Ferric polymaltose complex in treatment of iron deficiency and iron-deficiency anaemia with pregnancy
, 1, 3
Abstract
Introduction. Iron deficiency (ID), and iron deficiency anaemia (IDA) are consistently associated with reduced maternal cognitive function and increased depressive disorders. In addition, the preterm delivery, and intra-uterine growth restriction were reported as an adverse neonatal outcome for ID and IDA. This study designed to evaluate the efficacy of ferric hydroxide polymaltose (FPM) in treatment of ID, and IDA during pregnancy.
Materials and methods. One hundred and twenty-two women with ID (ferritin < 15 μg/L), and moderate IDA (haemoglobin ≥ 7 and < 10 g/dL) during pregnancy were included in this study. Studied women treated with FPM tablets for ≥ 3 months. The pre-treatment ferritin, haemoglobin, red blood cells (RBCs)-mean corpuscular volume (MCV), and -mean corpuscular haemoglobin (MCH) were compared by post-treatment values.
Results. The mean pre-treatment ferritin, and haemoglobin significantly increased from 12.4 ± 5.6 μg/L and 7.8 ± 3.3 g/dL; respectively to 116.5 ± 6.9 μg/L and 11.1 ± 2.8 g/dL; respectively, 3-months’ after FPM treatment (p = 0.02 and 0.0002; respectively). In addition, the mean pretreatment RBCs MCV, and MCH significantly increased from 73.5 ± 4.6 fL and 24.2 ± 7.7 pg; respectively to 94.0 ± 3.8 fL and 31.7 ± 6.3 pg; respectively 3-months’ after FPM treatment (p = 0.02 and 0.01; respectively).
Conclusion. The FPM (Ferose®) is an effective therapeutic option for treatment of ID, and IDA during pregnancy with high safety profile, and low side effects. The superior tolerability of FPM is an important advantage because compliance to oral iron is the main obstacle toward effective treatment of ID, and IDA during pregnancy.
Keywords: ferric polymaltose complexirondeficiencyanaemiapregnancy
References
- Api O, Breyman C, Çetiner M, et al. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turk J Obstet Gynecol. 2015; 12(3): 173–181.
- World Health Organization. Iron and folate supplementation: standards for maternal and neonatal care. Integrated Management of Pregnancy and Childbirth (IMPAC). Department of Making Pregnancy Safer. WHO, 2007. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/iron_folate_supplementation.pdf (November 10, 2020).
- Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000; 72(1 Suppl): 257S–264S.
- Meyron-Holtz EG, Moshe-Belizowski S, Cohen LA. A possible role for secreted ferritin in tissue iron distribution. J Neural Transm (Vienna). 2011; 118(3): 337–347.
- Khalafallah AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012; 2012: 630519.
- Stafford I, Dildy GA, Clark SL, et al. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008; 199(5): 519.e1–519.e7.
- Breymann C, Bian XM, Blanco-Capito LR, et al. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med. 2011; 39(2): 113–121.
- Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009; 130(5): 627–633.
- Shafi D, Purandare SV, Sathe AV. Iron deficiency anemia in pregnancy: intravenous versus oral route. J Obstet Gynaecol India. 2012; 62(3): 317–321.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol. 2008; 112(1): 201–207.
- Abdelazim IA, Abu-Faza M, Bou Hamdan S. Intravenous iron saccharate infusion for treatment of iron deficiency anemia before labor. ARC Journal of Gynecology and Obstetrics. 2016; 1(3): 16–20.
- Froessler B, Gajic T, Dekker G, et al. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018; 298(1): 75–82.
- Roberts CL, Nippita T. International caesarean section rates: the rising tide. Lancet Glob Health. 2015; 3(5): e241–e242.
- Patterson JA, Roberts CL, Isbister JP, et al. What factors contribute to hospital variation in obstetric transfusion rates? Vox Sang. 2015; 108(1): 37–45.
