Efficacy of erythropoietin combined with intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis of randomized controlled trials

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OBJECTIVE

To assess the effectiveness of therapy and the need for blood transfusion when using erythropoietin and intravenous iron therapy compared to intravenous iron monotherapy in correction of iron deficiency postpartum anemia.

MATERIAL AND METHODS

We analyzed the MEDLINE, Scopus, EBSCOhost and other databases regarding randomized controlled trials (RCTs) investigating erythropoietin combined with intravenous iron therapy vs. intravenous iron therapy alone for postpartum anemia. Primary endpoints: hematological response (changes in hemoglobin concentration, hemoglobin level, ferritin), number of blood transfusions. Secondary endpoints: level of endogenous erythropoietin, soluble transferrin receptors, C-reactive protein, number of adverse reactions. The data were summarized in accordance with the Cochrane guidelines (PRISMA 2020).

RESULTS

The review included two RCTs involving 90 women. One RCT enrolled multiple groups and two erythropoietin dosing regimens. Erythropoietin combined with intravenous iron therapy resulted significant difference in hemoglobin concentration at baseline and 2 weeks later compared to the control group (MD=3.49 (95% CI 0.55-6.43) g/l; p=0.02) (low-quality evidence (GRADE) due to risk of bias and inconsistency). After 1 week, there was no significant between-group difference (MD=2.71 (95% CI –0.52-5.95 g/l; p=0.10) (moderate-quality evidence due to risk of bias). We found no significant differences between cumulative means of hemoglobin concentration and secondary endpoints between groups after 2-week therapy.

CONCLUSION

We observed significant positive effect of erythropoietin on hemoglobin level after 2-week therapy in women with postpartum anemia. The effect of erythropoietin on transfusion requirements could not be assessed due to few data. Further randomized controlled trials of larger samples are required.

Keywords:

iron deficiency anemia

postpartum period

iron preparations

erythropoiesis-stimulating drugs

systematic review

meta-analysis

Authors:

Barkovskaya N.A.

Privolzhsky Research Medical University;
Dzerzhinsk Perinatal Center

SPIN RSCI: 8594-9393
Scopus AuthorID: 57221995735
ORCID: 0000-0002-2360-0805

Shifman E.M.

Moscow Regional Research and Clinical Institute

SPIN RSCI: 4582-8494
Scopus AuthorID: 6507655298
ResearcherID: AAY-3981-2020
ORCID: 0000-0002-6113-8498

Katkova N.Yu.

Privolzhsky Research Medical University

SPIN RSCI: 7967-5759
Scopus AuthorID: 57200605131
ORCID: 0000-0002-6188-9769

Received:

15.01.2023

Accepted:

29.01.2023

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