Daily versus every other day oral iron supplementation in patients with iron deficiency anemia (DEODO): study protocol for a phase 3 multicentered, pragmatic, open-label, pilot randomized controlled trial

Amie Kron, M Elisabeth Del Giudice, Michelle Sholzberg, Jeannie Callum, Christine Cserti-Gazdewich, Vidushi Swarup, Mary Huang, Lanis Distefano, Waseem Anani, Robert Skeate, Chantal Armali, Yulia Lin, Amie Kron, M Elisabeth Del Giudice, Michelle Sholzberg, Jeannie Callum, Christine Cserti-Gazdewich, Vidushi Swarup, Mary Huang, Lanis Distefano, Waseem Anani, Robert Skeate, Chantal Armali, Yulia Lin

Abstract

Background: Iron deficiency anemia (IDA) accounts for the majority of anemia cases across the globe and can lead to impairments in both physical and cognitive functioning. Oral iron supplementation is the first line of treatment to improve the hemoglobin level for IDA patients. However, gaps still exist in understanding the appropriate dosing regimen of oral iron. The current trial proposes to evaluate the feasibility of performing this study to examine the effectiveness and side-effect profile of oral iron once daily versus every other day.

Methods: In this open-label, pilot, feasibility, randomized controlled trial, 52 outpatients over 16 years of age with IDA (defined as hemoglobin < 12.0 g/dL in females and < 13.0 g/dL in males and ferritin < 30 mcg/L) will be enrolled across two large academic hospitals. Participants are randomized in a 1:1 ratio to receive 300 mg oral ferrous sulfate (60 mg of elemental iron) either every day or every other day for 12 weeks. Participants are excluded if they are as follows: (1) pregnant and/or currently breastfeeding, (2) have a disease history that would impair response to oral iron (e.g., thalassemia, celiac disease), (3) intolerant and/or have an allergy to oral iron or vitamin C, (4) on new anticoagulants in the past 6 months, (5) received IV iron therapy in the past 12 weeks, (6) have surgery, chemotherapy, or blood donation planned in upcoming 12 weeks, (7) a creatinine clearance < 30 mL/min, or (8) hemoglobin less than 8.0 g/dL with active bleeding. The primary outcome is feasibility to enroll 52 participants in this trial over a 2-year period to determine the effectiveness of daily versus every other day oral iron supplementation on hemoglobin at 12 weeks post-initiation and side-effect profile.

Discussion: The results of this trial will provide additional evidence for an appropriate dosing schedule for treating patients with IDA with oral iron supplementation. Additional knowledge will be gained on how the dosing regimen of oral iron impacts quality of life and hemoglobin repletion in IDA patients. If this trial is deemed feasible, it will inform the development and implementation of a larger multicenter definitive trial.

Trial registration: ClinicalTrials.gov: NCT03725384 . Registered 31 October 2018.

Keywords: Hemoglobin; Iron deficiency; Iron deficiency anemia; Oral iron.

Conflict of interest statement

Jeannie Callum has research support from Canadian Blood Services, Canadian Institutes for Health Research, and Octapharma Canada. Yulia Lin has received research funding from Novartis and consulting fees from Pfizer.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Pilot trial schematic

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