Hypophosphataemia, fibroblast growth factor 23 and third-generation intravenous iron compounds: a narrative review

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Abstract

Third-generation intravenous (i.v.) iron preparations are safe and efficacious and are increasingly used in the treatment of iron-deficiency anaemia. Hypophosphataemia is emerging as an established side-effect following the administration of certain compounds. Symptoms of hypophosphataemia can be masked by their similarity to those of iron-deficiency anaemia and both acute and chronic hypophosphataemia can be detrimental. Hypophosphataemia appears to be linked to imbalances in the metabolism of the phosphatonin fibroblast growth factor 23. In this narrative review, we discuss the possible pathophysiology behind this phenomenon, the studies comparing third-generation i.v. iron compounds, and the potential implications of the changes in fibroblast growth factor 23 and hypophosphataemia. We also present an algorithm of how to approach such patients requiring i.v. iron in anticipation of hypophosphataemia and how the impact related to it can be minimized.

Keywords: ferric carboxymaltose, ferric derisomaltose, ferumoxytol, fibroblast growth factor 23, hypophosphataemia, intravenous iron, iron-deficiency anaemia, safety.

Citation: Kassianides X, Bhandari S. Hypophosphataemia, fibroblast growth factor 23 and third-generation intravenous iron compounds: a narrative review. Drugs in Context 2021; 10: 2020-11-3. DOI: 10.7573/dic.2020-11-3

Contributions: XK was involved in the conceptualization of the manuscript and prepared all drafts of the paper with supervision from SB. All the authors contributed to drafting and revising the manuscript and approved the final version submitted for publication. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. No medical writing assistance was required.

Disclosure and potential conflicts of interest: XK has no disclosures. SB has received honorarium, consultancy fees, membership advisory board, and travel funding from Pharmacosmos A/S, Vifor Pharma, Astellas, and Astra Zeneca. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/12/dic.2020-11-3-COI.pdf

Acknowledgements: All figures represent original work. Images used to create figures originate from Smart – SERVIER MEDICAL ART (https://smart.servier.com/) have not been altered and can be used under a Creative Commons Attribution 3.0 Unported License. No medical writing assistance was required.

Funding declaration: This work has not received any external funding or has been supported by any external grants.

Copyright: Copyright © 2021 Kassianides X, Bhandari S. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0, which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Kassianides X, Bhandari S. https://doi.org/10.7573/dic.2020-11-3. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/hypophosphataemia,-fibroblast-growth-factor-23,-and-third-generation-intravenous-iron-compounds:-a-narrative-review

Correspondence: Xenophon Kassianides, Department of Academic Renal Research, Hull University Teaching Hospitals NHS Trust, 2nd Floor Alderson House, Hull Royal Infirmary, Anlaby Road, Kingston upon Hull, HU3 2JZ, UK. xenophon.kassianides@hey.nhs.uk

Provenance: Invited; externally peer reviewed.

Submitted: 10 November 2020; Accepted: 8 December 2020; Publication date: 19 January 2021.

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