Treatment of Anemia: Intravenous Iron More Effective Than Oral Tablets

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A study revealed that the medication ferric carboxymaltose, administered intravenously, is more effective and acts more rapidly than oral iron tablets in treating anemia. Furthermore, it maintains a safety profile comparable to that of the tablets. These results were published in Lancet Global Health ().

Why a Need for Effective and Safer Alternative for Anemia

Anemia, characterized by low blood levels, is one of the common reasons for health complications and mortality among mothers and their infants. This is observed particularly in regions such as sub-Saharan Africa and Southeast Asia, where over 40% of pregnant women are affected by this condition. In Nigeria, a significant number of pregnant women continue to give birth while still experiencing anemia, even after taking iron supplements intended for prevention during pregnancy. This situation can be attributed to several factors, including the intolerance some women have towards these tablets due to side effects such as diarrhea, nausea, or vomiting, or they may not remember to take the tablets regularly. Furthermore, iron preparations administered intravenously in Nigeria, such as iron dextran, have been linked to a heightened risk of severe adverse effects, while iron sucrose requires multiple doses. Therefore, there is an urgent need for a more effective and safer alternative to address these challenges.

‘Did You Know?
In a worldwide projection, it is estimated that 40% of children between the ages of 6 and 59 months, 37% of pregnant women, and 30% of women aged 15 to 49 years are impacted by anemia. #Anemia #Iron #medindia’

A group of researchers has recently completed a clinical trial known as the IVON TRIAL, which evaluated a novel medication for the treatment of anemia, specifically ferric carboxymaltose. This medication is newly introduced in Nigeria and most of sub-Saharan Africa.

The researchers conducted a comparison of the efficacy and safety of this medication against a widely used tablet known as ferrous sulfate, which is being presently used in the treatment of anemia in Nigeria. Their findings indicated that the new medication, administered intravenously as a continuous drip, demonstrates a more rapid and effective response in treating anemia compared to oral iron tablets. In addition, it was noted that it maintains a safety profile comparable to that of the tablet.

Comparison of Iron Given as Tablets Vs. Iron Administered Intravenously

The study enrolled 1,056 pregnant women, aged 15 - 49 years, who were between five and seven-and-half months pregnant and had anemia with hemoglobin (red blood level) measurement less than 10 g/dl.

"We used a web-based platform to assign them to treatment groups. Half of the women were treated with one dose of iron given in drip through the vein while half took iron tablets three times a day till they gave birth", says Ochuwa A. Babah, a doctoral student at the Department of Global Public Health, Karolinska Institutet and one of the authors of the paper.

Their hemoglobin levels and iron levels were checked, and they were screened for depression at specific time points. The follow-up was done regularly until six weeks after delivery to collect more data from the mother and baby. Blood was collected from the baby's cord at delivery to know if the medicine affected the baby's phosphate level.

Only one dose of iron (ferric carboxymaltose) given by drip through a vein during pregnancy causes a faster rise in blood level after four weeks compared to an iron tablet taken by mouth three times every day. The drip iron also corrects low body iron better than iron tablets. The side effects of the drip iron are comparable to those of iron tablets, with no adverse effect on the babies.

"These findings are reassuring because pregnant women often reject new medicines because of fear of harm to their babies. We now have evidence that implementing the use of this new drip iron (ferric carboxymaltose) in regions where many pregnant women suffer anemia like Africa, will be a valuable step towards reducing the proportion of pregnant women who suffer from this condition and its complications", says Ochuwa A. Babah and continues:

"The pregnant women were willing to accept the drip iron during pregnancy, supported by their families. The healthcare workers were ready to administer drip iron but identified a need to increase staff strength and possibly medicine subsidy. We know from the clinical trial that the drip iron is effective and safe, so we are already liaising with the Federal Ministry of Health, Nigeria to add it to the essential drug list."

Reference:

1. Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial - (https:www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00239-0/fulltext)

Source: Medindia