Rethinking oral iron: a safer and more accessible strategy in the management of iron deficiency

At IMCID 2025, Prof. Ioav Cabantchik highlights the need for clearer definitions, personalized evaluations, and greater awareness of oral iron efficacy in chronic patients.

The 9th edition of the International Multidisciplinary Course on Iron Deficiency (IMCID) brought together experts from around the world to discuss the latest evidence on the diagnosis and treatment of iron deficiency. Among the central topics this year was the role of oral iron supplementation, particularly in patients with chronic conditions.

Chairing the dedicated session was Prof. Ioav Cabantchik, Emeritus Professor of Life Sciences at the Hebrew University of Jerusalem, who offered an in-depth reflection on current clinical practice and future perspectives.

Professor, IMCID has become a reference platform for updating knowledge on iron deficiency. What makes this edition particularly significant?

This edition is especially important because, perhaps for the first time, there has been a thorough discussion of what “iron deficiency” truly means. Which markers should be used? How should they be interpreted? And which clinical parameters are best suited to assess therapeutic outcomes?

Without appropriate indicators, diagnosis remains uncertain. Moreover, each country applies different standards, making a critical and contextualized approach indispensable. It is not enough to apply reference values automatically; they must be interpreted in the light of local clinical practice. IMCID has played a crucial role in raising awareness of this issue, providing clinicians with more reliable tools for assessment.

What is the latest evidence on the efficacy of oral iron in chronic patients?

We do not yet have all the comparative data, but evidence is mounting that oral iron supplementation, when used with the right expectations, can deliver results comparable to intravenous iron. The advantages are clear: fewer risks, lower costs, and reduced logistical complications.

The main challenge, however, is cultural. Many physicians still consider oral iron ineffective, overlooking the fact that some modern formulations can yield outcomes very similar to intravenous therapy. Training is essential, as is presenting data that demonstrate the availability of safe, well-tolerated, and accessible options.

Therapy adherence improves significantly when “user-friendly” formulations are prescribed. During the COVID-19 pandemic, for instance, many patients avoided infusions due to fear of infection. In such cases, having an effective oral alternative was — and still is — crucial. Yet if clinicians are unaware of these therapeutic options, it is as if they do not exist. Awareness and availability are therefore key factors.

Can the evidence presented at IMCID change current approaches to oral iron supplementation?

One of the most relevant insights to emerge at IMCID 2025 is that not all oral supplements are the same. Some are highly effective but associated with gastrointestinal side effects that reduce adherence. Others, perhaps slightly less potent, offer much better tolerability and thus support long-term therapeutic continuity.

This distinction is still insufficiently recognized within the medical community. For this reason, training is vital — not only for specialists but also for general practitioners. They are often the first to detect iron deficiency and must be able to prescribe the right tests, both before and after treatment. Relying solely on ferritin is not enough: basic hematological parameters must also be considered.

Personalization and awareness in iron therapy

The message from Prof. Cabantchik at IMCID 2025 is clear: oral iron supplementation is evolving, and clinical practice must evolve alongside it. Personalized treatment, continuous education, and a thorough knowledge of the available formulations are essential tools to improve patient care, especially in chronic settings.
A deeper understanding of iron deficiency and its therapeutic options can make treatments more effective, safer, and more accessible worldwide.

The Abstract Book of the 9^th IMCID – International Multidisciplinary Course on Iron Deficiency, held in Palermo (Sicily, Italy) from 3 to 4 April 2025, has been published as Supplement n°3 of the last issue of May 2025 of the international journal Blood Transfusion (IF=2.4).
Download the abstract book here!