Iron deficiency and
iron-deficiency anemia are associated with increased morbidity and mortality in a wide range of conditions. In many patient populations, this can be treated effectively with oral
iron supplementation; but in patients who are unable to take or who do not respond to oral
iron therapy, intravenous
iron administration is recommended. Furthermore, in certain conditions, such as
end-stage kidney disease, chronic
heart failure, and
inflammatory bowel disease, intravenous
iron administration has become first-line treatment. One of the first available intravenous
iron preparations is
iron sucrose (Venofer®), a nanomedicine that has been used clinically since 1949. Treatment with
iron sucrose is particularly beneficial owing to its ability to rapidly increase
hemoglobin,
ferritin, and
transferrin saturation levels, with an acceptable safety profile. Recently, important new data relating to the use of
iron sucrose, including the findings from the landmark PIVOTAL trial in patients with
end-stage kidney disease, have been reported. Several years ago, a number of
iron sucrose similars became available, although there have been concerns about the clinical appropriateness of substituting the original
iron sucrose with an
iron sucrose similar because of differences in efficacy and safety. This is a result of the complex and unique physicochemical properties of nanomedicines such as
iron sucrose, which make copying the molecule difficult and problematic. In this review, we summarize the evidence accumulated during 70 years of clinical experience with
iron sucrose in terms of efficacy, safety, and cost-effectiveness.