Canadian Primary Care Today

Comparative Study of Ferrous Fumarate, Ferrous Ascorbate, and Polysaccharide Iron for Treating Iron Deficiency Anemia in Adults

Anil Gupta — 2025-08-26

Iron deficiency anemia (IDA) is a highly prevalent condition encountered in clinical practice and represents a major global health concern, affecting an estimated 1.92 billion individuals worldwide. Despite its prevalence and the availability of various oral iron formulations with wide cost variations, comparative data on their efficacy and tolerability remain limited.

This randomized, open-label trial conducted across two centres evaluated the efficacy, tolerability, and adherence of three oral iron supplements in improving hemoglobin and ferritin levels in adults with IDA. The study compared ferrous fumarate (Eurofer, 100 mg elemental iron, $15.87 for 90 tablets), ferrous ascorbate (EBMfer, 100 mg elemental iron, $68.97 for 90 tablets), and polysaccharide iron (FeraMAX, 150 mg elemental iron, $77.97 for 90 tablets). A total of 111 participants aged ≥18 years were randomly assigned into one of three treatment groups and monitored over a 12-week period.

Both ferrous fumarate (p=0.001) and ferrous ascorbate (p<0.001) demonstrated significantly greater hemoglobin and ferritin levels compared to polysaccharide iron. Specifically, ferrous fumarate led to mean increases in hemoglobin and ferritin of 11.59 g/L (95% confidence interval [CI]: 7.87–15.3, standard deviation [SD]: 10.7) and 19.21 µg/L (95% CI: 7.82–28.6, SD: 29.8), respectively. Ferrous ascorbate showed mean increases in hemoglobin and ferritin levels of 17.14 g/L (95% CI: 13.5–20.8, SD: 10.7) and 23.51 µg/L (95% CI: 16.5–30.5, SD: 20.3), respectively. Polysaccharide iron showed mean increases in hemoglobin and ferritin of 3.56 g/L (95% CI: -0.06–7.18, SD: 10.4) and 3.21 µg/L (95% CI: -0.07–6.48, SD: 9.39), respectively.

Adverse events occurred more frequently with ferrous fumarate (13 events) compared with ferrous ascorbate (8 events) and polysaccharide iron (6 events). The most commonly reported side effects across all groups were constipation and bloating, well-documented side effects of iron supplements.

These findings demonstrate that ferrous fumarate and ferrous ascorbate significantly outperformed polysaccharide iron in improving hemoglobin and ferritin levels. Given its lower cost and comparable efficacy, ferrous fumarate may be the most cost-effective option and warrants consideration in updates to Canadian treatment guidelines.

Acne Therapies for the Primary Care Physician: What’s New and What’s Practical

Santina Conte — 2025-08-26

Acne vulgaris is the most common dermatologic condition worldwide, affecting people across a broad range of ages and skin phototypes. There are a variety of pathophysiological processes involved in the formation of acne lesions, with available anti-acne therapies targeting such pathways. Herein, we provide a review of important acne treatment classes and present novel topical, oral and energy-based interventions.

Clinical Spotlight for Primary Care: Five Things to Know About Women and Girls with Bleeding Disorders

Kelsey Uminski — 2025-08-26

Although common, HMB is often an underrecognized symptom, and affects up to 39% of individuals diagnosed with a bleeding disorder. Taking a structured medical history is key. Tools such as the Pictorial Blood Assessment Chart and the Menorrhagia Screening Tool can aid in identifying HMB. Screening for iron deficiency, even in the absence of anemia, is essential, as low iron can impact cognition, energy, and quality of life.

Managing Gout in the Clinic: Pearls for Family Medicine Specialists

Shelly Dunne — 2025-08-26

Gout is the most common form of inflammatory arthritis worldwide, often presenting diagnostic and management challenges. However, it can also be gratifying to treat, as successful treatment provides relief from an extremely painful arthritis, and proper preventive strategies can lead to a gout free future. We will begin with a case from my clinical practice.

Update on Early Prenatal Screening in 2025

Ken Seethram — 2025-08-26

Advances in prenatal screening over the last three decades have delivered methods which broadly focus on genetics, fetal well-being, and preeclampsia screening, offering early insights in pregnancy to enable better risk management and planning strategies.