohydrate moiety. This study compares the risk of HSRs between iron dextran and ferric carboxymaltose.

This was a retrospective pharmacoepidemiological study with a case–population design covering 2008–2017. Global exposure data were estimated using IQVIA™ sales data. Spontaneously reported HSR data were retrieved from the World Health Organization database (VigiBase™) using different search criteria including: the Standardized MedDRA® Query (SMQ) ‘Anaphylactic reaction’; type I–IV HSR terms; narrow terms for anaphylactic/anaphylactoid reactions; and cases with a fatal outcome.

Total exposure in 100 mg doses was 117.3 million for iron dextran and 84.2 million for ferric carboxymaltose. The relative risk (with 95% confidence interval) for ferric carboxymaltose versus iron dextran was 4.18 (3.88–4.50) for SMQ Anaphylactic reaction; 12.9 (9.90–16.7) for type I–IV HSRs; 1.72 (1.45–2.04) for anaphylactic/anaphylactoid reactions; and 1.92 (1.24–2.99) for death.

The risk of spontaneously reported HSRs was consistently higher with ferric carboxy-maltose than with iron dextran over the period 2008–2017. Thus, this study does not support that dextran-free intravenous irons are associated with fewer HSRs than iron dextran.