• Data from five randomized trials were pooled to evaluate the use of oral iron therapy for patients with iron-deficiency anemia. Most of the participants (72.8%) responded to oral iron therapy, evidence by a hemoglobin increase of ≥1.0 g/dL in 14 days. The greatest hemoglobin increases were seen in women with postpartum anemia, followed by those with heavy uterine bleeding or gastrointestinal-related causes of anemia. The most accurate predictor of a satisfactory overall hemoglobin response to oral iron on day 42 was a ≥1.0 g/dL increase in hemoglobin on day 14. Quality of life improved with treatment, and fatigue was reduced.
• The authors suggest that patients with iron-deficiency anemia with a <1.0 g/dL increase in hemoglobin after 14 days of oral iron therapy should be given intravenous iron therapy.

Abstract

BACKGROUND

Oral iron-replacement therapy is the mainstay of treatment for iron-deficiency anemia, but it is often poorly tolerated or ineffective. Hemoglobin response at day 14 of oral iron may be useful in assessing whether and when to transition patients from oral to intravenous (IV) iron.

METHODS

Pooled data from 5 randomized trials were analyzed to compare oral and IV iron-replacement therapy for iron-deficiency anemia. Treatment criteria and assignment to oral versus IV iron were defined per protocol; this analysis included only subjects receiving oral iron. Responders were subjects with ≥1.0 g/dL increases in hemoglobin at day 14, and nonresponders were those with smaller increases. Demographic and clinical characteristics were evaluated for association with hemoglobin response at multiple timepoints.

RESULTS

Most subjects (72.8%) were classified as responders. The proportion of subjects with hemoglobin increases ≥1.0, ≥2.0, and ≥3.0 g/dL was greatest among those with postpartum anemia, intermediate among those with heavy uterine bleeding or gastrointestinal-related causes of anemia, and lowest among those with other causes; this proportion was also significantly greater among responders than nonresponders. A ≥1.0 g/dL increase in hemoglobin on day 14 most accurately predicted satisfactory overall hemoglobin response to oral iron on day 42/56 (sensitivity: 90.1%; specificity: 79.3%; positive and negative predictive values: 92.9% and 72.7%, respectively). Iron-replacement therapy improved quality of life and reduced fatigue.

CONCLUSION

Hemoglobin responses <1.0 g/dL at day 14 of oral iron identify subjects with iron-deficiency anemia who should be transitioned to IV iron supplementation.

Story Source
Journal Abstract