Efficacy and safety of intravenous iron sucrose, ferric carboxymaltose and iron isomaltoside in gynaecological patients: a comparative study

Background: Anaemia is a serious global public health problem that particularly affects young children, menstruating adolescent girls, pregnant and postpartum women. Parental iron therapy with iron sucrose or ferric carboxy maltose or iron isomaltoside results in faster and higher replenishment of iron stores with correction of Hb and ferritin levels and better patient compliance compared to oral drugs. Methods: This was a prospective, randomized comparative study conducted over 18 months in Department of Obstetrics & Gynaecology, Hind Institute of Medical Science, Barabanki, Uttar Pradesh. Total of 87 female patients of age group 18-50 years with haemoglobin level of <10gm/dl and serum ferritin <100ng/dl in Gynaecology OPD and IPD were assigned to 3 groups of Iron Sucrose (IS) group, Ferric Carboxymaltose (FCM) group and Iron Isomaltoside (IIM) group. Each group included 29 women with a ratio of 1:1:1. Iron requirement was calculated by Ganzoni formula and parenteral iron was given intravenously. Baseline values of haemoglobin and serum ferritin was noted and repeated at the end of 4 weeks of therapy. The observed values were compared and analysed. Results: The rise in haemoglobin and ferritin was higher with iron isomaltoside and ferric carboxymaltose (p value 0.000, statistically significant) when compared with iron sucrose group. However, rise was statistically not significant when compared between FCM and IIM group (for hemoglobin, p=0.32 and ferritin, p=8.18). The occurrence of adverse reactions was seen more commonly in iron sucrose but it was not found to be statistically significant. Conclusions: The ability to deliver a high dose of iron within a short time, with single prick and less adverse effects make FCM and iron isomaltoside suitable for patients requiring quicker restoration of iron stores.