This series of bite-sized episodes contains important information you need to know about iron deficiency and iron deficiency anemia in your female patients. Dr. Malcolm Munro and colleagues discuss recent evidence and provide practical approaches for screening, diagnosing, treating, and preventing the progression of this condition.
All Oral Iron Therapies Are Not Created Equal
All Oral Iron Therapies Are Not Created Equal
Welcome to CME on ReachMD. This episode is part of our MinuteCME curriculum.
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This is CME on ReachMD, and I’m Dr. Arjeme Cavens from Northwestern University, and I’m here today with my colleague, Dr. Lee Shulman.
So, Lee, I think we all know that patients have some difficulty adhering to oral iron therapies that may be recommended over the counter or may be prescribed to them. This is mostly due to GI [gastrointestinal] side effects, and often this contributes to these therapies really not being as effective as they could be. We certainly know that pregnant patients in the first trimester, for example, will often require iron and can’t be offered IV iron therapy at that point due to the lack of safety data. Now on top of that, there are some patients that just in general may be a little more resistant to IV iron. So can you help us understand a little bit better whether or not all oral iron supplementation is truly equivalent?
Well, Arjeme, it’s great to be here with you today. And, in one sense, they’re all equivalent in that they all contain iron. But they range in a wide variety of differences from the cations that they’re associated with to the doses of iron and to the fact that whether they’re prescriptive or over the counter, they are, in general, associated with a poor GI side effect profile. And it’s that poor GI side effect profile that truly limits their ability to ultimately provide the iron that’s needed to reverse the iron deficiency. If you have an effective regimen that’s not being taken, it’s no longer an effective regimen.
I think it’s important to understand that changing the dosing from once a day to every other day doesn’t necessarily reduce the inability of that regimen to provide the adequate iron supplementation. I think it’s important that our audience knows that recently there was a new prescriptive regimen, ferric maltol, that has been shown to be a much better tolerated oral regimen. I think it’s important for our audience to know that in clinical trials of ferric maltol, that when the product is used consistently and correctly over the course of 12 weeks, that the increase in serum iron levels is comparable to that seen with IV iron. Again, highlighting the importance, not just that it provides an effective dose of iron, but also that its good tolerability facilitates proper use and consistent use over the course of time.
I think our audience also should understand that unless there is a temporal need for a rapid replacement of lost iron, for example, if a patient is being sent to the operating room in the next week or so, that IV irons are specifically recommended and indicated – especially in situations of iron deficiency – in cases where there’s been a failure of the oral iron regimen to provide the adequate iron supplementation. So while IV iron is effective, it is costly, it has its own side effect profile, and I think it’s important that for the vast majority of women who are seeking iron supplementation – whether they be pregnant, as Arjeme said, who can’t use IV iron, but even those who could use IV iron – that in many cases, if not almost all cases it’s best to start with an oral iron regimen, and in particular an oral iron regimen that’s been shown to have a far better tolerability than the width and breadth of prescriptive and over-the-counter regimens.
And that’s also important to keep in mind. Key takeaways, that for instance, clinicians, when we do have a patient that needs iron supplementation, we, as you mentioned, do have to take into account the convenience of that regimen, the ease of dosing, administration, the tolerability, and also the cost to the patient.
Now, time is of the essence, and the earlier we can correct iron deficiency and associated anemia, especially in pregnancy, the better. And as you mentioned, the best option is really to start with an oral regimen as long as there is sufficient time remaining, but also to recognize that not all of these oral preparations are equally tolerated, and to that end, they’re not all as equally effective either.
On that note, I think, Lee, this has been a great micro discussion, but unfortunately our time is up. Thank you all for listening.
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In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Malcolm G. Munro MD, FRCS(c), FACOG
Clinical Professor, Department of Obstetrics & Gynecology
David Geffen School of Medicine at UCLA
Chair, Women’s Health Research Collaborative
Los Angeles, CA
Research: AbbVie, Pharmacosmos
Ownership Interest: Channel Medical, Okon, Gynesonics, U-Vision 360
Patent Holder: Simulators – Assigned to AAGL
Consulting Fees: AbbVie, American Regent
Michael Auerbach, MD
Clinical Professor of Medicine
Georgetown University School of Medicine
Research: Covis Pharma
Arjeme Denise Cavens, MD
Instructor of Obstetrics and Gynecology
Northwestern University Feinberg School of Medicine
No relevant relationships reported.
Michael K. Georgieff, MD
Martin Lenz Harrison Land Grant Chair in Pediatrics
Professor of Pediatrics, Obstetrics and Gynecology, and Developmental Psychology
University of Minnesota Medical School
No relevant relationships reported.
Lee P. Shulman, MD, FACOG, FACMG
The Anna Ross Lapham Professor and Chief
Division of Clinical Genetics
Feinberg School of Medicine of Northwestern University
Consulting Fees: Agile, Aspira, Bayer, Biogix, Celula China, Daiichi Sankyo, Mayne, Organon, Shield
Other: Astellas (DSMB Chair)
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP
Owner and Family Nurse Practitioner
Wright & Associates Family Healthcare
Consulting Fees: AbbVie, Biohaven, GSK, Idorsia, Merck, Moderna, Pfizer, Sanofi, Seqirus, Shield Therapeutics
- Jennifer Brutsche, RN, BSN, AHA BLS Instructor, has nothing to disclose.
- Cindy Davidson has nothing to disclose.
- Libby Lurwick has nothing to disclose.
- Kate Nagele has nothing to disclose.
- Robert Schneider, MSW, has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Describe the basics of iron physiology, including its critical role in cellular processes, and impact on growth and development throughout the life span.
- Identify appropriate screening and diagnosis methods throughout the life span.
- Describe the potential impact of iron deficiency (ID)/ ID anemia (IDA) and its treatment, throughout the life span.
- Identify the benefits and disadvantages of using oral iron therapies in the management of iron deficiency (ID) and ID anemia (IDA).
This activity is designed to meet the educational needs of obstetrician-gynecologists, other women’s health HCPs, and primary care physicians.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
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This activity is supported by an independent educational grant from Shield Therapeutics.
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