Comparative Analysis of Injection Ferric Carboxymaltose vs Iron Sucrose for Treatment of Iron-deficiency Anemia in Pregnancy: Systematic Review and Meta-analysis

Abstract

Aim: Anemia is a serious global health problem amongst pregnant women with iron-deficiency being the most common cause. This adversely impacts the outcome of pregnancy in both the mother and the fetus. Oral iron has been the standard of care for treatment for this condition but due to its potential for severe adverse effects sometimes parenteral iron complexes have an important role as the newer complexes have a higher efficacy and safety profile. Background: Both intravenous iron sucrose (IS) vs ferric carboxymaltose (FCM) are interchangeably used for the treatment of iron-deficiency anemia (IDA) in pregnancy when oral iron is not tolerated but the superiority of one over the other is equivocal. Result: After a comprehensive literature search as per PRISMA guidelines 22 studies (3 randomized trials and 19 observational) revealed a significantly higher rise in hemoglobin [standardized mean difference of 0.59 gm/dL (95% confidence interval 0.26–0.93 gm/dL) in favor of carboxymaltose group (p = 0.001)] and ferritin levels [standardized mean difference of 54.85 µg/L (95% confidence interval 36.33–74.37 µg/L) in favor of carboxymaltose group (p = 0.001)] along with lesser adverse effects with FCM as compared to IS [26% lesser with FCM vis-a-vis IS group (p = 0.001)]. Conclusion: Both intravenous IS vs FCM are interchangeably used for the treatment of IDA in pregnancy when oral iron is not tolerated. Ferric carboxymaltose has an upper edge over IS due to a higher rise of hemoglobin and ferritin levels along with lesser adverse effects and also its convenience in use. However, side-effects of the FCM need to be analyzed more definitively to convincingly accept its superiority in the treatment of IDA in pregnancy.