Interventions for treating iron deficiency anaemia in inflammatory bowel disease

Gordon, Morris; Sinopoulou, Vassiliki; Iheozor‐Ejiofor, Zipporah; Iqbal, Tariq; Allen, Patrick B.; Hoque, Sami; Akobeng, Anthony K

doi:10.1002/14651858.cd013529.pub2

Cited by 17 publications

(17 citation statements)

References 61 publications

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“…In patients with IBD, 56-61% achieved a 2 g/dL increase in hemoglobin by week 12. Although ferric maltol has not been directly compared with other oral iron replacement therapies, this is similar to rates reported with oral ferrous sulphate (58-71% at weeks 8-12) [93], and a network meta-analysis indicated favorable hemoglobin improvements with ferric maltol (mean change 2.76 g/dL versus placebo at 12 weeks) compared with other oral irons (mean change 1.04 g/dL) and IV irons (mean change 1.27-2.12 g/dL) after adjusting for baseline hemoglobin levels [66]. Over 52 weeks of treatment, ferric maltol provided similar hemoglobin increases to IV ferric carboxymaltose in patients with IBD, while ferritin levels increased substantially over time [71].…”

Section: Review Of the Evidence And Clinical Implicationssupporting

confidence: 57%

Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion

Schmidt

Allen

Kopyt

et al. 2021

JCM

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Iron deficiency is the most common cause of anemia globally and is frequently reported in patients with underlying inflammatory conditions, such as inflammatory bowel disease (IBD) and chronic kidney disease (CKD). Ferric maltol is a new oral iron replacement therapy designed to optimize iron absorption while reducing the gastrointestinal adverse events associated with unabsorbed free iron. Ferric maltol has been studied in clinical trials involving almost 750 adults and adolescents with iron-deficiency anemia associated with IBD, CKD, and other underlying conditions, and it has been widely used in clinical practice. It is approved for the treatment of adults with iron deficiency with or without anemia, independent of the underlying condition, and is commercially available in Europe and the United States. We review the published evidence for ferric maltol, which demonstrates consistent and clinically meaningful improvements in hemoglobin and measures of iron availability (ferritin and transferrin saturation) and shows that it is well-tolerated over long-term treatment for up to 64 weeks—an important consideration in patients with chronic underlying conditions such as IBD and CKD. We believe that ferric maltol is an effective, convenient, and well-tolerated treatment option for iron deficiency and iron-deficiency anemia, especially when long-term management of chronic iron deficiency is required. Writing support was provided by Shield Therapeutics (Gateshead, UK).

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Section: Review Of the Evidence And Clinical Implicationssupporting

confidence: 57%

Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion

Schmidt

Allen

Kopyt

et al. 2021

JCM

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“…However, the findings in some of the identified studies yielded contradictory results for the relative frequencies of certain AEs. Additionally, a recent and comprehensive Cochrane review of IDA treatments in IBD concluded that no significant differences in the rates of AEs could conclusively be identified between IV iron treatments [41]. Thus, the authors of this study decided that a more cautious approach of not including AE risks in the model was more appropriate while acknowledging that further research needs to be conducted to assess the relative risks.…”

Section: Discussionmentioning

confidence: 96%

Cost-Effectiveness of Intravenous Iron Formulations in Patients with Iron Deficiency Anaemia and Inflammatory Bowel Disease, in a Swedish Regional Setting Using Real-World Tender Prices

