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In reply—Continued Caution Recommended in Use of Intravenous Iron Preparations

      We thank Dr Cachat and colleagues for their interest in our article and for the valuable information they are reporting. We tried to conduct an unbiased systematic review, but we are aware of the shortcomings of using published results of randomized, controlled trials (RCTs) to report severe adverse events: severe events are too rare to be captured by RCTs (this is why we included all trials on intravenous iron), recording of adverse events might be less rigorous and more biased than that of the primary outcome in such studies, the patients included in RCTs might not be representative of the patients given the drug in clinical practice, and for some medications, the time frame for identifying the adverse events might be the wrong one.
      Postmarketing surveillance adds valuable information, but we should remember that it lacks comparison, and some of the patients given iron have severe underlying disorders. Further, the quality of the reported data might be problematic.
      As clinicians, we need to weigh all available data when offering intravenous iron to our patients, and the postmarketing surveillance should be part of these data.

      Linked Article

      • Continued Caution Recommended in Use of Intravenous Iron Preparations
        Mayo Clinic ProceedingsVol. 90Issue 5
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          We read with interest the report of the well-performed study of Avni et al1 on the safety of intravenous (IV) iron administration published in the January 2015 issue of Mayo Clinic Proceedings. After carefully analyzing more than 100 published randomized, controlled trials (RCTs) that included more than 10,000 patients, the authors concluded that there is no increased risk of serious adverse effects (SAEs) with IV iron preparations compared with other oral iron preparations or placebo and that IV iron formulations are safe and may be given to iron-deficient individuals without fear of infection or cardiovascular events.
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