Oral versus intravenous iron therapy in iron deficiency anemia: An observational study

Abstract

Background: Intravenous (IV) iron sucrose is claimed to have better safety profile and efficacy in treatment of iron deficiency anemia than conventional oral iron supplements. Aim: The aim of the study was to compare the efficacy and safety of IV iron therapy with oral iron supplements in iron deficiency anemia. Methods: An observational study was carried out by allocating 100 patients with baseline hemoglobin between 5 and 10 g/dL into two groups of oral iron and IV iron group. Hemoglobin and serum ferritin levels were measured at admission, on day 14 and on day 28. Adverse effect profile for each group was tabulated. Mean and standard deviation were calculated for each group and compared. Results: A total of 100 patients participated consisting of 37 males and 63 females. Baseline hemoglobin and serum ferritin for both groups were comparable. After initiation of therapy, hemoglobin in oral iron group raised from 6.45 (0.72) to 8.84 (0.47) on day 14 and to 9.69 (0.47) on day 28. Hemoglobin in IV iron group increased from 6.34 (0.86) to 10.52 (0.61) on day 14 and to 11.66 (0.84) on day 28. Serum ferritin in oral iron group increased from 8.3 (1.9) to 33.8 (1.29) on day 14 and to 43.61 (8.8) on day 28. Serum ferritin in IV iron group raised from 8.23 (4.64) to 148.23 (11.86) on day 14 but decreased to 115.76 (15.3) on day 28. The data were statistically significant for IV iron therapy on day 14 and day 28. Of 100 patients, 18 patients (12 in oral and 6 in IV iron groups) had adverse effects. Among the oral iron group, metallic taste and constipation were major side effects followed by heart burn and nausea. In the IV iron group, arthralgia (4 patients of 6) was the major side effect observed. One patient (of 6) in IV group had hypotension. Anaphylaxis was not observed in any patient in either group. Conclusion: IV iron therapy is effective and safe for management of iron deficiency anemia.

Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions

“…Intravenous (IV) iron is more effective and faster acting than oral iron; however, concerns persist among some clinicians regarding the overall safety of certain IV iron formulations. [1][2][3][4] IV iron carries a minimal (1:100-250) risk of inducing a minor hypersensitivity reaction that can include flushing, urticaria, pruritus, or chest and/or back pressure. [5][6][7][8] Severe adverse events (SAEs) are exceedingly rare, but the exact frequency is unclear.…”

Association of iron therapy with incidence of chronic kidney disease

“…Prior clinical trials found that oral iron therapy was effective in increasing absolute hemoglobin concentration in patients with iron deficiency anemia. [35][36][37] Iron therapy in patients with heart failure and iron deficiency anemia has shown significant reduction in all-cause mortality, cardiovascular and heart failure hospitalization; improvement in the hypercapnic ventilatory response and sleep-related breathing disorders; improvement in exercise capacity and quality-of-life. [38][39][40][41] On the other hand, iron replacement therapy T A B L E 1 Baseline characteristics of the overall cohort and of patients receiving oral iron replacement and not receiving oral iron replacement.…”

“…To our knowledge, this study is the first to examine the association of oral iron replacement with new onset CKD in a large population of patients with no pre‐existing kidney disease. Prior clinical trials found that oral iron therapy was effective in increasing absolute hemoglobin concentration in patients with iron deficiency anemia 35–37 . Iron therapy in patients with heart failure and iron deficiency anemia has shown significant reduction in all‐cause mortality, cardiovascular and heart failure hospitalization; improvement in the hypercapnic ventilatory response and sleep‐related breathing disorders; improvement in exercise capacity and quality‐of‐life 38–41 .…”

Quercetin attenuates neurotoxicity induced by iron oxide nanoparticles

“…htm# indic ations the general public but up to 50% of patients experience gastrointestinal complications [161]. Poor absorption, poor compliance, intestinal barrier, first-pass metabolism, gastrointestinal side effects, hepatotoxicity, and intact intestinal mucosa requirement for uptake are some of the adverse effects of oral iron administration [162,163]. In addition, the bioavailability of ferric iron salts or ferric iron complexes is low that can prolong the duration of treatment [161].…”