An open-label, prospective, blinded endpoint, randomized controlled trial (PROBE) revealed that the four commonly prescribed oral iron preparations such as ferrous fumarate, ferrous sulfate, ferrous ascorbate, and carbonyl iron are equally effective to treat iron-deficiency anemia and can be prescribed interchangeably in pregnant females.

Nanda Gamad et al. undertook this study to determine the tolerability, effectiveness and cost of  commonly used iron preparations to combat iron-deficiency anemia during pregnancy. Overall, 120 participants (age between 20 and 40 years) were segregated to receive ferrous fumarate, ferrous sulfate, ferrous ascorbate, and carbonyl iron (30 participants in each group). The major endpoint was the percentage of people becoming non-anemic (hemoglobin  ≥ 11 g%) at the end of the trial.

The secondary outcomes were: (i) Percentage of people attaining normal iron indices like total iron-binding capacity, serum ferritin, serum iron, and transferrin saturation; (ii) Percentage of people attaining normal red blood corpuscular indices like mean corpuscular hemoglobin concentration,  mean corpuscular hemoglobin, and mean corpuscular volume; (iii) Occurrence of any adverse events, and (iv) Inter-group comparison of costs of individual drug therapy.

No profound differences were noted in terms of primary endpoint ascertained, as shown in Figure 1:

All the 4 iron salts at the dose of 200 mg elemental iron per day were equally effective to improve hemoglobin concentration (Figure 2) and other hematological parameters.

The side effects were highly common in the ferrous fumarate recipients (56.7%). Ferrous fumarate, ferrous sulfate, ferrous ascorbate, and carbonyl iron were found to be equally cost-effective as per the pharmacoeconomic assessment.