Iron Supplementation for Iron Deficiency Anemia: Does it Need to be Daily?

In One Study, Three Times Weekly Seemed Similar to Three Times Daily at 12 Weeks

Several studies have previously shown that use of oral iron supplements every other day rather than daily could have similar efficacy and fewer side effects in the treatment of patients with iron deficiency anemia. 

In a new study, authors from Thailand reported results from a prospective open-labeled randomized controlled study which was designed to compare whether use of 200 mg ferrous fumarate three times per week (TIW) was not inferior to a three times per day TID) regimen in the treatment of iron deficiency anemia. The authors also wished to assess the incidence of adverse events between two regimens.

The authors recruited adult patients with iron deficiency anemia (Hemoglobin < 12 g/dL in females or < 13 g/dL in males and serum ferritin level of < 30 ng/mL).

In total, 64 patients were randomized: 32 receiving iron three times per week and 32 in receiving iron three times per day.

Overall, the trial demonstrated that three times weekly iron therapy was not inferior compared to three times daily.
At week 4, the mean Hemoglobin level in the three times per day group was significantly higher than the three times per week group (9.9 vs. 10.8 g/ dL, respectively, p = 0.040). However,  the mean hemoglobin levels were not substantially different in either group at week 12 (11.9 vs. 12.4 g/dL, p = 0.188).

The proportion of patients who had serum ferritin levels above 30 ng/mL was not different between the two groups at week 12 (64.3% vs. 73.1%, p = 0.430). There were more gastrointestinal  releated side effects (nausea and epigastric discomfort) in the group using three times per day.

In conclusion, this study showed that the use of iron three times per week was non-inferior to the use of iron three times per day in the treatment of iron deficiency anemia at a 12 week time point and had fewer adverse events and lower costs.

REFERENCE
Jongkraijakra  S et al. A randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia. Ann Hematol. 2023 Apr 3;1-8. #irontherapy #irondeficiencyanemia #irondeficiency #dermatology #hematology