19.02.2020 – 11:00
New Data Show Oral Ferric Maltol (FERACCRU®) May Be a Cost-effective Alternative to Intravenous (IV) Carboxymaltose With at Least as Great Benefits in the Quality of Life of Patients With Iron Deficiency Anaemia and Inflammatory Bowel Disease
- Ferric maltol (FM) was associated with substantially lower use of healthcare resources than IV ferric carboxymaltose (FCM)
- IV FCMwas linked to greater productivity loss and disruption to patients' work and family life due to the need for clinic-based IV administration
- 50% of patients on IV FCM lost at least one full day due to treatment with 43% losing up to EUR387.51, as quantified for a German setting
- Mean total per patient drug costs were approximately 1.6 times higher for treatment with IV FCM compared to FM
Norgine B.V. highlighted new data from three post hoc analyses of the randomised controlled, open label, phase 3b non-inferiority study of oral ferric maltol vs intravenous ferric carboxymaltose (NCT02680756), presented at the 15th European Crohn's and Colitis Organisation (ECCO) Congress in Vienna. Ferric maltol, a novel oral iron replacement therapy, was found to be a cost-saving alternative to intravenous (IV) ferric carboxymaltose (FCM) by reducing drug administration costs and productivity loss, with at least as great benefit to the health-related quality of life (HRQoL) of patients with iron deficiency anaemia (IDA) and inflammatory bowel disease (IBD).
Dr. Stefanie Howaldt from the Hamburg Research Institute for IBD, HaFCED e.K., Germany presented the new research findings at ECCO and commented, "Iron deficiency anaemia is very common in inflammatory bowel disease and can significantly impair the quality of life of patients. Due to very common intolerance to standard oral iron products, IV iron is currently the main treatment alternative for IBD patients with IDA. These new data demonstrate that ferric maltol is not only a well-tolerated and effective therapy, which we previously knew, but also a cost-saving treatment for the healthcare system, representing an alternative oral treatment option with substantial health-related quality of life benefit for IBD patients with IDA.''
IDA can be a serious complication of IBD resulting from inflammation, chronic mucosal blood loss and iron malabsorption. Treatment of IDA involves iron-replacement therapy often with oral iron supplementation in the first instance. However, use of oral ferrous iron medications may be limited by poor absorption and adverse events[4,5] which can lead to many unwell patients having to receive IV iron in hospital.
Patient-reported outcomes are an important way to measure health and wellbeing. Measures of HRQoL in IDA have the potential to reflect both IDA symptoms and treatment-related issues such as adverse effects, so are a useful tool to capture additional treatment benefits beyond those typically reported in clinical studies.
In the quality of life post hoc analysis, the HRQoL benefits of FM and IV FCM and their relationship to haematological parameters were analysed using data from a randomised controlled trial. The analysis showed that improvements in SF-36 PCS and MCS scores were slightly greater with FM than with IV FCM (difference not statistically significant). FM patients experienced at least as great benefit in all SF-36 domains such as general and mental health, bodily pain, vitality, physical, social and emotional functioning.
IDA imposes a substantial economic burden on the healthcare payer system resulting primarily from increased medical costs and hospital admissions. The second post hoc analysis looked at the impact on productivity comparing the associated productivity loss of oral FM vs. IV FCM. The study found that 50% of patients treated with IV FCM lost at least one full day due to treatment, with 1 in 15 losing 4-6 days. Productivity loss was quantified, with IV FCM treatment associated with losses between EUR0.00 and EUR107.21 in 50% of patients, EUR129.17 and EUR387.51 in 43% of patients and EUR516.68 and EUR775.02 in 7% of patients. As FM was administered orally by the patient and did not require any in-hospital treatment administration, there was no treatment linked productivity loss. FM did not have the indirect costs associated with IV FCM and as such may provide an oral alternative to IV iron in patients with IBD, enabling them to avoid the disruption of everyday life activities due to the need for in-hospital IV administration.
The third post hoc analysis compared the health care resource use (HCRU) associated with oral FM and IV FCM. The data showed that total per patient drug costs (acquisition and administration) were approximately 1.6 times higher for treatment with IV FCM than FM. The total cost of IV FCM is not only influenced by the higher drug cost, but additional costs associated with IV administration which was required to be carried out in a hospital or outpatient setting. FM has no additional costs or resource use associated with administration and is therefore less of a burden on local health care systems. 
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Notes to Editors:
About the post hoc analyses
Patients with IBD and IDA (haemoglobin [Hb] >=8.0 g/dL and <=11.0 g/dL for women or >=8.0 g/dL and <=12.0 g/dL for men, and ferritin <30 ng/mL or ferritin <100 ng/mL with transferrin saturation <20%) were randomised to FM (30 mg b.d.) or IV FCM (as per local Summary of Product Characteristics [SmPC] or prescribing information) in an open-label, Phase 3b non-inferiority study. The primary endpoint was Hb responder rate (proportion of patients achieving a >=2 g/dL increase or normalisation of Hb at week 12). 250 patients were randomised: 125 to FM (per-protocol [PP] n=86) and 125 to IV FCM (PP n=93). The Hb responder rate for oral FM was non-inferior to IV FCM in the PP population (74% vs 83%); risk difference was -0.1 (two-sided p=0.017; 95% CI -0.2, 0.0), within the pre-defined non-inferiority margin of 20% difference.
