Pharmacological treatments for RLS 711 Iron replacement therapy

While Ekbom did recognize the possible role of iron therapy in RLS, it was not until 1994 when O'Keeffe in Dublin did the first clinical trial of iron replacement therapy. In that study of 18 elderly patients with 18 matched controls, iron status and RLS response to iron therapy was observed. The researchers found that serum ferritin levels were reduced in RLS subjects compared to the control group and that levels were inversely correlated to the severity of RLS symptomatology. In the 15 RLS patients treated with iron replacement therapy for 2 months, there was a significant improvement in RLS symptoms (O'Keeffe ST, 1994). In a recent double-blinded, placebo-controlled study, Wang and colleagues showed the benefit of iron replacement in RLS patients with low serum ferritin. In this study, 373 patients were screened and 157 (42%) met the 2003 IRLSSG criteria for RLS. Of these, there were only 18 patients who consented to participate and met the inclusion criteria (which included having a low-normal serum ferritin between 15-75 ng/ml). Eleven patients were randomized to iron replacement (ferrous sulfate 325mg po bid) and 7 to placebo for 12 weeks and IRLS scores were obtained at the start and end of the study. The researchers found a clinically significant (p = 0.01) improvement in IRLS scores in the iron therapy group and a non-significant (p = 0.07) trend towards improvement in quality of life (Wang J, 2009).

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