Comparison of Efficacy, Safety and Cost of Therapy with Oral Ferrous Ascorbate and Ferrous Sulphate in Patients with Iron Deficiency Anemia

Abstract

Objective: To compare the efficacy and safety of oral ferrous ascorbate and ferrous sulphate in patients with iron deficiency anemia

Methods: An observational, prospective study in patients of anemia in chronic kidney disease (CKD) and pregnancy receiving oral ferrous ascorbate and ferrous sulfate respectively were included. Demographic details, clinical history, baseline hemoglobin, anemia indices data were recorded in a case record form. The patients were followed up monthly for 12 weeks and observed for clinical and hematological improvement and adverse drug reactions (ADRs). The data was analyzed using paired t-test, unpaired t-test and Fisher`s exact test.

Results: Out of 148 anemic patients, 62 CKD patients received ferrous ascorbate and 86 pregnant patients treated with ferrous sulfate. Ferrous ascorbate and ferrous sulphate have significantly (P<0.0001) improved mean hemoglobin and anemia indices at the end of study, however, mean increase in hemoglobin was more and significant (P<0.000) with ferrous ascorbate (3.45 g/dL) as compared to ferrous sulfate (3.3 g/dL). Mean increase in MCV and MCHC were comparable in both ferrous ascorbate and ferrous sulfate treated patients, however, mean increase in MCH was significantly (P <0.005) with ferrous sulfate (4.7 pg/cell) treated patients as compared to ferrous ascorbate (3.15 pg/cell). ADRs were more in patients treated with ferrous sulfate (86%) than ferrous ascorbate (71%). Cost of therapy incurred to patient treated with ferrous ascorbate (Rs. 1269.6) was three time more as compared to ferrous sulfate (Rs. 409.7).

Conclusion: Ferrous ascorbate and ferrous sulfate, both were effective and safe in treating iron deficiency anemia in patients with CKD and pregnancy respectively. However, ferrous ascorbate increased hemoglobin more, with better tolerated by patients. Unfortunately, cost of therapy with ferrous ascorbate was high as compared to ferrous sulfate.  

Key words: anemia in pregnancy, chronic kidney disease, ferrous ascorbate, ferrous sulfate