Alternate day vs. daily oral iron in IDA
Trial question
Is alternate day oral iron therapy superior to daily oral iron therapy in patients with iron deficiency anemia?
Study design
Single center
Double blinded
RCT
Population
200 patients.
Inclusion criteria: patients with iron deficiency anemia.
Key exclusion criteria: CKD; chronic liver disease; HF; malignancy; hemolytic anemia; pregnancy; blood transfusions within past 3 months; severe anemia requiring transfusion.
Interventions
N=100 alternate day iron therapy (120 mg elemental iron tablets on alternate days for 8 weeks).
N=100 daily iron therapy (single tablet of 60 mg elemental iron daily for 8 weeks).
Primary outcome
Mean improvement in hemoglobin level at week 8
1.05 g/dL
1.36 g/dL
1.4 g/dL
1.0 g/dL
0.7 g/dL
0.3 g/dL
0.0 g/dL
Alternate day iron
therapy
Daily iron
therapy
No significant
difference ↔
No significant difference in mean improvement in hemoglobin level at week 8 (1.05 g/dL vs. 1.36 g/dL; AD -0.31 g/dL, 95% CI -1.13 to 0.51).
Secondary outcomes
No significant difference in improvement in ferritin level at week 4 (30.84 ng/mL vs. 17.69 ng/mL; AD 13.15 ng/mL, 95% CI -12.52 to 38.82).
No significant difference in the proportion of patients with at least 2 g/dL rise in hemoglobin at week 8 (17.71% vs. 22.45%; ARD -4.74, 95% CI -15.84 to 6.36).
Safety outcomes
No significant difference in other adverse events.
Significant difference in nausea at week 4 (10.3% vs. 2%).
Conclusion
In patients with iron deficiency anemia, alternate day iron therapy was not superior to daily iron therapy with respect to mean improvement in hemoglobin level at week 8.
Reference
Elamparithi Pasupathy, Ravichandran Kandasamy, Kurien Thomas et al. Alternate day versus daily oral iron for treatment of iron deficiency anemia: a randomized controlled trial. Sci Rep. 2023 Feb 1;13(1):1818.
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