Intravenous Versus Oral Iron for the Treatment of Anemia in Inflammatory Bowel Disease

Bonovas, Stefanos; Fiorino, Gionata; Allocca, Mariangela; Lytras, Theodore; Tsantes, Argirios; Peyrin–Biroulet, Laurent; Danese, Silvio

doi:10.1097/md.0000000000002308

Cited by 93 publications

(108 citation statements)

References 40 publications

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“…Other feature that has negatively influenced the option of treatment with oral iron is the putative reported increased prevalence of intestinal adenomas associated to prolonged oral iron treatment, in murine colitis model [30,32,33]. However, the true impact of oral iron on mucosal injury in IBD patients is not well established and the potential risk of colorectal carcinoma in humans remains controversial [36].…”

Section: Current Topics In Anemiamentioning

confidence: 99%

“…However, evidence regarding the superiority of IV iron versus oral formulas is yet to be proven [30][31][32][33]. In fact, there are several studies and systematic reviews comparing oral and different IV formulas, with variable results considering efficacy in improving Hb levels, tolerance, and safety (related to common severe adverse effects) [4,6].…”

Section: Efficacy Safety and Tolerance Datamentioning

confidence: 99%

“…Other described side effects include itching, dyspnea, wheezing, and myalgias (especially in the infusion of large-molecule iron complexes); however, it should be referred that an acute myalgia at the first administration of IV (without any other symptoms) that alleviates spontaneously within minutes (i.e., the so-called Fishbane reaction) usually does not recur, and rechallenge is unnecessary. Serious side effects are rare and include severe allergic reactions, anaphylactic shock, and cardiac arrest, but such problems are more common with the older IV formulas mostly dextran-containing preparations [30][31][32][33].…”

Section: Current Topics In Anemiamentioning

confidence: 99%

“…These new formulas largely replaced the use of iron dextrans, as they have better safety profiles (allowing the administration without the need of a test dose), and also allowing a more time-efficient fashion in a single high-dose infusion. Nevertheless, iron reactions may occur with all IV iron preparations, but they are generally not thought to be immune mediated [30][31][32][33].…”

Section: Current Topics In Anemiamentioning

confidence: 99%

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Anemia and IBD: Current Status and Future Prospectives

Lopes¹,

Azevedo²

2018

Current Topics in Anemia

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Anemia is a common complication of inflammatory bowel disease (IBD), usually recognized at diagnosis and during flare-ups. However, the exact prevalence of anemia associated to IBD (IBD-A) is unknown. Despite its major clinical relevance and quality of life impact in both adult and pediatric IBD patients, it has been for long time neglected. It is mostly multifactorial, being a unique example of the combination of chronic iron deficiency (ID) and anemia of chronic disease (ACD). The current management of IBD-A represents a paradigm shift in clinical practice, involving several challenges. A pro-active approach is recommended and with the new generation of available iron compounds and recent guidelines, the ultimate goal will be the improvement of the patients' quality of life. Sound data are still lacking, concerning the best treatment/ prevention approach for IDA/ID. Based on current evidence, oral iron therapy might be preferred in mild IDA, whereas intravenous iron may be advantageous in more severe IDA/flaring IBD. Long-term prospective clinical trials are needed, to optimize treatment schedule and to better define the clinical and hematological long-term outcomes, both in adults and in children. They should demonstrate the efficacy, safety, and tolerance profile of different available iron formulas, as well as their cost-efficacy ratio.

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Section: Current Topics In Anemiamentioning

confidence: 99%

Section: Efficacy Safety and Tolerance Datamentioning

confidence: 99%

Section: Current Topics In Anemiamentioning

confidence: 99%

Section: Current Topics In Anemiamentioning

confidence: 99%

See 2 more Smart Citations

Anemia and IBD: Current Status and Future Prospectives

Lopes¹,

Azevedo²

2018

Current Topics in Anemia

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“…In a recently published meta-analysis by Bonovas et al (25), integrated evidence from randomized controlled trials showed that IV administration of iron is more effective than oral iron uptake in achieving hemoglobin rise of ≥2.0 g/dL, and it is better tolerated as compared to oral iron in IBD. In another metaanalysis by Tolkien et al (26) oral iron (ferrous sulfate) resulted in remarkable GI side effects in adults when compared to either placebo or IV iron.…”

Section: Treatment Of Anemia Due To Ibd and Gi Hemorrhagementioning

confidence: 99%

Diagnosis and treatment of iron deficiency anemia in patients with inflammatory bowel disease and gastrointestinal bleeding: iron deficiency anemia working group consensus report

Akpınar

Çetiner²,

Keshav³

et al. 2017

Turk J Gastroenterol

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Iron deficiency (ID) and iron deficiency anemia (IDA) are important signs of gastrointestinal (GI) hemorrhage. Therefore, the evaluation of the GI tract should be a part of the diagnostic protocol in patients with IDA. GI hemorrhage is not a disease but a symptom, which might have different underlying causes. ID and IDA have significant negative impacts on the life quality and work ability, and they may lead to frequent hospitalization, delay of discharge, and increased healthcare costs. Therefore, an optimal management of the disease causing GI hemorrhage should include iron replacement therapy, along with the treatment of the underlying condition. IDA in inflammatory bowel disease (IBD) has received particular attention owing to its high prevalence, probably due to a number of other factors such as chronic hemorrhage, reduced dietary iron intake, and impaired absorption of iron. Historically, in IBD and in patients with GI hemorrhage, the diagnosis and management of IDA have been suboptimal. Options for iron replacement include oral and intravenous (IV) iron supplementation. Oral iron supplementation frequently results in GI side effects, and theoretically, it may exacerbate IBD activity; therefore, IV iron supplementation is usually considered in patients not responding to or not complying with oral iron supplementation or patients having low hemoglobin concentration and requiring prompt iron repletion. The aim of this report was to review the diagnostic and therapeutic considerations of IDA in IBD and GI hemorrhage with a multidisciplinary group of experts and to formulate necessary practical recommendations.

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Risk of Infection Associated With Administration of Intravenous Iron

et al. 2021

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IMPORTANCEIntravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain. OBJECTIVE To examine the risk of infection associated with intravenous iron compared with oral iron or no iron. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform. STUDY SELECTION Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility. DATA EXTRACTION AND SYNTHESIS Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection. MAIN OUTCOMES AND MEASURESThe primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.RESULTS A total of 154 RCTs (32 920 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.17; 95% CI, 1.04-1.31; I 2 = 37%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g/dL; 95% CI, 0.50-0.64 g/dL; I 2 = 94%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.93; 95% CI, 0.76-0.89; I 2 = 15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay. (continued) Key Points Question In patients who require treatment with intravenous iron, what is the evidence that this intervention increases the risk of developing a new infection? Findings In this systematic review and meta-analysis of 154 randomized clinical trials that included 32 920 participants, intravenous iron was associated with an increased risk of infection. Meaning The results of this study suggest that, despite broad advocacy in clinical guidelines, intravenous iron may increase the risk of infection, which must be balanced with the potential benefits of treating anemia and reducing blood transfusion requirements.

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Intravenous Versus Oral Iron for the Treatment of Anemia in Inflammatory Bowel Disease

Abstract: Supplemental Digital Content is available in the text

Cited by 93 publications

References 40 publications

Anemia and IBD: Current Status and Future Prospectives

Anemia and IBD: Current Status and Future Prospectives

Diagnosis and treatment of iron deficiency anemia in patients with inflammatory bowel disease and gastrointestinal bleeding: iron deficiency anemia working group consensus report

Risk of Infection Associated With Administration of Intravenous Iron

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