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Ferric Carboxymaltose With or Without Phosphate Substitution for the Treatment of Iron Deficiency or Iron Deficiency Anemia

Primary Purpose

Anemia, Iron-deficiency, Hypophosphatemia

Status
Completed
Phase
Phase 4
Locations
Switzerland
Study Type
Interventional
Intervention
Verum
Placebo
Sponsored by
Donat R. Spahn
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anemia focused on measuring iron-deficiency anemia, hypophosphatemia, elective surgery, iron-deficiency, preoperative iron substitution, phosphate substitution

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Informed Consent as documented by signature (Appendix 5: Informed Consent Form)
  • Male or female ASA 1 to 3 patients, at least 18 years old
  • Scheduled for an elective major abdominal or thoracic surgery.
  • Patients with isolated iron deficiency (defined as hemoglobin concentration (Hb) > 130 g/l, and plasma Ferritin < 100 ng/ml or TSAT < 20%), or iron deficiency anemia (defined as Hb 100-130 g/l, and plasma Ferritin < 100 ng/ml or TSAT < 20%).
  • Patients scheduled to be hospitalized ≥ 3 days.

Exclusion Criteria:

  • Patients with known anaphylactic reactions to parenteral iron products. Patients with allergy/hypersensitivity to any contents of Ferinject® or Phoscap®.
  • Patients with iron overload or disturbances in utilization of iron (e.g. haemochromatosis, hemosiderosis).
  • Patients with ≥3 times increase in aspartate aminotransferase or alanine aminotransferase as per reference range.
  • Patients with excessive blood loss requiring massive transfusion (≥ 10 more red blood cell units).
  • Patients with known myelodysplastic syndromes.
  • Patients with chronic kidney disease with an estimated GFR < 30 ml/min or with end-stage renal disease requiring scheduled dialysis.
  • Patients with known urinary tract infections with urea-splitting bacteria.
  • Patients with known diseases influencing phosphate, calcium or vitamin D homeostasis (e.g. Hyperparathyroidism, X-linked hypophosphatemia, renal tubular acidosis).
  • Patients taking medication significantly influencing phosphate, calcium or vitamin D homeostasis (e.g. vitamin D substitution > 800 I.E. per day in the last 4 months, pre-existing phosphate substitution, phosphate binders).
  • Patients with preexisting hypophosphatemia
  • Any patient judged to lack the ability to give informed consent or perform the trial assessments (e.g. due to dementia, insufficient knowledge of the German language).
  • Women who are pregnant or breast feeding,
  • Intention to become pregnant during the course of the study,
  • Lack of safe contraception, defined as: Female participants of childbearing potential, not using and not willing to continue using a medically reliable method of contraception for the entire study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices, or who are not using any other method considered sufficiently reliable by the investigator in individual cases (Female participants who are surgically sterilized / hysterectomized or post-menopausal for longer than 2 years are not considered as being of child bearing potential),
  • Known or suspected non-compliance, drug or alcohol abuse.
  • Participation in another study with investigational drug within the 30 days preceding and during the present study.
  • Any patient judged by the Principal Investigator or Sub-Investigator to be inappropriate for the trial for any other reason.

Sites / Locations

  • University Hospital Zurich

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Verum

Placebo

Arm Description

Outcomes

Primary Outcome Measures

Establish superior serum phosphate stability
The primary endpoint is superior serum phosphate stability. The investigators measure perioperative phosphate concentrations in participants during the follow-up visits and compare the results between verum and placebo group.

Secondary Outcome Measures

Perioperative hemoglobin concentration
Mean perioperative Hb of the day of surgery, post-operative day (POD)2 and POD4.
Core muscle strength
Pre- and postoperative assessment of core muscle strength by volitional testing of maximal inspiratory and expiratory pressures.

Full Information

First Posted
October 14, 2021
Last Updated
May 23, 2023
Sponsor
Donat R. Spahn
Collaborators
University of Zurich
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1. Study Identification

Unique Protocol Identification Number
NCT05098249
Brief Title
Ferric Carboxymaltose With or Without Phosphate Substitution for the Treatment of Iron Deficiency or Iron Deficiency Anemia
Official Title
Ferric Carboxymaltose With or Without Phosphate Substitution for the Treatment of Iron Deficiency or Iron Deficiency Anemia Before Elective Surgery - the DeFICIT Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
November 11, 2021 (Actual)
Primary Completion Date
May 9, 2023 (Actual)
Study Completion Date
May 23, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Donat R. Spahn
Collaborators
University of Zurich

