Alternate day iron dosing may increase compliance and efficacy among many women with anemia

Iron deficiency is often treated with daily oral iron supplementation. However, a recent Swiss study published in eClinicalMedicine Lancet challenges this norm, introducing a novel approach with potential benefits.

A recent double-masked, randomized, placebo-controlled trial has challenged traditional guidelines for treating iron deficiency. The study, conducted with 150 young Swiss women with serum ferritin levels below 30 μg/L, compared the effects of consecutive-day versus alternate-day iron supplementation. Participants were assigned to either a consecutive-day group, receiving 100 mg of iron daily for 90 days followed by daily placebos for another 90 days, or an alternate-day group, taking the same daily iron dose on alternate days for a total of 180 days.

At equal total iron doses, the study found that while median serum ferritin levels were comparable between the two groups, the alternate-day dosing regimen demonstrated a remarkable reduction in iron deficiency at the 6-month mark. This novel approach also significantly decreased the prevalence of gastrointestinal side effects associated with iron intake.

The findings challenge the conventional wisdom of daily iron supplementation, suggesting that adopting an alternate-day schedule could be equally effective, if not more so, in certain aspects. Notably, the reduced prevalence of iron deficiency after 6 months is a key highlight, potentially indicating a more sustainable and tolerable approach. The high adherence and meticulous reporting of side effects using a mobile application contribute to the robustness of the results.

While the research offers a promising alternative, it also raises questions about the long-standing practices of daily iron provision. The potential shift toward alternate-day supplementation could mark a significant advancement in optimizing iron therapy for enhanced efficacy and patient comfort. 

Source:

von Siebenthal, H. K., Gessler, S., Vallelian, F., Steinwendner, J., Kuenzi, U.-M., Moretti, D., Zimmermann, M. B., & Stoffel, N. U. (2023). Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. In eClinicalMedicine (Vol. 65, p. 102286). Elsevier BV. https://doi.org/10.1016/j.eclinm.2023.102286