Written informed consent was provided by all

subjects. The trial was designed, implemented, and overseen by the LDK378 cost PACTTE Steering Committee. An independent DSMB reviewed the safety data and study progress on an ongoing basis. Outpatient men and women with the following criteria were eligible to enroll: age ≥ 65 years with a hemoglobin concentration of ≥ 9 g/dL and < 11.5 g/dL for women or < 12.7 g/dL for men with unexplained anemia; serum ferritin between 20 and 200 ng/mL (inclusive); ability to walk without the use of a walker or motorized device, or the assistance of another person; lack of significant cognitive impairment defined by a Montreal Cognitive Assessment score of 22 or higher; and ability to understand and speak English (Table 1). The protocol initially included subjects with a serum ferritin between 20 and 100 ng/mL (inclusive) but was modified on March 26, 2012, due to poor recruitment to allow serum ferritin levels between 20 and 200 ng/mL (inclusive). The protocol was additionally modified on

August 20, 2012, at sites with Spanish-speaking study staff to include subjects who were able to speak and understand Spanish. Unexplained anemia was defined, similar to published criteria [13] and [14], as not meeting criteria for any known etiology of anemia, including vitamin B12, folate, or iron deficiency (defined as serum ferritin < 20 ng/mL); renal insufficiency (defined as glomerular filtration rate of less than 30 [16] using the four-variable Modification of Diet in Renal Disease equation [17]); thyroid dysfunction; myelodysplastic PCI32765 syndrome; anemia of inflammation; plasma cell

dyscrasia; thalassemia trait; alcohol overuse; any prior history of hematologic malignancy; unexplained splenomegaly or lymphadenopathy; or the presence of any condition reasonably assumed to be causing anemia and not corrected for 3 months (Table 2). Subjects were excluded if they had received a red blood cell transfusion, intravenous iron, or an erythropoiesis stimulating agent within 3 months prior to enrollment; had unstable angina, a myocardial infarction, a stroke, or a transient ischemic attack within 3 months prior to enrollment; had uncontrolled hypertension; had a positive fecal occult blood test during the screening period; had significant impairment in liver else function; had a documented history of anaphylactic reaction to iron sucrose infusion; had recently initiated oral iron supplementation; or if the distance walked on the 6-minute walk test (6MWT) was above the median for age and sex, to avoid a ceiling effect (Table 1; Appendix A). Subjects were randomized to start IVIS either immediately (immediate intervention group) or after a 12-week wait list period (wait list control group) at a 1:1 ratio via an interactive voice and web response system. The randomization sequence was computer-generated with random block sizes. Neither subjects nor investigators were blinded.