Intravenous ferumoxytol bests oral ferrous sulfate for anaemia in pregnancy

In the treatment of iron-deficiency anaemia in pregnancy, the use of intravenous (IV) ferumoxytol appears to lead to greater improvements in haemoglobin at delivery and more frequent resolution of anaemia compared with oral ferrous sulfate, according to an open-label randomized controlled trial.

The trial included 80 pregnant women with iron-deficiency anaemia, defined as ferritin <30 ng/dL or transferrin saturation <20 percent and haemoglobin <11 g/dL, at 24–34 weeks of gestation. Those with hereditary anaemias or malabsorptive disorders were excluded.

The patients were randomly assigned to receive IV ferumoxytol (at 510 mg for those with haemoglobin 9–10.9 g/dL or at 1,020 mg for those with haemoglobin 7–8.9 g/dL) (n=40) or oral ferrous sulfate every other day (at 325 mg for those with haemoglobin 9–10.9 g/dL or at 650 mg for those with haemoglobin 7–8.9 g/dL) (n=40).

The change in haemoglobin levels from treatment initiation to week 4 was assessed as the primary outcome.

At week 4, patients who received IV ferumoxytol had a significantly greater increase in haemoglobin concentration compared with those on oral ferrous sulfate (median, 1.10 vs 0.40 g/dL; p<0.001).

IV ferumoxytol was also associated with a larger haemoglobin concentration increase at 8 weeks (median, 1.80 vs 0.70 g/dL; p<0.001), greater likelihood of anaemia resolution (92.5 percent vs 65 percent; p=0.005), and higher postpartum haemoglobin concentrations (median, 10.25 vs 9.65 g/dL).