Quality -of-life scores ( Piper Fatigue Scale MD 0.73 , 95 % CI 0.29 to 1.18 ; I2 = 0 % ; studies = 3 ) and peak oxygen consumption ( MD 2.77 mL/kg/min , 95 % CI -0.89 to 6.43 ; I2 = 36 % ; 2 studies , 32 participants ) were associated with very low- quality evidence , and we remain uncertain about the role of intravenous iron for these metrics .
Current evidence is insufficient to show benefit of intravenous iron preparations for the treatment of non-anaemic iron deficiency across a variety of patient population s , beyond stating that it may result in a small , clinical ly insignificant increase in haemoglobin concentration .
BACKGROUND Iron deficiency is one of the most common nutritional deficiencies , and has a number of physiological manifestations .
Early , or non-anaemic iron deficiency can result in fatigue and diminished exercise capacity .
Oral iron preparations have a high incidence of intolerable side effects , and are ineffective in certain forms of iron deficiency .
Consequently , intravenous iron preparations are increasingly used in the treatment of non-anaemic iron deficiency .
The newer , more stable iron preparations in particular purport to have a lower incidence of side effects , and are now used across a range of different patient population s. OBJECTIVES To assess the effects of intravenous iron therapy in the treatment of adults with non-anaemic iron deficiency .
Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials.
BACKGROUND Current guidelines to treat iron deficiency recommend daily provision of ferrous iron divided through the day to increase absorption . However , daily dosing and split dosing might increase serum hepcidin and decrease iron absorption from subsequent doses . Our study aim was to compare iron absorption from oral iron supplements given on consecutive versus alternate days and given as single morning doses versus twice-daily split dosing . METHODS We did two prospect i ve , open-label , r and omised controlled trials assessing iron absorption using (54Fe)-labelled , (57Fe)-labelled , or (58Fe)-labelled ferrous sulfate in iron-depleted ( serum ferritin ≤25 μg/L ) women aged 18 - 40 years recruited from ETH Zurich and the University of Zurich , Switzerl and . In study 1 , women were r and omly assigned ( 1:1 ) to two groups . One group was given 60 mg iron at 0800 h ( ±1 h ) on consecutive days for 14 days , and the other group was given the same doses on alternate days for 28 days . In study 2 , women were assigned to two groups , stratified by serum ferritin so that two groups with similar iron statuses could be formed . One group was given 120 mg iron at 0800 h ( ±1 h ) and the other was given the dose split into two divided doses of 60 mg at 0800 h ( ±1 h ) and 1700 h ( ±1 h ) for three consecutive days . 14 days after the final dose , the groups were each crossed over to the other regimen . Within-individual comparisons were done . The co- primary outcomes in both studies were iron bioavailability ( total and fractional iron absorption ) , assessed by measuring the isotopic label abundance in erythrocytes 14 days after administration , and serum hepcidin . Group allocations in both studies were not masked and primary and safety analyses were done on an intention-to-treat basis . The studies were registered at Clinical Trials.gov , numbers NCT02175888 ( study 1 ) and NCT02177851 ( study 2 ) and are complete . FINDINGS For study 1 , 40 women were enrolled on Oct 15 - 29 , 2015 . 21 women were assigned to the consecutive-day group and 19 to the alternate-day group . At the end of treatment ( 14 days for the consecutive-day group and 28 days for the alternate-day group ) , geometric mean ( -SD , + SD ) cumulative fractional iron absorptions were 16·3 % ( 9·3 , 28·8 ) in the consecutive-day group versus 21·8 % ( 13·7 , 34·6 ) in the alternate-day group ( p=0·0013 ) , and cumulative total iron absorption was 131·0 mg ( 71·4 , 240·5 ) versus 175·3 mg ( 110·3 , 278·5 ; p=0·0010 ) . During the first 14 days of supplementation in both groups , serum hepcidin was higher in the consecutive-day group than the alternate-day group ( p=0·0031 ) . In study 2 , 20 women were enrolled between Aug 13 and 18 , 2015 . Ten women were assigned to receive once-daily dosing and ten were assigned to receive twice-daily divided dosing . No significant differences were seen in fractional ( day 1 - 3 geometric mean : 11·8 % [ 7·1 , 19·4 ] once daily vs 13·1 % [ 8·2 , 20·7 ] twice daily ; p=0·33 ) or total iron absorption ( day 1 - 3 : 44·3 mg [ 29·4 , 66·7 ] once daily vs 49·4 [ 35·2 , 69·4 ] twice daily ; p=0·33 ) between the two dosing regimens . Twice-daily divided doses result ed in a higher serum hepcidin concentration than once-daily dosing ( p=0·013 ) . No grade 3 or 4 adverse events were reported in either study . INTERPRETATION In iron-depleted women , providing iron supplements daily as divided doses increases serum hepcidin and reduces iron absorption . Providing iron supplements on alternate days and in single doses optimises iron absorption and might be a preferable dosing regimen . These findings should be confirmed in iron-deficient anaemic patients . FUNDING Swiss National Science Foundation , Bern , Switzerl and
Quality -of-life scores ( Piper Fatigue Scale MD 0.73 , 95 % CI 0.29 to 1.18 ; I2 = 0 % ; studies = 3 ) and peak oxygen consumption ( MD 2.77 mL/kg/min , 95 % CI -0.89 to 6.43 ; I2 = 36 % ; 2 studies , 32 participants ) were associated with very low- quality evidence , and we remain uncertain about the role of intravenous iron for these metrics .
Current evidence is insufficient to show benefit of intravenous iron preparations for the treatment of non-anaemic iron deficiency across a variety of patient population s , beyond stating that it may result in a small , clinical ly insignificant increase in haemoglobin concentration .
BACKGROUND Iron deficiency is one of the most common nutritional deficiencies , and has a number of physiological manifestations .
Early , or non-anaemic iron deficiency can result in fatigue and diminished exercise capacity .
Oral iron preparations have a high incidence of intolerable side effects , and are ineffective in certain forms of iron deficiency .
Consequently , intravenous iron preparations are increasingly used in the treatment of non-anaemic iron deficiency .
The newer , more stable iron preparations in particular purport to have a lower incidence of side effects , and are now used across a range of different patient population s. OBJECTIVES To assess the effects of intravenous iron therapy in the treatment of adults with non-anaemic iron deficiency .