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P369. Rapid infusion, high dose ferric carboxymaltose in the treatment of iron deficiency in paediatric inflammatory bowel disease - a single centre experience

N. Carman, R. Muir, P. Lewindon, Royal Children's Hospital, Gastroenterology Department, Brisbane, Australia

Background

Iron deficiency (ID) and iron deficiency anaemia (IDA) cause fatigue and impaired physical and cognitive function in inflammatory bowel disease (IBD). In children with IBD, up to 90% will be iron deficient at diagnosis and remain resistant to treatment because of recurrent inflammation. Improvement of iron with systemic therapy is associated with improved quality of life scores independent of disease. Previously, intravenous replacement has been hindered by iron toxicity limiting dosing (eg 5 mg/kg iron sucrose) and slow infusions (over 90 minutes) limiting access. Ferric Carboxymaltose (FCM) is an intravenous preparation administered rapidly in single doses up to 2000 mg over 15–20 minutes. The efficacy and tolerability of FCM has been shown in various chronic diseases but no data has been published in children.

Methods

From April 2012 to November 2013 the RCHB has used rapid infusion FCM in a single dose, over 15–20 minutes up to 15 mg/kg in children aged 6 and over with ID, with or without anaemia (IDA). Blood testing prior to FCM infusion and within 8 weeks post infusion included Haemoglobin (Hb), mean corpuscular volume (MCV), ferritin, transferrin saturation (TS) and CRP was measured as marker of coexisting inflammation. IDA was defined as Hb <130 g/L in males, <120 g/L in females, with microcytosis MCV <80 fl [1]. ID was defined as: without biochemical evidence of inflammation serum ferritin <30 µg/L or TS <16%; patients with inflammation as TS <16% and ferritin <100. Outcomes after each infusion are described.

Results

82 patients with IBD (58 Crohn's Disease, 24 Ulcerative Colitis) received 125 infusions of at least one dose FCM. Mean age 14.4, range 7–18. No child experienced serious or anaphylactic reactions, 1 (0.8%) had a mild reaction characterised by urticarial rash, itch and low grade fever, resolving with antihistamine. 49/125 (39%) children had IDA, 7/125 (6%) had ID with isolated microcytosis and 69/125 (55%) had only ID. 21 (26%) had more than one infusion. 36/49 patients with IDA had follow up iron studies. Of these, 22 (61%) IDA had improvement of Hb >20 g/L, of whom 21 (58%) had complete restoration of normal Hb, 18 after one infusion, 3 after two infusions. 6/7 (86%) infusions for microcytosis had MCV normalisation with one infusion, the other patient not having repeat iron studies. 52/69 infusions for ID had follow up iron studies. Of these, 36/52 (69%) had normalisation of ID, 34 after one infusion, 2 patients required 2 infusions.

Conclusion

Rapid, high dose FCM in children aged 6 and over is safe, well tolerated and efficacious for correction of ID. Replenishing iron in IBD is important and FCM improves our ability to meet this need.