Iron Supplementation in TAVI and SAVR Patients With Iron Deficiency

NCT04786769 | Unknown Phase 4 DMC

• 1 other identifier: UNICARV-1
• Study Type: interventional
• Target: 2,500
• Locations: 0 countries
• Sites: N/A

Brief Summary

The INERTIA trial is a multicenter double-blinded randomized trial of intravenous iron supplementation in patients with severe aortic stenosis and iron deficiency undergoing TAVI or SAVR. The primary endpoint is the time to HF hospital admission or cardiovascular death. Secondary endpoints will assess quality of life indicators and functional capacity at 6 months.

Conditions

Aortic Stenosis; Iron-deficiency

Outcome Measures

Primary Outcomes (1)

• Number of patients with heart failure hospital admission or cardiovascular death

  Analyzed as time-to-event

  up to 52 weeks

Secondary Outcomes (5)

• Total number of allogeneic RBC units received

  30 days post-TAVI or SAVR

• Walking distance

  6 months post-TAVI or SAVR

• Kansas City Cardiomyopathy Questionnaire

  6 months post-TAVI or SAVR

• Patient Global Assessment

  6 months post-TAVI or SAVR

• EQ-5D-5L

  6 months post-TAVI or SAVR

Study Arms (2)

Iron supplementation

EXPERIMENTAL

Intravenous ferric carboxymaltose will be administered according to weight and hemoglobin values at randomization as follows: 2-4 weeks before valve intervention On the day of admission to valve intervention (if determined by dose calculation, otherwise placebo) 12 weeks after valve intervention (if iron deficiency persists, otherwise placebo)

Drug: Ferric carboxymaltose

Placebo

PLACEBO COMPARATOR

Intravenous 0.9% NaCl (placebo) will be administered as follows: 2-4 weeks before valve intervention On the day of admission to valve intervention 12 weeks after valve intervention

Drug: Ferric carboxymaltose

Interventions

Ferric carboxymaltose DRUG

Intravenous ferric carboxymaltose according to baseline weight and hemoglobin

Iron supplementation; Placebo

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Severe aortic stenosis
• Enrolled for TAVI or SAVR procedures
• Documented iron deficiency with either: Ferritin \<100ug/L or Ferritin between 100-299ug/L and Transferrin Saturation \< 20%.

You may not qualify if:

• Use of packed red blood cells or whole blood in the past 3 months;
• Use of erythropoietin-stimulating agent or IV iron in the past 3 months;
• Use of oral or IV iron (\>100mg/day) in the past 3 months;
• Haemoglobin (Hb) levels \> 15g/dL or \< 8g/dL;
• Active cancer;
• Infection requiring antibiotic treatment at the time of first scheduled dose;
• Any known contraindication to study intervention

Sponsors & Collaborators

• Hospital de Santa Cruz, Portugal: lead

Related Publications (18)

• Carroll JD, Mack MJ, Vemulapalli S, Herrmann HC, Gleason TG, Hanzel G, Deeb GM, Thourani VH, Cohen DJ, Desai N, Kirtane AJ, Fitzgerald S, Michaels J, Krohn C, Masoudi FA, Brindis RG, Bavaria JE. STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020 Nov 24;76(21):2492-2516. doi: 10.1016/j.jacc.2020.09.595.

  PMID: 33213729 BACKGROUND

• Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG; PARTNER 2 Investigators. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016 Apr 28;374(17):1609-20. doi: 10.1056/NEJMoa1514616. Epub 2016 Apr 2.

  PMID: 27040324 BACKGROUND

• Vemulapalli S, Dai D, Hammill BG, Baron SJ, Cohen DJ, Mack MJ, Holmes DR Jr. Hospital Resource Utilization Before and After Transcatheter Aortic Valve Replacement: The STS/ACC TVT Registry. J Am Coll Cardiol. 2019 Mar 19;73(10):1135-1146. doi: 10.1016/j.jacc.2018.12.049.

  PMID: 30871697 BACKGROUND

• Myles PS, Richards T, Klein A. Preoperative intravenous iron for cardiac surgery. Lancet. 2020 Dec 12;396(10266):1883-1884. doi: 10.1016/S0140-6736(20)32406-5. No abstract available.

  PMID: 33308468 BACKGROUND

• Abdul-Jawad Altisent O, Puri R, Regueiro A, Chamandi C, Rodriguez-Gabella T, Del Trigo M, Campelo-Parada F, Couture T, Marsal JR, Cote M, Paradis JM, DeLarochelliere R, Doyle D, Mohammadi S, Dumont E, Rodes-Cabau J. Predictors and Association With Clinical Outcomes of the Changes in Exercise Capacity After Transcatheter Aortic Valve Replacement. Circulation. 2017 Aug 15;136(7):632-643. doi: 10.1161/CIRCULATIONAHA.116.026349. Epub 2017 Jun 6.

  PMID: 28588077 BACKGROUND

• Zimarino M, Barbanti M, Dangas GD, Testa L, Capodanno D, Stefanini GG, Radico F, Marchioni M, Amat-Santos I, Piva T, Saia F, Reimers B, De Innocentiis C, Picchi A, Toro A, Rodriguez-Gabella T, Nicolini E, Moretti C, Gallina S, Maddestra N, Bedogni F, Tamburino C. Early Adverse Impact of Transfusion After Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the TRITAVI Registry. Circ Cardiovasc Interv. 2020 Dec;13(12):e009026. doi: 10.1161/CIRCINTERVENTIONS.120.009026. Epub 2020 Dec 4.

  PMID: 33272037 BACKGROUND

• Costa F, Cohen MG. Transfusion and Mortality After Transcatheter Aortic Valve Replacement: Association or Causation? Circ Cardiovasc Interv. 2020 Dec;13(12):e010225. doi: 10.1161/CIRCINTERVENTIONS.120.010225. Epub 2020 Dec 4. No abstract available.

