IV Ferric Carboxymaltose Tops IV Iron Sucrose for Iron-deficiency Anemia in IBD

By Reuters Staff

February 02, 2021

NEW YORK (Reuters Health) - For iron-deficiency anemia (IDA) in patients with inflammatory bowel disease (IBD), intravenous ferric carboxymaltose is probably a better bet than IV iron sucrose, according to a Cochrane review of therapies to treat IDA in patients with Crohn's disease (CD) and ulcerative colitis (UC).

The reviewers note that IBD affects roughly seven million people around the world and is often accompanied by IDA. The different routes of iron administration, doses and preparations have varying advantages and disadvantages, yet "no consensus has been reached amongst physicians as to which treatment path is most beneficial," they say.

Using data available through November 2019, Dr. Morris Gordon of the University of Central Lancashire, in Preston, U.K., and colleagues evaluated the efficacy and safety of the various interventions for treatment of IDA in patients with IBD.

Eleven studies, with a total of 1,670 participants, met their inclusion criteria. These were randomized controlled trials comparing iron administration interventions against each other or placebo in adults IDA and IBD.

"The primary outcome of number of responders, when defined, was stated to be an increase in hemoglobin of 20 g/L in all but two studies in which an increase in 10 g/L was used," the authors write in the Cochrane Database of Systematic Reviews.

Based on their findings, they say IV ferric carboxymaltose probably leads to more people having resolution of IDA than IV iron sucrose.

For example, one study comparing IV ferric carboxymaltose and IV iron sucrose provided "moderate-certainty" evidence that IV ferric carboxymaltose was "probably superior" to IV iron sucrose, although there were responders in both groups.

In the IV ferric carboxymaltose group, 150 of 244 (61%) patients responded as did 118 of 239 patients (49%) in the IV iron sucrose. The risk ratio was 1.25 (95% confidence interval: 1.06 to 1.46) and number needed to treat for an additional beneficial outcome (NNTB) was nine.

The data also suggest that oral ferric maltol may lead to more people having resolution of IDA than placebo. One study comparing oral ferric maltol to placebo provided "low-certainty" evidence of superiority (RR, 73.00; 95% CI, 4.58 to 1,164).

An analysis comparing all IV iron preparations to all oral iron preparations showed that the IV route may lead to more responders (RR, 1.17; 95% CI, 1.05 to 1.31; NNTB, 11), albeit with "low-certainty due to risk of bias and inconsistency," report Dr. Gordon and colleagues.

Their data review also suggests that withdrawals due to side effects may be more common with oral than IV iron preparations (RR, 0.39; 95% CI, 0.20 to 0.74), but again with "low-certainty due to risk of bias, inconsistency and imprecision. It is unclear whether any therapy leads to a difference in adverse events (minor or serious) when compared to any other therapy."

Aside from IV ferric carboxymaltose and oral ferric maltol, it is unclear whether there is any difference between any of the other treatments studied for IDA, "due to low numbers of studies in each comparison area and clinical heterogeneity within the studies. Therefore, there are no other conclusions regarding the treatments that can be made and certainty of all findings (is) low or very low."

SOURCE: https://bit.ly/2M47rrV Cochrane Database of Systematic Reviews, online January 13, 2021.

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