et al. 2022

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Aims. A widespread complication of inflammatory bowel disease (IBD) is iron deficiency anaemia (IDA), which affects quality of life (QoL) and is associated with frequent hospitalizations. The intravenous iron therapies, ferric carboxymaltose (FCM), ferric derisomaltose (FD), and iron sucrose (IS), have previously been shown to replenish haemoglobin (Hb) levels more effectively than oral iron. However, they differ in both costs and efficacy (response to treatment), leading to differences in acquisition by health-care payers. We investigated the cost-effectiveness of FCM versus FD and IS, in terms of additional cost per additional responder, for the treatment of IBD-associated IDA in multiple Swedish regional settings, using current tender prices. Methods and Materials. A microsimulation model estimated the additional cost per patient achieving a response, based on Hb normalization or an increase of ≥2 g/dL in Hb levels. Efficacy estimates were taken from a previously published network meta-analysis. Treatment costs (2021 SEK) included current tender prices in Swedish health-care regions. Resource use depended partly on dosing, which was based on patient characteristics simulated in the model. Results. The analysis showed that FCM was associated with the highest number of responders (81%) compared to FD (74%) and IS (75%), while costing less per responder than its comparators, in included regions. Conclusions. These results suggest that regional health-care budget holders should consider more than drug prices when choosing which IV formulations to acquire and that they should use all available tools when deciding how to fulfil the needs of their patients.

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“…The most frequent intravenous treatment used was ferric carboxymaltose. A recent Cochrane systematic review including 11 randomized clinical trials evaluated the efficacy and safety of the interventions for the treatment of iron deficiency anemia in patients with IBD [ 23 ]. Intravenous iron was associated with a greater response compared with oral iron, and intravenous ferric carboxymaltose probably led to a higher resolution rate of iron deficiency anemia than intravenous iron sucrose [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent Cochrane systematic review including 11 randomized clinical trials evaluated the efficacy and safety of the interventions for the treatment of iron deficiency anemia in patients with IBD [ 23 ]. Intravenous iron was associated with a greater response compared with oral iron, and intravenous ferric carboxymaltose probably led to a higher resolution rate of iron deficiency anemia than intravenous iron sucrose [ 23 ]. Another study by Stein et al compared the long-term outcomes and costs of oral and intravenous iron supplementation in patients with IBD [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Iron Deficiency in Patients with Inflammatory Bowel Diseases: A Prospective Multicenter Cross-Sectional Study

et al. 2022

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Background Iron deficiency (ID) is a frequent condition in patients with inflammatory bowel disease (IBD). Aim Our aim was to investigate the prevalence of ID in patients with IBD. Methods This was a prospective multicenter cross-sectional study conducted in 21 gastroenterology departments in France between January and March 2020. All adult patients with confirmed IBD who were admitted to the hospital were eligible for inclusion. ID was defined as ferritinemia ≤ 100 μg/L in patients with signs of inflammation (C-reactive protein (CRP) ≥ 5 mg/L) or ferritinemia < 30 μg/L in the absence of inflammation. Results In total, 1036 IBD (685 Crohn's disease and 351 ulcerative colitis) patients (52.1% women) with a mean age of 41.8 ± 15.5 years were recruited. Approximately half of the patients (504, 51.1%) were in disease remission at the time of enrollment. Systematic monitoring of iron status was performed in 12/21 (57%) participating centers, including measurements of ferritin (12/12, 100%), hemoglobin (11/12, 92%), transferrin saturation (TSAT) (6/12, 50.0%), and serum iron (5/12, 42%). About one-fifth of the patients had been treated with intravenous iron (218, 21.0%), whereas only a small percentage received oral iron (36, 3.5%). ID occurred in 97 patients (23.7% CI 95% 19.8-28.1). Patients with moderate/severe IBD activity (OR: 3.66; CI 95% 24.4-61.2; p = 0.007) or concomitant anemia (OR: 3.66; CI 95% 1.97-6.78; p < 0.001) had an increased likelihood of having ID. Conclusion Patients with moderate/severe IBD activity or concomitant anemia are at increased risk of ID. Early detection and management of ID in patients with IBD is recommended.

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Interventions for treating iron deficiency anaemia in inflammatory bowel disease

Cited by 17 publications

References 61 publications

Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion

Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion

Cost-Effectiveness of Intravenous Iron Formulations in Patients with Iron Deficiency Anaemia and Inflammatory Bowel Disease, in a Swedish Regional Setting Using Real-World Tender Prices

Iron Deficiency in Patients with Inflammatory Bowel Diseases: A Prospective Multicenter Cross-Sectional Study

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