  PMID: 33272032 BACKGROUND

• Nuis RJ, Rodes-Cabau J, Sinning JM, van Garsse L, Kefer J, Bosmans J, Dager AE, van Mieghem N, Urena M, Nickenig G, Werner N, Maessen J, Astarci P, Perez S, Benitez LM, Dumont E, van Domburg RT, de Jaegere PP. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation. Circ Cardiovasc Interv. 2012 Oct;5(5):680-8. doi: 10.1161/CIRCINTERVENTIONS.112.971291. Epub 2012 Oct 9.

  PMID: 23048055 BACKGROUND

• Klein AA, Chau M, Yeates JA, Collier T, Evans C, Agarwal S, Richards T; UK Cardiac and Vascular Surgery Interventional Anaemia Response (CAVIAR) study team. Preoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study. Br J Anaesth. 2020 Mar;124(3):243-250. doi: 10.1016/j.bja.2019.11.023. Epub 2020 Jan 3.

  PMID: 31902590 BACKGROUND

• Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, Luscher TF, Bart B, Banasiak W, Niegowska J, Kirwan BA, Mori C, von Eisenhart Rothe B, Pocock SJ, Poole-Wilson PA, Ponikowski P; FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361(25):2436-48. doi: 10.1056/NEJMoa0908355. Epub 2009 Nov 17.

  PMID: 19920054 BACKGROUND

• Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, McDonagh T, Parkhomenko A, Tavazzi L, Levesque V, Mori C, Roubert B, Filippatos G, Ruschitzka F, Anker SD; CONFIRM-HF Investigators. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiencydagger. Eur Heart J. 2015 Mar 14;36(11):657-68. doi: 10.1093/eurheartj/ehu385. Epub 2014 Aug 31.

  PMID: 25176939 BACKGROUND

• Jankowska EA, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, Banasiak W, Filippatos G, Anker SD, Ponikowski P. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail. 2016 Jul;18(7):786-95. doi: 10.1002/ejhf.473. Epub 2016 Jan 28.

  PMID: 26821594 BACKGROUND

• Ponikowski P, Kirwan BA, Anker SD, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Haboubi T, Keren A, Khintibidze I, Kragten H, Martinez FA, McDonagh T, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Jankowska EA. Rationale and design of the AFFIRM-AHF trial: a randomised, double-blind, placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalisations and mortality in iron-deficient patients admitted for acute heart failure. Eur J Heart Fail. 2019 Dec;21(12):1651-1658. doi: 10.1002/ejhf.1710. Epub 2019 Dec 28.

  PMID: 31883356 BACKGROUND

• Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Gohring UM, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Lewis BS, Comin-Colet J, von Haehling S, Cohen-Solal A, Danchin N, Doehner W, Dargie HJ, Motro M, Butler J, Friede T, Jensen KH, Pocock S, Jankowska EA; AFFIRM-AHF investigators. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020 Dec 12;396(10266):1895-1904. doi: 10.1016/S0140-6736(20)32339-4. Epub 2020 Nov 13.

  PMID: 33197395 BACKGROUND

• Richards T, Baikady RR, Clevenger B, Butcher A, Abeysiri S, Chau M, Macdougall IC, Murphy G, Swinson R, Collier T, Van Dyck L, Browne J, Bradbury A, Dodd M, Evans R, Brealey D, Anker SD, Klein A. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet. 2020 Oct 24;396(10259):1353-1361. doi: 10.1016/S0140-6736(20)31539-7. Epub 2020 Sep 5.

  PMID: 32896294 BACKGROUND

• Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR; PARTNER 3 Investigators. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019 May 2;380(18):1695-1705. doi: 10.1056/NEJMoa1814052. Epub 2019 Mar 16.

  PMID: 30883058 BACKGROUND

• Durand E, Doutriaux M, Bettinger N, Tron C, Fauvel C, Bauer F, Dacher JN, Bouhzam N, Litzler PY, Cribier A, Eltchaninoff H. Incidence, Prognostic Impact, and Predictive Factors of Readmission for Heart Failure After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2017 Dec 11;10(23):2426-2436. doi: 10.1016/j.jcin.2017.09.010.

  PMID: 29217006 BACKGROUND

• Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL 3rd, Forrest JK, Tchetche D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ; Evolut Low Risk Trial Investigators. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019 May 2;380(18):1706-1715. doi: 10.1056/NEJMoa1816885. Epub 2019 Mar 16.

  PMID: 30883053 BACKGROUND

MeSH Terms

Conditions

Aortic Valve Stenosis; Anemia, Iron-Deficiency

Interventions

ferric carboxymaltose

Condition Hierarchy (Ancestors)

Aortic Valve Disease; Heart Valve Diseases; Heart Diseases; Cardiovascular Diseases; Ventricular Outflow Obstruction; Anemia, Hypochromic; Anemia; Hematologic Diseases; Hemic and Lymphatic Diseases; Iron Deficiencies; Iron Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases

Study Officials

• Afonso Félix-Oliveira, MSc

  Hospital de Santa Cruz, Portugal

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Afonso Félix-Oliveira, MSc

CONTACT

00351210433001; afonso.felix.oliveira@gmail.com

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Two-arm trial of intravenous iron supplementation vs placebo, randomized 1:1.

Study Record Dates

• First Submitted: March 2, 2021
• First Posted: March 8, 2021
• Study Start: January 1, 2022
• Primary Completion: January 1, 2025
• Study Completion: June 1, 2025
• Last Updated: March 8, 2021

Record last verified: 2021-03

Data Sharing

• IPD Sharing: Will not share