Managing chemotherapy-induced anemia with erythropoiesis-stimulating agents plus iron

This review included eight RCTs (N = 2,087) comparing ESAs plus iron with ESAs alone. No trials comparing iron alone with ESAs alone were found, and none of the RCTs reported on the primary outcome of overall survival. A beneficial effect of ESAs plus iron compared with ESAs alone on hematopoietic response was noted. There was no evidence of a difference between IV and oral iron, or between types of iron and types of ESAs, on hematopoietic response. Fewer participants treated with ESAs plus iron required RBC transfusions compared with those treated with ESAs alone. In terms of median time to hematopoietic response, no difference was noted with the addition of iron to ESAs, or with the route of iron administration or the types of ESAs. Results indicated possible improvement in hemoglobin levels with the addition of iron. In RCTs in which IV iron was used, mean change in hemoglobin level was greater with IV than oral iron. In this review, the addition of iron to ESAs improved hematopoietic response, reduced the risk of RBC transfusions, improved hemoglobin levels, and appeared to be well tolerated. No evidence for a difference in quality of life was noted. Where the follow-up times (up to 20 weeks) were short, the long-term effects of iron supplementation remain unknown