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Oral Iron for Anemia: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines

Last updated: January 7, 2016
Project Number: RC0735-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of oral iron complex products compared with oral iron salts for patients with anemia?
  2. What is the clinical effectiveness of oral iron complex products compared with injectable iron supplements for patients with anemia?
  3. What is the comparative clinical effectiveness of different oral iron complex products?
  4. What is the cost-effectiveness of oral iron complex products for patients with anemia?
  5. What are the evidence-based guidelines for the treatment of iron deficiency with oral iron products?

Key Message

Among chronic kidney disease (CKD) patients with iron deficiency anemia (IDA), oral heme iron polypeptide (HIP) was comparably effective compared with intravenous (IV) iron preparations or oral ferrous sulfate to improve hemoglobin levels and transferrin saturation. However, both IV iron and oral ferrous sulfate improved serum ferritin levels to a significantly higher level than HIP in CKD patients with IDA. Oral ferrous sulfate is similarly effective to either oral iron polymaltose complex (IPC) or iron-zinc combination preparations to improve hemoglobin levels in children with IDA aged between 6 months and 15 years. Oral ferrous sulfate has comparable efficacy as oral IPC for the treatment of IDA during pregnancy. Although oral IPC was associated with a lower incidence of adverse events compared with ferrous sulfate for the treatment of IDA during pregnancy, both interventions were generally well tolerated with no serious adverse events occurring with either treatment. No studies which compared the clinical or cost effectiveness of different oral iron complex products for patients with anemia were identified.