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Khatib MN, Sinha AP, Gaidhane S, Upadhyay S, Waghmare N, Anil A, Saxena D, Sawleshwarkar S, Simkhada PP, Gaidhane A, Quazi ZS. Effect of IV ferric carboxy maltose for moderate/severe anemia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1340158. [PMID: 38405188 PMCID: PMC10884292 DOI: 10.3389/fmed.2024.1340158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Anemia remains a prevalent global health issue with varying severity. Intravenous iron supplementation, particularly with ferric carboxymaltose (FCM), has appeared as a possible therapeutic intervention for individuals with moderate to severe anemia. The study aimed to assess the efficacy and safety of ferric carboxymaltose (FCM) in reducing anemia. Methods We searched electronic databases, registries, websites, e-libraries, reference lists of reviews, citations, etc. We included randomized control trials (RCTs), non-RCTs, and single-arm studies, while observational studies, case series, and case studies were excluded. Two reviewers independently screened the studies and extracted the data. We included studies of moderate-to-severely anemic Indians and excluded Indians with other comorbidities. We assessed the risk of bias and the overall quality of evidence (QoE) using GRADE GDT. Result We identified 255 studies and included 14 studies (11 RCT, one non-RCT, and two single-arm studies) with 1,972 participants for qualitative analysis and 10 studies in the meta-analysis. All the included studies detailed the use of FCM for anemia. The primary outcomes assessed in the included studies were anemia, hemoglobin, and adverse events. The outcomes assessed ranged from 2 weeks to 12 weeks. The risk of bias varied across different studies with different outcomes. FCM is consistent with a fewer number of adverse events as compared to other interventions and provides "moderate" to "very low" QoE. Conclusion A slow single infusion of 1 gram of FCM is well-tolerated, safe, and effective in treating iron deficiency anemia (IDA) and surpasses other interventions (Iron Sucrose Complex (ISC), Iron sucrose, and ferrous ascorbate) in elevating hemoglobin levels and replenishing iron stores. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459363, CRD42023459363.
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Affiliation(s)
- Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative (GESI), Division of Evidence Synthesis, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Anju Pradhan Sinha
- Division of Reproductive, Maternal and Child Health, Indian Council of Medical Research Headquarters, New Delhi, India
| | - Shilpa Gaidhane
- Centre of One Health Research, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Upadhyay
- Global Consortium of Public Health Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Nikita Waghmare
- i-Health Consortium, Division of Evidence Synthesis, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Abhishek Anil
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Shailendra Sawleshwarkar
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney Institute for Infectious Disease (Sydney ID), University of Syndey, Camperdown, NSW, Australia
| | - Padam Prasad Simkhada
- School of Human and Health Sciences, Global Health at the University of Huddersfield, Huddersfield, United Kingdom
| | - Abhay Gaidhane
- Stepping Stones, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Zahiruddin Syed Quazi
- South Asia Infant Feeding Research Network, Global Health Academy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
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Yourkavitch J, Obara H, Usmanova G, Semrau KEA, Moller AB, Garcia-Casal MN, Daru J. A rapid landscape review of postpartum anaemia measurement: challenges and opportunities. BMC Public Health 2023; 23:1454. [PMID: 37518003 PMCID: PMC10388528 DOI: 10.1186/s12889-023-16383-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression. They are also more likely to have anaemia in the postpartum period which can lead to an ongoing condition and affect subsequent pregnancies. In 2019 nearly 37% of pregnant women globally had anaemia, and estimates suggest that 50-80% of postpartum women in low- and middle-income countries have anaemia, but currently there is no standard measurement or classification for postpartum anaemia. METHODS A rapid landscape review was conducted to identify and characterize postpartum anaemia measurement searching references within three published systematic reviews of anaemia, including studies published between 2012 and 2021. We then conducted a new search for relevant literature from February 2021 to April 2022 in EMBASE and MEDLINE using a similar search strategy as used in the published reviews. RESULTS In total, we identified 53 relevant studies. The timing of haemoglobin measurement ranged from within the immediate postpartum period to over 6 weeks. The thresholds used to diagnose anaemia in postpartum women varied considerably, with < 120, < 110, < 100 and < 80 g/L the most frequently reported. Other laboratory results frequently reported included ferritin and transferrin receptor. Clinical outcomes reported in 32 out of 53 studies included postpartum depression, quality of life, and fatigue. Haemoglobin measurements were performed in a laboratory, although it is unclear from the studies if venous samples and automatic analysers were used in all cases. CONCLUSIONS This review demonstrates the need for improving postpartum anaemia measurement given the variability observed in published measures. With the high prevalence of anaemia, the relatively simple treatment for non-severe cases of iron deficiency anaemia, and its importance to public health with multi-generational effects, it is crucial to develop common measures for women in the postpartum period and promote rapid uptake and reporting.
