ACOG: Intravenous Ferumoxytol Compared With Oral Ferrous Sulfate for Iron Deficiency Anemia in Pregnancy – A Randomized Controlled Trial

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OBJECTIVE:

To evaluate the comparative effectiveness of intravenous (IV) ferumoxytol compared with oral ferrous sulfate for increasing hemoglobin levels in the treatment of iron deficiency anemia (IDA) in pregnancy.

METHODS:

We conducted an open-label randomized controlled trial to compare oral ferrous sulfate with IV ferumoxytol for the treatment of IDA in pregnancy. Pregnant women with IDA (ferritin less than 30 ng/dL or transferrin saturation less than 20% and hemoglobin less than 11 g/dL) at 24–34 weeks of gestation were eligible; patients with hereditary anemias or malabsorptive disorders were excluded. Patients were computer block randomized to IV ferumoxytol (510 mg for hemoglobin 9.0–10.9 g/dL or 1,020 mg for hemoglobin 7.0–8.9 g/dL) or oral ferrous sulfate every other day (325 mg for hemoglobin 9.0–10.9 g/dL or 650 mg for hemoglobin 7.0–8.9 g/dL). The primary outcome was the change in hemoglobin from treatment initiation to week 4 postinitiation. We estimated that 80 patients were needed, assuming an effect size of 1.0 g/dL, 90% power, 5% type I error rate, and 20% drop-out rate. Secondary outcomes included change in hemoglobin by 8 weeks, anemia resolution, and postpartum hemoglobin. Intention-to-treat analyses were conducted using Wilcoxon rank sum and Fisher exact tests.

RESULTS:

Of the 80 randomized patients, 40 were assigned to oral ferrous sulfate and 40 to IV ferumoxytol. Treatment with IV ferumoxytol resulted in a greater change in hemoglobin at 4 weeks than oral ferrous sulfate (median [Q1–Q3] 1.10 g/dL [0.70–1.70] vs 0.40 g/dL [−0.10 to 0.80], P<.001). Treatment with IV ferumoxytol also resulted in a larger hemoglobin increase at 8 weeks (median [Q1–Q3] 1.80 g/dL [1.20–2.10] vs 0.70 g/dL [0.20–1.20], P<.001), resolution of anemia (37/40 [92.5%] vs 26/40 [65.0%], P=.005), and higher postpartum hemoglobin (median [Q1–Q3] 10.25 g/dL [9.28–10.90] vs 9.65 [8.85–10.05]).

CONCLUSION:

Treatment of IDA during pregnancy with IV ferumoxytol improved hemoglobin at delivery and reduced the prevalence of anemia to a greater extent than oral ferrous sulfate.