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P494. High dose intravenous iron treatment in inflammatory bowel disease: hematological response and quality of life improvement

J. Millastre1, S. García López1, E. Bajador1, C. Castaño2, M.A. Morales1, M. Chaparro2, F. Gomollón3, J.P. Gisbert2, 1Miguel Servet University Hospital, Gastroenterology, Zaragoza, Spain, 2Hospital de La Princesa, Gastroenterology, Madrid, Spain, 3Hospital Clinico Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain

Background

Intravenous (iv) iron is very useful to treat iron deficiency anemia (IDA) in inflammatory bowel disease (IBD). New iron formulations allow administration of the total dose in 1–2 infusions, but clinical experience with these preparations is much lower. We try to analyze the usefulness of high-dose iv iron in IBD, assessing their efficacy, considering both hematological and quality of life (QoL) outcomes and safety.

Methods

We performed a 2-center prospective analysis of high-dose iv iron (carboxymaltose) in IBD. We included patients with IBD and IDA as used in clinical practice. Dose was calculated according to Ganzoni's formula. Efficacy was evaluated by hemoglobin (Hb) increase, defining complete response as normalization after treatment. We evaluated its correlation with improvement in QoL (CCVEII-9), taking into account the clinical activity of IBD (Truelove/Harvey–Bradshaw). We also evaluated the safety of the drug.

Results

We included 88 courses of iv iron treatments (55 women, 33 men, 57 Crohn's disease [CD], 31 ulcerative colitis [UC]). The Montreal classification was: CD: A1: 11, A2: 31, A3: 15; B1: 27, B2: 16, B3: 14; L1: 19, L2: 12, L3: 26; UC: E1: 5, E2: 11, E3: 12 pouchitis: 3. Activity disease: CD patients 71.1% inactive, 22.2% mild to moderate, 6.7% severe. UC patients: 45% mild, 45% moderate, 10% severe.

Hb increased in 84 cases (95.4%), achieving normal Hb levels (complete response) in 28 patients (31.8%). See Table 1.

Improvement in QoL (CCVEII-9 score) correlates with hematological response. We show the score average before and after treatment according to Hb increase in Table 2.

No increase of activity disease was observed in any patient. Only 2 adverse events were observed, just one enough severe to stop therapy

Table 1.
Hb increase, g/dlPatients, n (%)
<129 (34.5%)
1–228 (33.3%)
>227 (32.1%)
Table 2.
 CCVEII-9 score ±SD (range)
Basal60±16 (38–77)
Hb normal after treatment63±7.8 (45–73)
Hb increase >2 g/dl after treatment64±7 (45–73)
Hb increase <2 g/dl after treatment61.8±11.6 (48–75)

Conclusion

IV carboymaltose iron treatment is effective and well tolerated in IBD patients with IDA, and does not exacerbate disease activity. However, in our series the efficacy was moderate and lower than that obtained in similar studies. This may be due to the characteristics of our patients most of them with active disease. However, iv iron therapy was able to improve their QoL.