Efficacy of vitamin C with Fe supplementation in patients with iron deficiency anemia: a systematic review and meta-analysis

Blood Vessels, Thrombosis & Hemostasis Pub Date : 2024-08-02 DOI:10.1016/j.bvth.2024.100023

Joanna Deng ∗ , Luca Ramelli ∗ , Pei Ye Li , Ali Eshaghpour , Allen Li , Giovanna Schuenemann , Mark A. Crowther

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Abstract

Oral iron (Fe) supplementation is one of the mainstays of treatment for iron deficiency anemia (IDA). However, its therapeutic effects are limited when there is poor absorption from the gastrointestinal tract. Vitamin C is hypothesized to improve uptake when combined as an adjunct agent. We aimed to determine the difference in hematologic outcomes in patients with IDA receiving oral iron, with or without vitamin C. MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from database inception to July 2023 for studies investigating the use of oral iron supplements with vitamin C in patients with IDA. The primary outcome was the change in serum hemoglobin (Hb). Secondary outcomes include change in serum ferritin, reticulocyte percentage, and incidence of adverse events. A total of 2231 studies were retrieved; 10 randomized control trials (n = 1782), and 1 prospective cohort study (n = 148) comprising 1930 patients were included. Vitamin C supplementation was associated with a significant increase in serum Hb level (mean differences [MDs], 0.14 g/dL; 95% confidence interval [CI], 0.08-0.20; P < .01; 10 studies, 1490 patients) and serum ferritin levels (MD, 3.23 μg/L; 95% CI, 1.63-4.84; P < .01; 9 studies, 1682 patients) in the iron plus vitamin C group compared with the iron-only group. The addition of vitamin C to iron supplementation was associated with a small and likely clinically insignificant increase in serum Hb. The results of this study do not support routine supplementation of oral iron therapy with vitamin C in the treatment of IDA.

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缺铁性贫血患者补充维生素 C 和铁的疗效：系统回顾和荟萃分析

摘要口服铁（Fe）补充剂是治疗缺铁性贫血（IDA）的主要方法之一。然而，如果胃肠道吸收不良，其治疗效果就会受到限制。据推测，维生素 C 作为一种辅助药物可提高吸收率。我们的目的是确定口服铁剂（含或不含维生素 C）的 IDA 患者在血液学结果方面的差异。我们检索了 MEDLINE、Embase、Web of Science 和 Cochrane Central Register of Controlled Trials 数据库中从开始到 2023 年 7 月有关 IDA 患者口服铁剂和维生素 C 的研究。主要结果是血清血红蛋白（Hb）的变化。次要结果包括血清铁蛋白、网织红细胞百分比和不良事件发生率的变化。共检索到 2231 项研究；其中包括 10 项随机对照试验（n = 1782）和 1 项前瞻性队列研究（n = 148），共涉及 1930 名患者。与单纯铁剂组相比，补充维生素 C 可显著提高铁剂加维生素 C 组的血清 Hb 水平（平均差 [MDs], 0.14 g/dL; 95% 置信区间 [CI], 0.08-0.20; P <.01；10 项研究，1490 名患者）和血清铁蛋白水平（MD, 3.23 μg/L; 95% CI, 1.63-4.84; P <.01；9 项研究，1682 名患者）。在补充铁剂的同时添加维生素 C 可使血清 Hb 略有增加，但这种增加在临床上可能并不显著。这项研究结果并不支持在口服铁剂治疗中常规补充维生素 C 来治疗 IDA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Blood Vessels, Thrombosis & Hemostasis

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