- Froessler B, Palm P, Weber I, et al. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg. 2016; 264(1): 41–46.
- Scientific Opinion on the safety of heme iron (blood peptonates) for the proposed uses as a source of iron added for nutritional purposes to foods for the general population, including food supplements. EFSA Journal. 2010; 8(4): 1585.
- Pavord S, Myers B, Robinson S, et al. British Committee for Standards in Haematology. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2012; 156(5): 588–600.
- Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011; 4(3): 177–184.
- Abdelazim IA, Abu-Faza M, Shikanova S, et al. Heme-bound iron in treatment of pregnancy-associated iron deficiency anemia. J Family Med Prim Care. 2018; 7(6): 1434–1438.
- Radhika AG, Sharma AK, Perumal V, et al. Parenteral versus oral iron for treatment of iron deficiency anaemia during pregnancy and post-partum: a systematic review. J Obstet Gynaecol India. 2019; 69(1): 13–24.
- Gupta A, Manaktala U, Rathore AM. A randomised controlled trial to compare intravenous iron sucrose and oral iron in treatment of iron deficiency anemia in pregnancy. Indian J Hematol Blood Transfus. 2014; 30(2): 120–125.
- Toblli JE, Brignoli R. Iron(III)-hydroxide polymaltose complex in iron deficiency anemia / review and meta-analysis. Arzneimittelforschung. 2007; 57(6A): 431–438.
- Geisser P. Safety and efficacy of iron(III)-hydroxide polymaltose complex / a review of over 25 years experience. Arzneimittelforschung. 2007; 57(6A): 439–452.
- Ortiz R, Toblli JE, Romero JD, et al. Efficacy and safety of oral iron(III) polymaltose complex versus ferrous sulfate in pregnant women with iron-deficiency anemia: a multicenter, randomized, controlled study. J Matern Fetal Neonatal Med. 2011; 24(11): 1347–1352.
- Ferric polymaltose complex (Ferose) in treatment of iron deficiency and iron deficiency anemia with pregnancy. http://www.ANZCTR.org.au/ACTRN12619000230156.aspx (November 10, 2020).
- Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013; 87(2): 98–104.
- Abdelazim IA, Nusair B, Svetlana S, et al. Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet. 2018; 298(6): 1231–1232.
- Kanshaiym S, Abdelazim IA, Starchenko T, et al. Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard dose, to anemic pregnant women in rural Northern India. J Family Med Prim Care. 2019; 8(2): 769–770.
- Kanshaiym S, Zhurabekova G, Abdelazim IA, et al. Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia: Letter to Editor. Hematol Transfus Cell Ther. 2020; 42(1): 98–99.
- Geisser P, Burckhardt S. The pharmacokinetics and pharmacodynamics of iron preparations. Pharmaceutics. 2011; 3(1): 12–33.
- Yee J, Besarab A. Iron sucrose: the oldest iron therapy becomes new. Am J Kidney Dis. 2002; 40(6): 1111–1121.
- Teucher B, Olivares M, Cori H. Enhancers of iron absorption: ascorbic acid and other organic acids. Int J Vitam Nutr Res. 2004; 74(6): 403–419.
- Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008; 121(11): 943–948.
- Yasmeen S, Aktar N, Azim E, et al. Iron polymaltose complex in the treatment of iron deficiency anemia in pregnancy . Mymensingh Med J. 2016; 25(3): 506–513.
- Saha L, Pandhi P, Gopalan S, et al. Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulphate in the treatment of iron deficiency anemia in pregnant women. MedGenMed. 2007; 9(1): 1.
- Al-Momen AK, Al-Meshari A, Al-Nuaim L, et al. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1996; 69(2): 121–124.
- Toblli JE, Cao G, Angerosa M. Ferrous sulfate, but not iron polymaltose complex, aggravates local and systemic inflammation and oxidative stress in dextran sodium sulfate-induced colitis in rats. Drug Des Devel Ther. 2015; 9: 2585–2597.
