Every-other-day iron supplementation in male veterans with iron deficiency anaemia

Background

Iron deficiency anaemia (IDA) is prevalent in the male veteran population and requires iron replacement. Current data on alternate-day dosing for oral iron supplementation in IDA has focused on younger women.

Aim

To evaluate the effectiveness and safety of every-other-day (EOD) iron supplementation compared to daily dosing in men with IDA.

Method

This was a retrospective chart review which included American male veterans, aged 18 years or older, who had been diagnosed with IDA. To be included, patients required a haemoglobin (Hb) value >7 g/dL (70 g/L) but <13 g/dL (130 g/L) prior to initiation of oral ferrous sulfate and completed at least 60 days of oral ferrous sulfate therapy between January 2017–July 2021. The primary objective was to evaluate the change in Hb lab values after at least 60 days of oral ferrous sulfate 325 mg regardless of dosage regimen (twice daily [BID], daily [QD], or EOD). The secondary objectives were to evaluate changes in haematocrit, ferritin, iron saturation, and iron levels. In addition, we evaluated the rate of gastrointestinal adverse events for the previously listed dosing of ferrous sulfate. This project was exempt due to the local policy requirements that constitute research by the Southern Arizona VA Health Care System Institutional Review Board (11 February 2022, Vice Chair). The justification for this exemption was as follows: the study only included data and analysis involving the use of identifiable health information for the purposes of research. The data collection and use of the data was covered under Health Insurance Portability and Accountability Act (HIPAA) and for which a waiver of HIPPA authorisation was approved.

Results

Eighteen patients were randomly selected for each dosing group. An increase in Hb (± standard deviation) of 16 g/L ± 13 in the EOD dosing, 17 g/L ± 17 in the QD group, and 21 g/L ± 22 in the BID group. There was no statistical difference in change in Hb when the EOD group was compared to the QD or BID groups. There were also no statistical differences noted in the change of haematocrit, ferritin, iron level, or iron saturation between groups. The discontinuation rate in the EOD group was lower than those of the QD or BID groups (5.6%, 11.2%, and 11.7% respectively), though they were not statistically different.

Conclusions

EOD dosing was comparable in efficacy to daily dosing in older men with IDA.