Presentation (CTI)

OBJECTIVES: Iron-deficiency anemia exhibits a major public health challenge, which is more significant particularly in low‑ and middle‑income countries (LMICs) where wide treatment access, efficacy, and safety profiles variation are seen across different iron formulations. Limited comparative evidence creates challenges in the choice between intravenous and oral iron therapies. Hence, a network meta-analysis (NMA) was conducted to compare the relative efficacy of ferric carboxymaltose (FCM), iron sucrose complex (ISC), iron sorbitol, and oral iron among moderate-to-severe anemia patients in India.
METHODS: A systematic literature review (SLR) was conducted across electronic databases, trial registries, and websites. Randomized controlled trials, non‑RCTs, and single‑arm studies enrolling moderate-to-severely anemic participants in India were included, screened and extracted. Using SLR evidence, a network meta-analysis (NMA) was performed for comparison of interventions through both direct and indirect comparisons. To account for heterogeneity across studies a random‑effects model was applied. Study characteristics and effect modifiers were reviewed to assess network feasibility and transitivity. Consistency checks was conducted to ensure agreement between direct and indirect evidence. Further the interventions were ranked using SUCRA/P‑scores.
RESULTS: Based FCM consistently emerged as the most effective therapy. NMA estimates favored FCM over ISC (MD −0.94; 95% CrI −1.44 to −0.50), oral iron (MD −1.93; 95% CrI −2.57 to −1.37), and iron sorbitol (MD −1.82; 95% CrI −2.64 to −1.06). ISC also demonstrated superior efficacy vs. oral iron (MD −0.99; 95% CrI −1.53 to −0.47). Differences between oral iron and iron sorbitol were minimal with overlapping credible intervals. No evidence of inconsistency (P ≈ 0.65-0.66) were seen in the node‑splitting analyses which confirmed coherent direct and indirect estimates.
CONCLUSIONS: FCM demonstrated the highest efficacy, followed by ISC, and iron sorbitol showing performance comparable to oral iron. Our finding generates robust comparative evidence relevant for LMIC health systems for improving anemia management, however future research is warranted.