Intravenous Iron Replacement Improves Exercise Tolerance in COPD: A Single-Blind Randomized Trial

• Clara Martín-Ontiyuelo ^[1] ; Anna Rodó-Pin ^[1] ; Daniel Echeverría-Esnal ^[2] ; Mireia Admetlló ^[1] ; Xavier Duran-Jordà ^[3] ; Mariela Alvarado ^[1] ; Joaquim Gea ^[1] ; Esther Barreiro ^[1] ; Diego A. Rodríguez-Chiaradía ^[1]
  1. [1] Universitat Pompeu Fabra

     Universitat Pompeu Fabra

     Barcelona, España

     
  2. [2] Hospital del Mar

     Hospital del Mar

     Barcelona, España

     
  3. [3] Unidad de Apoyo a la Metodología y Bioestadística, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, España

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 58, Nº. 10 (October), 2022, págs. 689-698
• Idioma: inglés
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• Resumen

  • Introduction Iron deficiency affects exercise capacity because of the critical role iron plays in the optimal functioning of skeletal muscle metabolism. We hypothesized that intravenous iron may improve exercise tolerance, quality of life (QoL), and daily physical activity (DPA) in patients with chronic obstructive pulmonary disease (COPD).

    Methods This was a placebo-controlled, single-blind, parallel-group, randomized clinical trial. Iron deficiency was defined as a ferritin level<100ng/mL or a ferritin level between 100 and 299ng/mL with a transferrin saturation<20%, with or without mild anaemia. Patients were randomized at a 2:1 ratio to receive intravenous ferric carboxymaltose or placebo. The primary objective was to investigate whether intravenous iron replacement improved endurance time from baseline by at least 33%. The secondary objectives were to evaluate impact on QoL using the COPD Assessment Test (CAT) and on DPA by accelerometry.

    Results We included 66 patients, 44 (66.7%) in the intervention group and 22 (33.3%) in the placebo group. Among patients receiving ferric carboxymaltose, 23 (52.3%) achieved the primary endpoint compared to 4 (18.2%) in the placebo group [p=0.009; relative risk 3.12, (95% CI, 1.19–8.12)]. CAT score decreased −3 (−6.0–1.3) points from baseline in the intervention group (p=0.007), in contrast to placebo group [−1 (−4.0–2.3) points, p=0.236] with no differences in DPA and adverse events in both groups.

    Conclusions Iron replacement improved exercise capacity and QoL in stable COPD patients with iron deficiency. The treatment was well tolerated.