For the post hoc analysis 'Impact of oral ferric maltol and IV iron on health-related quality of life in patients with iron deficiency anaemia and inflammatory bowel disease, and relationship with haemoglobin and serum iron', patients with IBD and IDA were randomised to FM (30 mg b.d) or IV FCM (as per local SmPC) with primary endpoint Hb responder rate [proportion of patients with >=2 g/dL increase or normalisation of Hb at week 12; non-inferiority margin 20%]. HRQoL was assessed via the Short Form Health Survey (SF-36). In the post hoc analysis of patient-level data, Hb, serum iron and HRQoL at baseline and week 12 were summarised descriptively and correlations between HRQoL and haematological parameters were assessed via Pearson's correlation coefficient (PCC). Hb, serum iron and HRQoL all improved following both treatments at Week 12. Improvements in SF-36 physical component summary (PCS) and mental component summary (MCS) scores were slightly greater with FM (difference not statistically significant). HRQoL improved across all SF-36 domain scores with both FM and FCM, with no statistically significant differences between treatments. HRQoL (MCS and PCS) improvements were positively associated with increases in Hb and serum iron. 
For the post hoc analysis 'Productivity loss in patients with inflammatory bowel disease receiving treatment for iron deficiency anaemia: a comparison of ferric maltol and IV iron' Productivity loss was calculated based on the number of days lost due to iron therapy during the initial 12-week study period. The costs associated with lost productivity were calculated using the human capital approach and based on the average gross income from Germany. IV FCM treatment resulted in a loss of patient time because IV administration was limited to an outpatient setting: 50% of patients treated with IV FCM lost at least one full day due to treatment, with 1 in 15 losing 4-6 days. Productivity loss was quantified, with IV FCM treatment associated with losses between EUR0.00 and EUR107.21 in 50% of patients, EUR129.17 and EUR387.51 in 43% of patients and EUR516.68 and EUR775.02 in 7% of patients. FM was administered orally by the patient and did not require any in-clinic treatment, there was no treatment linked productivity loss. 
For the post hoc analysis 'Health care resource use associated with ferric maltol and IV iron treatment for iron deficiency anaemia in patients with inflammatory bowel disease', pHCRU was assessed based on the total costs of iron therapy (including drug costs and administration), and the number of clinic visits during the initial 12-week study period. Costs of IV FCM and FM were applied to a German setting. Mean (standard deviation; SD) total treatment costs per patient in the FM and IV FCM arms were EUR302.27 (EUR80.68) and EUR489.37 (EUR147.19) respectively. 87% of FM patients were still receiving treatment at week 12, and 45% and 36% of IV FCM patients required a repeat course of IV iron at weeks 4 and 12 respectively. The mean (SD) number of hospital/outpatient visits during the study period for patients receiving IV FCM was 2.30 (0.88) and the total dose of IV FCM received was 1621 mg (491 mg). The study showed that the total per patient drug costs were approximately 1.6 times higher for treatment with IV FCM than FM. The total cost of IV FCM is not only influenced by the higher drug cost, but additional costs associated with IV administration which was required to be carried out in an outpatient setting. FM had no additional costs or resource use associated with administration and was therefore less of a burden on local health care systems. FM was associated with and substantially lower HCRU than IV FCM, and may provide a cost-effective oral alternative to IV iron in patients with IBD. 
About oral ferric maltol (FERACCRU®)
Ferric maltol is a novel oral ferric iron therapy for the treatment of iron deficiency (ID) in adults. The recommended dose is one capsule (30mg) taken twice a day, morning and evening, on an empty stomach. Treatment duration depends on the severity of the iron deficiency (ID), but generally at least 12 weeks of treatment are required. For further information, please refer to the product Summary of Product Characteristics, available at: https://www.ema.europa.eu/en/documents/product-information/feraccru-epar-product-information_en.pdf
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1. Howaldt S, et al. P685, presented at ECCO 2020 2. Howaldt S, et al. P331, presented at ECCO 2020 3. Howaldt S, et al. P567, presented at ECCO 2020 4. Howaldt S, et al. Presented at UEGW 2019, abstract number OP195 5. Lugg et al. 2014 Journal of Crohn's and Colitis 8, 876-880 6. FERACCRU® UK Summary of Product Characteristics, Norgine B.V. January 2020. Available at https://www.ema.europa.eu/en/documents/ product-information/feraccru-epar-product-information_en.pdf Accessed February 2020
GL/COR/0220/0231, Date of preparation February 2020