Comparative efficacy and safety of intravenous ferric carboxymaltose and iron sucrose for iron deficiency anemia in obstetric and gynecologic patients

Abstract

Introduction: Iron deficiency anemia (IDA) is common among obstetric and gynecologic patients. This systematic review aimed to assess the comparative efficacy and safety of commonly used intravenous (IV) iron formulations, ferric carboxymaltose (FCM), and iron sucrose (IS) in the treatment of IDA in obstetric and gynecologic patients. Methods: We systematically searched PubMed, EMBASE, Cochrane CENTRAL, and Google Scholar for eligible randomized controlled trials (RCTs) comparing IV iron replacement using FCM and IS up to October 2019. The primary outcome was to compare the efficacy of FCM and IS, assessed by measuring serum hemoglobin (Hb) and ferritin levels before and after iron replacement. The secondary outcome was to compare the safety of FCM and IS, assessed by the incidence of adverse events during iron replacement. The meta-analysis was performed using RevMan 5.3. Results: We identified 9 RCTs with 910 patients (FCM group, n = 456; IS group, n = 454). Before iron replacement, FCM and IS group patients had similar baseline Hb (mean difference [MD], 0.04 g/dL; 95% confidence interval [CI], −0.07 to 015; I 2 = 0%; P = 0.48) and ferritin levels (MD, −0.42 ng/mL; 95% CI, −1.61 to 0.78; I 2 = 45%; P = 0.49). Following iron replacement, patients who received FCM had higher Hb (MD, 0.67; 95% CI, 0.25–1.08; I 2 = 92%; P = 0.002) and ferritin levels (MD, 24.41; 95% CI, 12.06–36.76; I 2 = 75%; P = 0.0001) than patients who received IS. FCM group showed a lower incidence of adverse events following iron replacement than IS group (risk ratio, 0.53; 95% CI, 0.35–0.80; I 2 = 0%; P = 0.003). Serious adverse events were not reported in any group. Conclusion: FCM group showed better efficacy in increasing Hb and ferritin levels and a favorable safety profile with fewer adverse events compared with IS group for IDA treatment among obstetric and gynecologic patients. However, this meta-analysis was limited by the small number of RCTs and high heterogeneity. Trial registration: The review was prospectively registered with the International Prospective Registry of Systematic Reviews ( https://www.crd.york.ac.uk/prospero/ , registration number CRD42019148905).

Reducing unnecessary premedication prior to parenteral iron therapy: A quality improvement project

“…13 Studies evaluating the efficacy of IV iron to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy have demonstrated superiority in achieving desired hemoglobin targets faster and with fewer side effects, with research ongoing. [14][15][16][17] To minimize anaphylactic reactions, some physicians empirically premedicated patients with corticosteroids, acetaminophen, and/or antihistamines. While this might have offered some protection with the older, high-molecular-weight iron formulations, there is not sufficient evidence to support its routine use in the prevention of HSRs due to newer IV iron formulations.…”

“…IV iron may be used in the second or third trimester after a discussion of the risks and benefits with the patient 13 . Studies evaluating the efficacy of IV iron to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy have demonstrated superiority in achieving desired hemoglobin targets faster and with fewer side effects, with research ongoing 14–17 …”