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a confirmatory trial to establish superior serum phosphate stability associated with use of Phoscap® compared with placebo as a supplement for treatment of iron deficiency or iron deficiency anemia with Ferinject® before elective surgery.
Detailed Description
Iron deficiency anemia is a global health problem most commonly caused by excessive blood loss, impaired intestinal iron absorption, or chronic inflammation. In the perioperative setting, intravenous ferric carboxymaltose allows efficient treatment of preoperative iron deficiency and anemia. Recent studies have implied that ferric carboxymaltose might cause hypophosphatemia. Notably, hypophosphatemia has been associated with less muscle strength, which may influence early post-surgery recovery of patients. Additional oral phosphate supplementation may alleviate this hypophosphatemia. This is a confirmatory trial to establish superior serum phosphate stability associated with use of Phoscap® compared with placebo as a supplement for treatment of iron deficiency or iron deficiency anemia with Ferinject® before elective surgery. This is also a confirmatory trial to establish non-inferior efficacy of Phoscap® compared with placebo for the treatment of iron deficiency or iron deficiency anemia with Ferinject®; and to establish superior core muscle strength associated with the use of Phoscap® compared with placebo.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anemia, Iron-deficiency, Hypophosphatemia
Keywords
iron-deficiency anemia, hypophosphatemia, elective surgery, iron-deficiency, preoperative iron substitution, phosphate substitution

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
92 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Verum
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Verum
Intervention Description
The participant takes two capsules Phoscap® (3mmol/capsule) orally three times a day over 30 days beginning the day of Ferinject administration.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
The participant takes wo capsules Placebo orally three times a day over 30 days beginning the day of Ferinject administration.
Primary Outcome Measure Information:
Title
Establish superior serum phosphate stability
Description
The primary endpoint is superior serum phosphate stability. The investigators measure perioperative phosphate concentrations in participants during the follow-up visits and compare the results between verum and placebo group.
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Perioperative hemoglobin concentration
Description
Mean perioperative Hb of the day of surgery, post-operative day (POD)2 and POD4.
Time Frame
3 years
Title
Core muscle strength
Description
Pre- and postoperative assessment of core muscle strength by volitional testing of maximal inspiratory and expiratory pressures.
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed Consent as documented by signature (Appendix 5: Informed Consent Form) Male or female ASA 1 to 3 patients, at least 18 years old Scheduled for an elective major abdominal or thoracic surgery. Patients with isolated iron deficiency (defined as hemoglobin concentration (Hb) > 130 g/l, and plasma Ferritin < 100 ng/ml or TSAT < 20%), or iron deficiency anemia (defined as Hb 100-130 g/l, and plasma Ferritin < 100 ng/ml or TSAT < 20%). Patients scheduled to be hospitalized ≥ 3 days. Exclusion Criteria: Patients with known anaphylactic reactions to parenteral iron products. Patients with allergy/hypersensitivity to any contents of Ferinject® or Phoscap®. Patients with iron overload or disturbances in utilization of iron (e.g. haemochromatosis, hemosiderosis). Patients with ≥3 times increase in aspartate aminotransferase or alanine aminotransferase as per reference range. Patients with excessive blood loss requiring massive transfusion (≥ 10 more red blood cell units). Patients with known myelodysplastic syndromes. Patients with chronic kidney disease with an estimated GFR < 30 ml/min or with end-stage renal disease requiring scheduled dialysis. Patients with known urinary tract infections with urea-splitting bacteria. Patients with known diseases influencing phosphate, calcium or vitamin D homeostasis (e.g. Hyperparathyroidism, X-linked hypophosphatemia, renal tubular acidosis). Patients taking medication significantly influencing phosphate, calcium or vitamin D homeostasis (e.g. vitamin D substitution > 800 I.E. per day in the last 4 months, pre-existing phosphate substitution, phosphate binders). Patients with preexisting hypophosphatemia Any patient judged to lack the ability to give informed consent or perform the trial assessments (e.g. due to dementia, insufficient knowledge of the German language). Women who are pregnant or breast feeding, Intention to become pregnant during the course of the study, Lack of safe contraception, defined as: Female participants of childbearing potential, not using and not willing to continue using a medically reliable method of contraception for the entire study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices, or who are not using any other method considered sufficiently reliable by the investigator in individual cases (Female participants who are surgically sterilized / hysterectomized or post-menopausal for longer than 2 years are not considered as being of child bearing potential), Known or suspected non-compliance, drug or alcohol abuse. Participation in another study with investigational drug within the 30 days preceding and during the present study. Any patient judged by the Principal Investigator or Sub-Investigator to be inappropriate for the trial for any other reason.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Donat R Spahn, Prof. Dr.
Organizational Affiliation
University of Zurich
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Zurich
City
Zurich
ZIP/Postal Code
8091
Country
Switzerland

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26192787
Citation
Munoz M, Gomez-Ramirez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus. 2015 Jul;13(3):370-9. doi: 10.2450/2015.0014-15. Epub 2015 Jun 16. No abstract available.
Results Reference
result
PubMed Identifier
28382661
Citation
Munoz M, Laso-Morales MJ, Gomez-Ramirez S, Cadellas M, Nunez-Matas MJ, Garcia-Erce JA. Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery. Anaesthesia. 2017 Jul;72(7):826-834. doi: 10.1111/anae.13840. Epub 2017 Apr 6.
Results Reference
result
PubMed Identifier
23505057
Citation
Wolf M, Koch TA, Bregman DB. Effects of iron deficiency anemia and its treatment on fibroblast growth factor 23 and phosphate homeostasis in women. J Bone Miner Res. 2013 Aug;28(8):1793-803. doi: 10.1002/jbmr.1923.
Results Reference
result

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Ferric Carboxymaltose With or Without Phosphate Substitution for the Treatment of Iron Deficiency or Iron Deficiency Anemia

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