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Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis

  • Authors:
    • Caifang Zhao
    • Wei He
  • View Affiliations / Copyright

    Affiliations: Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, P.R. China
    Copyright: © Zhao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 11
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    Published online on: November 11, 2025
       https://doi.org/10.3892/br.2025.2084
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Abstract

The present systematic review and meta‑analysis evaluated the efficacy and safety of oral vs. intravenous (IV) iron therapy in managing iron deficiency anemia (IDA) across various clinical conditions. A comprehensive search was conducted in PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, Scopus, and ClinicalTrials.gov, yielding 31 eligible studies. IV iron demonstrated statistically significant superiority over oral iron in increasing hemoglobin levels among patients with chronic kidney disease (CKD), inflammatory bowel disease (IBD), cancer‑related anemia and general IDA. Specifically, pooled standardized mean differences (SMD) indicated significant improvements with IV iron for cancer‑related anemia (SMD: ‑0.662, P=0.011), CKD (SMD: ‑0.492, P=0.035), IBD (SMD: ‑0.560, P<0.001) and IDA (SMD: ‑0.397, P<0.001). However, no significant differences were observed for postoperative anemia or restless legs syndrome. IV iron consistently provided faster hemoglobin correction and fewer gastrointestinal side effects compared with oral iron; however, higher costs and logistical requirements may limit its widespread use. Meta‑regression analysis revealed that neither treatment duration nor dosage significantly influenced treatment outcomes, highlighting the role of patient‑specific factors in determining the efficacy of iron therapy. Despite substantial heterogeneity, sensitivity and publication bias analyses confirmed the robustness of the findings. Overall, IV iron therapy is the preferred choice in conditions with impaired iron absorption or urgent clinical needs, whereas oral iron remains suitable for mild to moderate cases.
View Figures

Figure 1

PRISMA flow diagram depicting the
systematic review and study selection process. This flowchart
details the stages of the systematic review, including initial
record identification, screening and final study inclusion,
highlighting the reasons for exclusion at each stage.

Figure 2

Forest plot illustrating the
meta-analysis of hemoglobin response comparing intravenous vs. oral
iron therapy across various clinical conditions. The pooled
standardized mean differences with 95% confidence intervals
demonstrate the comparative effectiveness of intravenous iron over
oral iron in subgroups such as cancer-related anemia, CKD, IBD and
general IDA. CKD, chronic kidney disease; IBD, inflammatory bowel
disease; IDA, iron deficiency anemia.

Figure 3

Sensitivity analysis (leave-one-out
analysis) assessing the robustness of the meta-analysis findings on
hemoglobin response. This plot shows the pooled standardized mean
differences after sequential removal of each study, indicating
stability and robustness of the overall effect favoring intravenous
iron.

Figure 4

Prediction interval plot illustrating
the overall pooled effect size and its variability across different
patient populations and settings. The wide prediction interval
reflects substantial heterogeneity, indicating that the true effect
of intravenous iron vs. oral iron may differ significantly
depending on specific clinical contexts.

Figure 5

Funnel plot assessing potential
publication bias in the meta-analysis of intravenous vs. oral iron
therapy for iron deficiency anemia. This plot visually depicts
study distribution and symmetry, suggesting some asymmetry
indicative of potential publication bias, although statistical
tests suggest minimal impact on the overall conclusions.

Figure 6

Meta-regression scatter plots showing
the relationship between covariates [(A) duration of treatment, (B)
oral iron dose and (C) IV iron dose) and the standardized mean
differences in hemoglobin levels (a, b, and c). The plots
demonstrate no statistically significant relationships, indicating
that these factors do not substantially explain the heterogeneity
observed in treatment effects. IV, intravenous.
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Copy and paste a formatted citation
Spandidos Publications style
Zhao C and He W: Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis. Biomed Rep 24: 11, 2026.
APA
Zhao, C., & He, W. (2026). Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis. Biomedical Reports, 24, 11. https://doi.org/10.3892/br.2025.2084
MLA
Zhao, C., He, W."Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis". Biomedical Reports 24.1 (2026): 11.
Chicago
Zhao, C., He, W."Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis". Biomedical Reports 24, no. 1 (2026): 11. https://doi.org/10.3892/br.2025.2084
Copy and paste a formatted citation
x
Spandidos Publications style
Zhao C and He W: Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis. Biomed Rep 24: 11, 2026.
APA
Zhao, C., & He, W. (2026). Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis. Biomedical Reports, 24, 11. https://doi.org/10.3892/br.2025.2084
MLA
Zhao, C., He, W."Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis". Biomedical Reports 24.1 (2026): 11.
Chicago
Zhao, C., He, W."Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta‑analysis". Biomedical Reports 24, no. 1 (2026): 11. https://doi.org/10.3892/br.2025.2084
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