Clinical Significance of C-Reactive Protein Levels in Predicting Responsiveness to Iron Therapy in Patients with Inflammatory Bowel Disease and Iron Deficiency Anemia

Iqbal, Tariq; Stein, Jürgen M.; Sharma, Naveen; Kulnigg-Dabsch, Stefanie; Vel, Senthil; Gasché, Christoph

doi:10.1007/s10620-014-3460-4

Cited by 34 publications

(36 citation statements)

References 33 publications

(52 reference statements)

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“…Indeed, raised CRP levels have been suggested as a marker for patients who may benefit from first-line intravenous iron therapy. 10 As we stated, almost all adverse events were minor. Our own safety analysis found that all four intravenous compounds were safe (and indeed, effective), as stated in our conclusion.…”

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confidence: 75%

“…Aksan that we should be cautious about applying rank probabilities to important decision-making, 10 and that further head-to-head efficacy and safety trials are needed. Meanwhile, the intravenous preparation selected in most centres will be guided mainly by its local cost, convenience of administration and individual patients' tolerance.…”

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confidence: 99%

“…We chose the fixed effects model after evaluating statistical heterogeneity and consistency of trial data, both of which influence the reliability of network 8 including patients with higher CRP levels seems illogical, since -as Kennedy and colleagues mention -IBD patients with active inflammation tend to respond poorly to oral iron and should usually proceed directly to intravenous iron treatment. 9,10 Thus, these patients represent a specific target population for intravenous iron therapy. Indeed, raised CRP levels have been suggested as a marker for patients who may benefit from first-line intravenous iron therapy.…”

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confidence: 99%

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Editorial: which iron preparation for patients with IBD? Authors’ reply

Aksan

Işık

Radeke

et al. 2017

Aliment Pharmacol Ther

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When appropriately managed, modern intravenous iron therapy is safe 6 : among the 1746 patients included in Aksan's study, there were no severe hypersensitivity reactions. Aksan's analysis perhaps overemphasises differences in safety between the intravenous products: the reported adverse events were almost all minor, with a rate of 12%-17%.So how should IDA in patients with IBD be managed? ECCO recommends up to 100 mg/day elemental Fe as oral iron for patients with mild anaemia and inactive IBD.1 Patients with active disease, evidenced by markedly raised CRP levels, tend to respond poorly to oral iron, 7,8 and like those intolerant of oral iron or having Hb <100 g/L, should usually proceed directly to intravenous iron.Whether ferric maltol, a new, more expensive and better tolerated oral iron 9 will be an option in this situation is under further evaluation (ClinTrials.gov NCT02680756).For intravenous treatment, we do not feel that the current analysis establishes beyond doubt the superior efficacy of FCM. We agree withAksan that we should be cautious about applying rank probabilities to important decision-making, 10 and that further head-to-head efficacy and safety trials are needed. Meanwhile, the intravenous preparation selected in most centres will be guided mainly by its local cost, convenience of administration and individual patients' tolerance. Kennedy and colleagues propose an alternative analysis using the random effects model. However, they have moved the goalposts, altering the efficacy endpoint to haemoglobin increase ≥2 g/dL only.Our efficacy endpoint, haemoglobin normalisation or increase ≥2 g/dL was carefully chosen to match the goal of iron replacement therapy specified in the current ECCO anaemia guidelines. 6 We recommend using this endpoint as a measure of treatment success in future trials of intravenous iron in IBD.Kennedy and colleagues suggest that removing certain trials from the analysis would change its results. Since only five studies fulfilled the inclusion criteria, it is unsurprising that removing any one study could affect the result-especially the large Evstatiev trial, 7 exclusion of which would reduce the NMA population by two-fifths (483/1143) and remove the majority of patients treated with IS(239/306) and FCM(244/380). This is the only study included which directly compares two IV products, and we believe its inclusion is entirely justified, despite the simplified dosing schedule, since this is a reflection of differing current dosage recommendations. Removal of the trial

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confidence: 75%

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confidence: 99%

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confidence: 99%

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Editorial: which iron preparation for patients with IBD? Authors’ reply

Aksan

Işık

Radeke

et al. 2017

Aliment Pharmacol Ther

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“…Several studies have suggested a link between iron deficiency and thrombocytosis in non-CKD patients. 9,21,22 Furthermore, ESA dose was one of the independent determinants of TSAT, and vice versa. 23 Also, ESA-associated venous thromboembolism could be caused by iron-restricted erythropoiesis and would be countered by iron supplementation in non-CKD patients.…”

Section: Discussionmentioning

confidence: 97%

Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients

Koike

Fukami

Kawaguchi

et al. 2016

IJNRD

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Higher doses of erythropoiesis-stimulating agents (ESAs) contribute to atherothrombotic cardiovascular disease in hemodialysis (HD) patients. Thrombocytosis is associated with increased mortality in ESA-treated HD patients. We investigated variables affecting platelet count and its variability (platelet count increment [∆platelet count]) in HD patients. This retrospective longitudinal and observational study of HD outpatients was carried out over 3 years. The outcome was independent determinants of platelet count and ∆platelet count, which were associated with iron indices, ESA dose, and C-reactive protein. In univariate regression analysis, V-shaped relationship was observed between platelet count and transferrin saturation (TSAT), ferritin, serum iron, and hemoglobin (Hb) with the bottom of 0.21, 330 ng/mL, 49 µg/ dL, and 10.3 g/dL, respectively. Mixed-effect multivariate regression analysis revealed that TSAT (inversely), Hb #10.3 g/dL (inversely), C-reactive protein, and ESA dose were independently associated with platelet count. ∆platelet count was independently and inversely correlated with ∆TSAT and directly correlated with ∆ferritin. TSAT was independently and inversely associated with ESA dose. ESA dose was directly correlated with iron dose and inversely correlated with TSAT, ferritin #330 ng/mL, and Hb #10.3 g/dL. ESA dose and TSAT were correlated in determining platelet count and ∆platelet count. Targets of iron indices that reflect iron supply sufficient to avoid platelet count increment and variability may be .21% of TSAT and 300 ng/mL of serum ferritin for appropriate ESA therapy in HD patients.

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“…ECCO recommends up to 100 mg/day elemental Fe as oral iron for patients with mild anaemia and inactive IBD. 1 Patients with active disease, evidenced by markedly raised CRP levels, tend to respond poorly to oral iron, 7,8 and like those intolerant of oral iron or having Hb <100 g/L, should usually proceed directly to intravenous iron.…”

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confidence: 99%