Intravenous Iron Replacement Improves Quality of Life in Hypoferritinemic Inflammatory Bowel Disease Patients with and without Anemia

Abstract

Background: No study has compared changes in quality of life (QoL) following iron therapy between anemic and non-anemic, hypoferritinemic patients. This study compares the impact of parenteral iron replacement on QoL in inflammatory bowel disease (IBD) patients with anemia, or in those with hypoferritinemia alone. Methods: Consecutive IBD patients diagnosed with anemia or hypoferritinemia were enrolled. IBD questionnaire (IBDQ) and 36-Item Short Form Survey (SF36) at diagnosis and 6 weeks post treatment were measured. Results: Ten patients with anemia and 13 with hypoferritinemia were treated with intravenous iron polymaltose. Across all patients, there was a significant improvement in median SF36 mental component score by 8.5 (p = 0.004) and median IBDQ by 12 (p = 0.02). There was a trend towards improved median SF36 physical component score by 3.2 (p = 0.6). These changes were not significantly different when comparing anemic with hypoferritinemic patients. In IBDQ, there was a trend toward greater improvement in hypoferritinemic vs. anemic patients (20 vs. 1.5, p = 0.31). Conclusions: This is the first study to show that improvements in QoL in hypoferritinemic patients are similar to those with anemia. Based on these results, patients with IBD should be offered the option of iron therapy when they are found to be hypoferritinemic, even in the absence of anemia.

Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease

“…Thus, a placebo-controlled, double-blinded, randomized study in women with iron deficiency but without anaemia indicated that intravenous iron administration resulted in an improvement of fatigue in 82% of patients in the intervention group compared with 47% in the placebo group and that the effect of iron supplementation on fatigue was most pronounced in women with an initial ferritin concentration of less than 15 ng/mL [ 174 ]. Similar beneficial effects of intravenous iron administration regarding quality of life in non-anaemic patients with IBD have recently been published [ 175 , 176 ]. Thus, none of these observational, single centre studies included a placebo control given the high incidence of placebo mediated benefits on quality of life in such patient cohorts [ 174 , 177 ].…”

Review article: treating‐to‐target for inflammatory bowel disease‐associated anaemia

“…The Short Form (SF)‐36 physical component summary significantly increased in 13 IBD patients with non‐anaemic iron deficiency receiving iron therapy . In the same way, the SF36 mental component score is improved with iron supplementation in both anaemic and non‐anaemic iron‐deficient IBD patients. In the FERGICOR trial, treatment with both IV iron compounds (ferric carboxymaltose and iron sucrose) were associated with significant improvement in Inflammatory Bowel Disease Questionnaire IBDQ scores from baseline to week 12 ( P < 0.001) .…”

“…In a study enrolling 85 non‐anaemic iron‐deficient IBD patients, IV iron sucrose supplementation significantly improved quality of life assessed with the Inflammatory Bowel Disease Questionnaire (IBDQ) and the SF‐36 Health Survey . Another small study evaluated quality of life with IBDQ and SF‐36 in 10 patients with anaemia and 13 with hypoferritinemia treated with IV iron polymaltose . Improvements in quality of life in hypoferritinemic patients were similar to those with anaemia.…”

“…The tight monitoring of IBD patients, ideally using the combination of ferritin and TS, may improve early ID detection and thus allow anaemia prevention. ID in itself could be a valid therapeutic target for IBD patients, regardless of haemoglobin level, as suggested by studies showing improvements in quality of life in iron‐deficient IBD patients without anaemia and the stronger evidence from other disease areas. After iron supplementation, anaemia may reoccur in up to 50% of patients .…”

Management of anemia in inflammatory bowel disease: a challenge in everyday clinical practice

“…Treatment of anemia should not be overlooked and should be started as soon as possible, as iron replacement improves quality of life of anemic and hypoferritinemic patients with IBD [ 21 ]. The decision to initiate the therapy and route of administration depend on a number of factors including the general condition of the patient, IBD activity, anemia severity and the prior tolerance of oral iron preparations.…”