Time Course and Comparative Risk of Hypophosphatemia After Ferric Carboxymaltose versus Ferric Derisomaltose: A Systematic Review, Meta-analysis, and Clinical Cost Considerations
9 affiliations
- 1School of Medicine, Xiamen University, Xiamen, China
- 2ESIC Medical College and Hospital, Sanathnagar, Hyderabad, India
- 3Flinders University, Adelaide, Australia
- 4DOW University of Health Sciences, Karachi, Pakistan
- 5Davao Medical School Foundation, Inc., Davao City, Philippines
- 6Royal College of Surgeons in Ireland, Dublin, Ireland
- 7Bahria University Health Sciences Campus, Karachi, Pakistan
- 8St George’s University Hospitals NHS Foundation Trust, London, UK
- 9College of Medical Sciences, Bharatpur, Nepal
Abstract
Objectives:: To compare the risk of hypophosphatemia and associated outcomes following ferric carboxymaltose (FCM) versus ferric derisomaltose (FDI) in adults with iron deficiency anemia.
Methods:: We conducted a systematic review and meta-analysis of studies identified through database searches up to November 2025. Randomized and observational studies comparing FCM and FDI were included. The primary outcome was the incidence of hypophosphatemia within 35 to 42 days after infusion. Secondary outcomes included severe and persistent hypophosphatemia, patient-reported outcomes, and economic outcomes. Data from randomized trials were quantitatively pooled using a random-effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs), whereas findings from observational and economic studies were summarized narratively.
Results:: Twenty-one studies were included, comprising 3 randomized controlled trials (364 participants) and 18 observational or economic evaluation studies. In pooled randomized comparisons, FCM was associated with a higher risk of hypophosphatemia within 35 to 42 days than FDI (RR 8.37, 95% CI 5.10-13.75; P < .00001; I2 = 0%). Severe hypophosphatemia occurred in 11.3% of patients receiving FCM and was not observed with FDI. Persistent hypophosphatemia beyond 5 to 8 weeks was more frequent with FCM. Fatigue scores improved more with FDI. Economic evaluations reported greater quality-adjusted life years and lower healthcare costs with FDI.
Conclusion:: Ferric carboxymaltose is associated with a higher risk of hypophosphatemia compared with ferric derisomaltose. Ferric derisomaltose demonstrates a more favorable safety profile and consistent economic findings.
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BibTeX
@article{dangre2026time,
title = {{Time Course and Comparative Risk of Hypophosphatemia After Ferric Carboxymaltose versus Ferric Derisomaltose: A Systematic Review, Meta-analysis, and Clinical Cost Considerations}},
author = {Vidhita Dangre and Mohd Rafiuddin and Krithika Sriram and Iqra Aslam Siddiqui and Hadia Fahim and Shanthakumar Sakthivel Murugan and Federica Copeta and Noor Ul Ain Fatima and Belinda Eze and Swostika Pokhrel},
journal = {Hospital Pharmacy},
year = {2026},
month = oct,
doi = {10.1177/00185787261485528},
url = {https://doi.org/10.1177/00185787261485528},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Time Course and Comparative Risk of Hypophosphatemia After Ferric Carboxymaltose versus Ferric Derisomaltose: A Systematic Review, Meta-analysis, and Clinical Cost Considerations
AU - Vidhita Dangre
AU - Mohd Rafiuddin
AU - Krithika Sriram
AU - Iqra Aslam Siddiqui
AU - Hadia Fahim
AU - Shanthakumar Sakthivel Murugan
AU - Federica Copeta
AU - Noor Ul Ain Fatima
AU - Belinda Eze
AU - Swostika Pokhrel
PY - 2026
DA - 2026/10/24
JO - Hospital Pharmacy
DO - 10.1177/00185787261485528
UR - https://doi.org/10.1177/00185787261485528
AB - Objectives:: To compare the risk of hypophosphatemia and associated outcomes following ferric carboxymaltose (FCM) versus ferric derisomaltose (FDI) in adults with iron deficiency anemia. Methods:: We conducted a systematic review and meta-analysis of studies identified through database searches up to November 2025. Randomized and observational studies comparing FCM and FDI were included. The primary outcome was the incidence of hypophosphatemia within 35 to 42 days after infusion. Secondary outcomes included severe and persistent hypophosphatemia, patient-reported outcomes, and economic outcomes. Data from randomized trials were quantitatively pooled using a random-effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs), whereas findings from observational and economic studies were summarized narratively. Results:: Twenty-one studies were included, comprising 3 randomized controlled trials (364 participants) and 18 observational or economic evaluation studies. In pooled randomized comparisons, FCM was associated with a higher risk of hypophosphatemia within 35 to 42 days than FDI (RR 8.37, 95% CI 5.10-13.75; P < .00001; I2 = 0%). Severe hypophosphatemia occurred in 11.3% of patients receiving FCM and was not observed with FDI. Persistent hypophosphatemia beyond 5 to 8 weeks was more frequent with FCM. Fatigue scores improved more with FDI. Economic evaluations reported greater quality-adjusted life years and lower healthcare costs with FDI. Conclusion:: Ferric carboxymaltose is associated with a higher risk of hypophosphatemia compared with ferric derisomaltose. Ferric derisomaltose demonstrates a more favorable safety profile and consistent economic findings.
SN - 0018-5787
SN - 1945-1253
ER -