The addition of oral iron improves chemotherapy‐induced anemia in patients receiving erythropoiesis‐stimulating agents

Abstract

Although many studies have shown that supplementation with iron and erythropoiesis-stimulating agents (ESA) is frequently used for managing chemotherapy-induced anemia (CIA), optimal combination therapy using these agents together to ameliorate anemia is not well characterized. To assess the effects of ESA combined with oral or intravenous (IV) iron on relieving CIA, PubMed, Cochrane Library, Embase and China National Knowledge Infrastructure (CNKI) were searched for articles. Data collected in the articles were meta-analyzed using RevMan 5.3 software with a random-effects model. Our comprehensive search yielded 1666 potentially relevant trials. A total of 41 trials randomizing 4200 patients with CIA fulfilled inclusion criteria, including 34 Chinese articles and 7 English articles. Meta-analysis showed that treatment with both ESA and iron more effectively improved CIA relative to iron supplementation alone, with increased hemoglobin, hematocrit, red blood cell count and hematopoietic response rate. Subgroup analyses revealed iron administration, both oral and IV iron, improved anemia in ESA-treated cancer patients with CIA. Our analysis demonstrates that iron supplementation combined with ESA more effectively ameliorates CIA relative to iron supplementation alone, without regard to whether IV or oral iron was used. Together, our findings may contribute to the clinical treatment of CIA using iron therapy with or without ESA.chemotherapy-induced anemia, erythropoiesis-stimulating agents, intravenous iron, meta-analysis, oral iron What's new?Chemotherapy-induced anemia is a common event among cancer patients, and it is generally treated with oral or intravenous iron supplementation as well as erythropoiesis-stimulating agents. Here, the authors analyzed the literature, both in English and Chinese, to assess the effectiveness of these treatments. They identified 41 trials, involving 4200 patients, and showed that treatment with both ESA and iron more effectively improved anemia compared to iron supplementation alone. This is the first analysis that incorporates the Chinese literature on this subject, substantially increasing the number of trials available.

Practical aspects of the use of erythropoiesis-stimulating agent in patients with hematological malignancy

“…Преимущество парентерального препарата заключается в том, что необходимую дозу элементарного железа можно ввести одномоментно и, конечно, не возникает проблем с плохой переносимостью, характерной для пероральных форм [25]. Метаанализ 41 клинического исследования, включавшего 4 200 пациентов, получавших ЭСП по поводу анемии, индуцированной химиотерапией, не выявил различий по частоте гематологического ответа и приросту гемоглобина между суплементацией с помощью перорального или внутривенного железа [26]. Если анемия вызвана не химиотерапией, а происходит по механизму «анемии хронических болезней», когда гепсидин блокирует систему ферропортина, -пероральный прием железа работать не будет [27].…”