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P080. Current European practice in diagnosis and treatment of IBD-associated anaemia

J. Stein1, P. Bager2, R. Befrits3, S. Danese4, C. Gasche5, F. Magro6, F. Mearin7, D. Mitchell8, B. Oldenburg9, S. Travis10

1Crohn Colitis Center, Rhein Main, Germany; 2University Hospital, Aarhus, Denmark; 3Karolinska University Hospital, Stockholm, Sweden; 4Istituto Clinico Humanitas, Milan, Italy; 5Medical University, Vienna, Austria; 6Hospital de Sao Joan, Porto, Portugal; 7Centro Médico Teknon, Barcelona, Spain; 8Vifor Pharma, Glattbrugg, Switzerland; 9University Medical Center, Utrecht, The Netherlands; 10John Radcliffe Hospital, Oxford, United Kingdom

Aim: Iron deficiency (ID) is a major cause of anaemia in patients with inflammatory bowel disease (IBD), which can trigger hospitalisation and increase morbidity. International guidelines from 2007 recommend intravenous (i.v.) iron for the management of IBD-associated anaemia. This study evaluated current European practice for diagnosis and the role of iron for treatment of IBD-associated anaemia.

Materials and Methods: Gastroenterologists from France, Germany, Spain, UK and Switzerland completed questionnaires (June-September 2009) on patient demographics, blood tests, initial Hb-levels and iron parameters, and therapies for the last five IBD patients treated for anaemia within six months. Results are presented as median and range across countries.

Results: 236 gastroenterologists (166 hospital-, 70 office-based) reported 1173 cases of IBD-associated anaemia. Tests to confirm anaemia and assess the iron status were haemoglobin (Hb; 87% [77–91%]) and serum ferritin (82% [56–88%]). Transferrin saturation (TSAT) was tested in 25% [19–33%] of patients. At diagnosis, 55% [26–63%] presented with severe anaemia (Hb ≤10 g/dL) and 12% [2–15%] with Hb ≤8 g/dL. Absolute iron deficiency (ferritin ≤30 ng/mL) was found in 81% [66–89%]. A TSAT ≤20% (indicating insufficient iron available for effective erythropoiesis) was detected in 58% [46–83%] of those tested. Consistent with the high prevalence of ID, 65% [53–78%] received iron, mainly as monotherapy (51% [46–56%]). Except for Switzerland, only a minority [18–30%] received i.v. iron and a similar 9–19% of patients received a blood transfusion for anaemia within the surveyed period. In Switzerland, 56% of iron-treated patients received i.v. iron and only 6% had received a blood transfusion. An erythropoiesis-stimulating agent was included in a small minority of treatment regimes (2% [0–6%]) except for Spain (21%). ‘Rapid onset of action’ was stated as main reason for using i.v. iron (52%). ‘Familiarity’ or ‘Easy administration’ were the main arguments for oral iron (53% and 52%). ‘Good compliance’ (32%) and ‘Effective when used alone’ (26%) were other arguments for oral iron, but poor compliance is common and blood loss may not be adequately compensated.

Conclusions: Despite international recommendations stating i.v. iron as the preferred route of administration, most iron-treated anaemic IBD patients receive oral iron in current practice. The proportion of patients whose anaemia is not treated at all remains to be established. A high prevalence of absolute ID and severe anaemia indicate insufficient monitoring of iron status or lack of action to replace iron by an appropriate route. Awareness of evidence-based recommendations on iron supplementation in patients with IBD needs to be increased.