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Oral iron nonresponders must shift to IV iron supplementation

Stephen Padilla
15 Aug 2017

Patients with a haemoglobin response <1.0 g/dL at day 14 of oral iron therapy should be transitioned to intravenous (IV) iron supplementation, suggests a recent study.

“A haemoglobin increase ≥1.0 g/dL from baseline at day 14 is an accurate predictor of the subsequent overall haemoglobin response with continued oral supplementation,” researchers said. “In clinical practice, nonresponders should be transitioned to IV iron supplementation.”

Majority of the participants (72.8 percent) responded to the oral iron therapy. The proportion of responders with haemoglobin increases ≥1.0, ≥2.0 and ≥3.0 g/dL was greatest among those with postpartum anaemia, intermediate among those with heavy uterine bleeding or gastrointestinal-related causes of anaemia, and lowest among those with other causes. Such proportion was also significantly higher among responders than nonresponders. [Am J Med 2017;130:991.e1–991.e8]

Increases in haemoglobin ≥1.0 g/dL on day 14 were the most accurate predictor of satisfactory overall haemoglobin response to oral iron therapy on day 42/56 (sensitivity 90.1 percent; specificity 79.3 percent; positive and negative predictive values of 92.9 and 72.7 percent, respectively). Furthermore, quality of life (QoL) improved with iron-replacement therapy, which also attenuated fatigue.

“Iron therapy improved quality of life as measured by the SF-36 (Medical Outcomes Study Short Form 36) total score and reduced fatigue as measured by the Fatigue Severity Scale and the Fatigue Linear Analog Scale in the randomized clinical trials included in the present analysis,” researchers said.

These findings indicated that patients with iron-deficiency anaemia who had haemoglobin increases <1.0 g/dL at day 14 of oral iron supplementation should be transitioned to IV iron. Such findings were similarly reported by Onken et al, in which patients with haemoglobin increase <1.0 g/dL after 14 days of oral iron therapy were randomized to receive either IV iron or continued oral iron supplementation for 14 additional days. [Transfusion 2014;54:306–315]

“IV iron is more effective than oral iron in producing sustained haemoglobin responses and reducing the need for blood transfusions,” researchers said. [BMJ 2013;347:f4822]

A meta-analysis of 103 trials published from 1966 through 2013 revealed that IV iron did not correlate with an elevated risk of severe adverse events compared with control treatments, such as oral iron, intramuscular iron, placebo or no iron (relative risk, 1.04; 95 percent CI, 0.93 to 1.17). [Mayo Clin Proc 2015;90:12–23]

In the present study, researchers analysed pooled data from five randomized trials to compare oral and IV iron-replacement therapy for iron-deficiency anaemia. Patients with ≥1.0-g/dL increases in haemoglobin at day 14 were classified as responders, whereas those with smaller increases were categorized as nonresponders.

The authors also evaluated demographic and clinical characteristics for association with haemoglobin response at multiple timepoints.

Iron deficiency often results in iron-deficiency anaemia and is associated with fatigue, impaired QoL and decreased work capacity. [Int J Cardiol 2014;174:268–275; J Nutr 2001;131:676S–688S; Qual Life Res 2000;9:491–497]

In the 2014 Global Burden of Diseases, Injuries and Risk Factors study, iron deficiency was found to be the most common cause of anaemia worldwide, with the prevalence of other causes of anaemia varying widely by age, gender and geography. [Blood 2014;123:615–624; Lancet 2015;386:743–800]

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Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
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2 days ago
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3 days ago
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