Oral Iron for IBD Patients: Lessons Learned at Time of COVID-19 Pandemic

D’Amico, Ferdinando; Peyrin–Biroulet, Laurent; Danese, Silvio

doi:10.3390/jcm9051536

Cited by 13 publications

(22 citation statements)

References 32 publications

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“…Regarding the COVID-19 context, iron metabolism is clearly disrupted in SARS-CoV-2 infected patients, especially in subjects hardest hit by the disease [ 122 ], consequently anemia [ 123 ] or hyperferritinemia are typical manifestations of hospitalized COVID-19 patients. Therefore, optimal iron status may be crucial for better disease prognosis.…”

Section: Association Between 10 Critical Micronutrients and Prevalmentioning

confidence: 99%

Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework

2020

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The pandemic caused by the new coronavirus has caused shock waves in many countries, producing a global health crisis worldwide. Lack of knowledge of the biological mechanisms of viruses, plus the absence of effective treatments against the disease (COVID-19) and/or vaccines have pulled factors that can compromise the proper functioning of the immune system to fight against infectious diseases into the spotlight. The optimal status of specific nutrients is considered crucial to keeping immune components within their normal activity, helping to avoid and overcome infections. Specifically, the European Food Safety Authority (EFSA) evaluated and deems six vitamins (D, A, C, Folate, B6, B12) and four minerals (zinc, iron, copper and selenium) to be essential for the normal functioning of the immune system, due to the scientific evidence collected so far. In this report, an update on the evidence of the contribution of nutritional factors as immune-enhancing aspects, factors that could reduce their bioavailability, and the role of the optimal status of these nutrients within the COVID-19 pandemic context was carried out. First, a non-systematic review of the current state of knowledge regarding the impact of an optimal nutritional status of these nutrients on the proper functioning of the immune system as well as their potential role in COVID-19 prevention/treatment was carried out by searching for available scientific evidence in PubMed and LitCovid databases. Second, a compilation from published sources and an analysis of nutritional data from 10 European countries was performed, and the relationship between country nutritional status and epidemiological COVID-19 data (available in the Worldometers database) was evaluated following an ecological study design. Furthermore, the potential effect of genetics was considered through the selection of genetic variants previously identified in Genome-Wide Association studies (GWAs) as influencing the nutritional status of these 10 considered nutrients. Therefore, access to genetic information in accessible databases (1000genomes, by Ensembl) of individuals from European populations enabled an approximation that countries might present a greater risk of suboptimal status of the nutrients studied. Results from the review approach show the importance of maintaining a correct nutritional status of these 10 nutrients analyzed for the health of the immune system, highlighting the importance of Vitamin D and iron in the context of COVID-19. Besides, the ecological study demonstrates that intake levels of relevant micronutrients—especially Vitamins D, C, B12, and iron—are inversely associated with higher COVID-19 incidence and/or mortality, particularly in populations genetically predisposed to show lower micronutrient status. In conclusion, nutrigenetic data provided by joint assessment of 10 essential nutrients for the functioning of the immune system and of the genetic factors that can limit their bioavailability can be a fundamental tool to help strengthen the immune system of individuals and prepare populations to fight against infectious diseases such as COVID-19.

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Section: Association Between 10 Critical Micronutrients and Prevalmentioning

confidence: 99%

Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework

2020

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“…However, this study was not a direct comparison to other iron formulations, patients were only included if their disease was in remission or non-severe and if they had previously failed treatment with other oral ferrous formulations [ 35 , 36 ]. Further studies have confirmed an acceptable safety profile for ferric maltol, demonstrating good tolerability and the majority of patients had Hb normalisation within 3 months [ 3 ]. Howaldt et al also demonstrated greater improvements in short form (SF-36) and mental component summary (MCS) scores with ferric maltol over IV iron, suggesting a greater improvement in quality of life [ 37 ].…”

Section: Managementmentioning

confidence: 99%

“…The advantages of oral iron include a well-established safety profile, its ease of route of administration and reduced cost [ 3 ]. In addition, oral iron is not associated with reduced productivity [ 41 ].…”

Section: Managementmentioning

confidence: 99%

“…Data thus far suggest that newer iron formulations may be superior to traditional ferrous iron. However, in the absence of any head-to-head trials, it is not yet possible to draw any definitive conclusions [ 3 ].…”

Section: Managementmentioning

confidence: 99%

“…There are multiple extraintestinal manifestations associated with IBD with the most common complication presenting as anaemia [ 1 ]. Anaemia in IBD is detected in up to 70% of inpatients and 20% of outpatients [ 3 ] and is thought to affect one third of the IBD population at any one time [ 4 ]. Anaemia in IBD patients can be found both at the initial diagnosis stage and during repeated flares [ 5 ], more commonly seen in Crohn’s disease than Ulcerative Colitis [ 1 ], with females at higher risk than males [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Iron Therapy in Inflammatory Bowel Disease

Kumar

Brookes

2020

Nutrients

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The most common complication seen in inflammatory bowel disease (IBD) patients is iron deficiency anaemia (IDA). Symptoms such as chronic fatigue can be as debilitating to IBD patients as pathological symptoms of abdominal pain and diarrhoea. Recognising and correcting anaemia may be as important as managing IBD symptoms and improving overall quality of life. Thus, iron replacement should be commenced the moment IDA is identified. Although intravenous iron is now considered standard treatment for IBD patients in Europe, oral iron still appears to be the preferred option. Advantages of oral iron include greater availability, lower costs and ease of applicability. However, its multitude of side effects, impact on the microbiome and further exacerbating IBD activity can have consequences on patient compliance. The newer oral iron formulations show promising safety and efficacy data with a good side effect profile. Intravenous iron formulations bypass the gastrointestinal tract absorption thereby leading to less side effects. Multiple studies have shown its superiority compared to oral formulations although its risk for hypersensitivity reactions continue to lead to clinician hesitancy in prescribing this formulation. This article provides an updated review on diagnosis and management of IDA in IBD patients, discussing the newer oral and intravenous formulations.

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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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Oral Iron for IBD Patients: Lessons Learned at Time of COVID-19 Pandemic

Cited by 13 publications

References 32 publications

Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework

Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework

Iron Therapy in Inflammatory Bowel Disease

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

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