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Affiliation(s)
| | - Hiromi Obara
- National Center for Global Health and Medicine, Bureau of International Health Cooperation, Tokyo, Japan
| | | | - Katherine E A Semrau
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ann-Beth Moller
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | | | - Jahnavi Daru
- Wolfson Institute of Population Health Science, Women's Health Research Unit, Queen Mary University of London, London, UK
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Charmila A, Natarajan S, Chitra TV, Pawar N, Kinjawadekar S, Firke Y, Murugesan U, Yadav P, Ohri N, Modgil V, Rodge A, Swami OC. Efficacy and Safety of Ferric Carboxymaltose in the Management of Iron Deficiency Anemia: A Multi-Center Real-World Study from India. J Blood Med 2022; 13:303-313. [PMID: 35706850 PMCID: PMC9189149 DOI: 10.2147/jbm.s361210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Parenteral iron preparations, like ferric carboxymaltose (FCM), are commonly used to manage moderate-to-severe iron deficiency anemia (IDA). Real-world data on efficacy and safety of FCM is limited in India. Methods A retrospective, observational and real-world study was conducted to assess the efficacy and safety of FCM in adolescents and adults with IDA across 269 centers in India. Data was retrieved from medical records of patients who received FCM for management of IDA. Physicians’ clinical assessment of efficacy and safety of FCM was also assessed. Data were analyzed for hematological parameters at baseline and at 4 ± 1 week for study population, and for severity of anemia. Results In 1800 patients with IDA, intravenous FCM resulted in a significant increase in hemoglobin (Hb) of 2.76 g/dL, serum ferritin of 35.85 µg/L, red blood cell (RBC) count, hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) (P < 0.001 for all) at 4 ± 1 week as compared to baseline. In subjects with severe IDA, an increase in Hb was of 3.31 g/dL, serum ferritin increased of 35.84 µg/L, RBC count, hematocrit and MCH improved significantly (P < 0.001 for all). In subjects with moderate IDA, Hb (increase of 2.63 g/dL), serum ferritin (increase of 35.92 µg/L), RBC count, hematocrit, MCV, and MCH improved significantly (P < 0.001 for all). In subjects with mild IDA, only the mean Hb values at 4 weeks were significantly higher (P < 0.001; increased by 1.89 g/dL). Physicians rated efficacy of FCM as very good to good in 97.5% of patients. Similarly, safety of FCM was rated very good to good in 97.2% subjects. Conclusion FCM efficiently, safely and quickly corrects moderate-to-severe anemia in Indian patients in a short span of 4 weeks. Physicians’ positive clinical impression of efficacy and safety supports clinical usage of FCM in real-world scenario. ![]()
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Affiliation(s)
- Ayyavoo Charmila
- Obstetrics and Gynecology, Aditi Hospital, Tiruchirappalli, Tamil Nadu, India
| | - Suma Natarajan
- Obstetrics and Gynecology, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | | | - Nivedita Pawar
- Obstetrics and Gynecology, Nivedita Maternity Home, Nashik, Maharashtra, India
| | - Sucheta Kinjawadekar
- Obstetrics and Gynecology, Kamalesh Mother and Child Hospital, New Mumbai, Maharashtra, India
| | - Yogini Firke
- Obstetrics and Gynecology, Dhanvantari Hospital, Mumbai, Maharashtra, India
| | - Umaiyal Murugesan
- Obstetrics and Gynecology, Sri Kumaran A Speciality Hospital, Chennai, Tamil Nadu, India
| | - Poonam Yadav
- Obstetrics and Gynecology, SDMH Hospital, Jaipur, Rajasthan, India
| | - Neelam Ohri
- Obstetrics and Gynecology, New Life Hospital, Varanasi, Uttar Pradesh, India
| | - Vidhu Modgil
- Obstetrics and Gynecology, Suman Hospital, Ludhiana, Punjab, India
| | - Ajinkya Rodge
- Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
| | - Onkar C Swami
- Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
- Correspondence: Onkar C Swami, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, 411 057, India, Tel +91-93724 23101, Email
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