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Ferric Derisomaltose vs FCM Advantages — ESENeph MCQ

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ModerateChronic Kidney DiseaseFerric Derisomaltose vs FCM AdvantagesESENeph

A 50-year-old man with CKD G3b develops iron-deficiency anaemia. He is started on IV Ferric Derisomaltose (Monoferric). Compared to Ferric Carboxymaltose, what is the key advantage?

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Correct answer: B — Ferric Derisomaltose can be given as a single high-dose infusion (up to 20 mg/kg, maximum 2000 mg) in one visit AND has a lower risk of hypophosphataemia compared to Ferric Carboxymaltose (which frequently causes FGF23-mediated phosphate wasting)

Ferric Derisomaltose (Monoferric/iron isomaltoside) offers two practical advantages: (1) it can be given as a complete replacement dose in a single infusion (up to 20 mg/kg, max 2 g), reducing hospital visits – FCM is limited to 1 g per infusion (requiring 2 visits for larger deficits); (2) it has a significantly lower risk of FGF23-mediated hypophosphataemia compared to FCM (which causes hypophosphataemia in 50-75% of patients). The PHOSPHARE trials demonstrated this difference. For CKD patients (already at risk of phosphate/FGF23 disturbance), Ferric Derisomaltose may be preferred.

Reference: Wolf et al 2020 – PHOSPHARE Trials; BNF – IV Iron Preparations