title: Clinical efficacy and safety of IV ferric carboxymaltose (FCM) treatment of RLS: a multi-centred, placebo-controlled preliminary clinical trial.
abstract: OBJECTIVE
  Intravenous (IV) iron has been used as a treatment to reduce Restless Legs Syndrome (RLS) symptoms, but two double-blinded trials of a frequently prescribed IV iron formulation, iron sucrose, failed to show lasting efficacy. This study evaluates efficacy and safety of a new IV iron formulation (ferric carboxymaltose, FCM) with molecular properties that may make iron more available for uptake to the brain than iron sucrose does.
  
  
  METHODS
  In this 28-day, multi-centre, randomised, placebo-controlled trial 46 RLS patients were discontinued from all RLS treatment. Twenty-four received 500 mg FCM in two doses 5 days apart and 22 received a matching placebo. At day 28, those on placebo were given a single 1000 mg IV FCM and those not responding to initial treatment were given a third dose of 500 mg FCM. Patients were followed up for 24 weeks or until needing added RLS treatment.
  
  
  RESULTS
  FCM significantly improved primary and secondary outcomes compared to placebo: International Restless Legs Syndrome study group severity scale (IRLS) average (SD) decrease of 8.9 (8.52) versus 4.0 (6.11), p=0.040; Clinical Global Inventory of Change (CGI-1) very much or much improved 48.3% versus 14.3%, p=0.004. Quality of life was also significantly improved. Of the 24 with initial iron treatment 45% responded and 29% remitted (IRLS ≤ 10) at day 28, and 25% continued free of other RLS medications at 24 weeks after treatment. The single 1000 mg dose on day 28 produced the same degree of treatment response as the divided dose, but the added 500 mg dose for those not responding to the initial treatment showed little benefit. There were no significant adverse events.
  
  
  CONCLUSIONS
  IV FCM provided a safe and effective treatment for RLS that lasted for at least 24 weeks for some patients. Larger studies are needed to confirm these results.
authors: Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. richardjhu@mac.com
authors: Richard P
authors: RP
authors: Allen
authors: Charles H
authors: CH
authors: Adler
authors: Wei
authors: W
authors: Du
authors: Angelia
authors: A
authors: Butcher
authors: David B
authors: DB
authors: Bregman
authors: Christopher J
authors: CJ
authors: Earley
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000187:drug effects* / Q000378:metabolism*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron / Q000097:blood; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008875:Middle Aged; D010865:Pilot Projects; D010919:Placebos; D012148:Restless Legs Syndrome / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005290:Ferric Compounds; D010919:Placebos; C522335:ferric carboxymaltose; D008320:Maltose; D005293:Ferritins; D007501:Iron