Safety and efficacy of parenteral iron in children with inflammatory bowel disease

Abstract

Objectives: Iron deficiency anemia (IDA) frequently complicates inflammatory bowel disease (IBD) in children and adults. Oral iron may exacerbate gastrointestinal symptoms and absorption may be insufficient in intestinal inflammation. Even where oral iron is successful, repletion of iron stores can be unacceptably slow. Intravenous (IV) iron compounds were in the past associated with serious adverse reactions and historically were considered a last resort in children. New generation preparations have a safer profile in adults although reluctance to use them in children may persist, where safety data is lacking. We investigate the safety and efficacy of ferric carboxymaltose (FCM) and iron sucrose (IS) in children. Methods:We retrospectively identified all children with IBD who received parenteral iron over a 38 month period in a single regional referral centre. Safety, tolerability and adverse events were established by case note review. Efficacy was assessed by change in hematinic indices pre-and posttreatment.Results: 47 children (18 male; median age 14yrs, range 3-17) received a total of 104 iron infusions. 44% (21) had Crohn's disease (CD); 56% (27) ulcerative colitis (UC). 40 received FC, eight IS and one both. Three children developed mild rash post infusion which resolved quickly with chlorphenamine. Mean increase in hemoglobin (Hb) was 2.5g/dl (0.3-5.8). Iron levels increased by a mean of 8.4 g/dl (1-25), transfer in saturation by 16.2% (2-47). Transfer in decreased by 0.84 g/dl (0.3-3.4). Conclusion:New generation parenteral iron preparations are safe, well tolerated and efficacious in children with IDA and IBD.What is known: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and a significant contributor to morbidity.IDA should be actively treated in IBD.Parenteral iron is effective and relatively safe in adults. What is new:The intravenous iron preparations ferric carboxymaltose (FCM) and iron sucrose (IS) are effective treatments for IDA in children with IBD. The safety profiles of FCM and IS are favourable, and similar in children to that in adults.

Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management

“…Following FCM infusion as a single dose of 15 mg/kg up to 1000 mg over 15-20 min, 64% of patients with IDA had resolution of anemia, with 81% showing resolution for ID without anemia [175]. Similar data have been reported by other authors [176,177]. CD (and, for that matter, any other disease causing villous atrophy) is a classic scenario where the results of oral iron replacement are poor due impaired absorption inherent to mucosal injury.…”

Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel Disease

“…No adverse reactions to treatment were reported. More recently, two studies confirmed the previously observed efficacy and safety data of new-generation IV iron formulations in pediatric patients with IBD [37,56]. Stein et al [37] retrospectively reviewed the charts of all pediatric patients with IBD receiving iron sucrose infusions for IDA at a single center between 2011 and 2015.…”

“…Adverse effects were reported in 18.1% of subjects and 6.6% of infusions, none of which life-threatening or requiring hospitalization. The retrospective and single-center study by Papadopoulos et al [56] analyzed the safety and efficacy outcomes of 41 children with IBD (mostly [56%] with UC) who received parenteral iron (ferric carboxymaltose, n = 35; iron sucrose, n = 7; both, n = 1) over 38 months and showed a mean 2.5 g/dL, 8.4 g/dL, and 16.2% increase of Hb, iron levels, and transferrin saturation, respectively. Three children developed mild rash after infusion, which resolved quickly with chlorphenamine.…”

Dietary Management in Pediatric Patients with Crohn’s Disease

“…Whereas, historically, high-molecular-weight intravenous iron compounds were burdened by a significant rate of side effects and therefore underused due to safety concerns, the introduction of low-molecular-weight formulations led to a significant decrease in adverse effects [ 85 ]. Various studies performed in children and adolescents with IBD reported a high efficacy of intravenous iron formulations with a relatively low rate of adverse events [ 86 , 87 , 88 , 89 ]. Mamula et al [ 86 ] reported their retrospective experience with intravenous iron dextran infusions in 70 children affected by IBD.…”