To the Editor In a randomized clinical trial, Dr Kim and colleagues1 found that among adults with isovolemic anemia following radical gastrectomy, ferric carboxymaltose compared with placebo resulted in improved hemoglobin response at 12 weeks. We are concerned about the uncertain internal validity and selective outcome reporting in the article.
Patients 20 years or older with moderate anemia (hemoglobin level, ≥7-<10 g/dL) at 5 to 7 days after gastrectomy for gastric cancer were eligible for this study. However, patients were not excluded if they had clinical or laboratory evidence of other causes of anemia, such as poor nutrition (vitamin B12 and folate), abnormal hormone levels, bone marrow disease, inherited conditions, and some chronic diseases (HIV/AIDS, rheumatoid arthritis, Crohn disease, or other chronic inflammatory diseases).2 Those types of anemia may not respond to the use of iron therapy. If the distribution of other types of anemia were unbalanced between the groups, a possible bias might exist.
Yu Z, Li T. Ferric Carboxymaltose to Treat Isovolemic Anemia. JAMA. 2017;318(13):1281. doi:10.1001/jama.2017.11637
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