P377 Assessment of safety and efficacy of ferric carboxymaltose (Ferinject ®) in the management of iron deficiency with anaemia (IDA) or without anaemia in children and adolescents with inflammatory bowel disease (IBD)
S. Hachemi*1, M. Mutalib1, S. Chadokufa1, B. Huggett1, S. Sider1, N. Shah1, L. Whitley2, S. McCartney2, F. Kiparissi1, 2
1Great Ormond Street Hospital, Paediatric Gastroenterology, London, United Kingdom, 2University College London Hospitals NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
Iron deficiency is common in children with IBD with a prevalence of 6-74%. The aetiology is multi-factorial with reduced dietary intake, low iron intestinal bioavailability, decreased internal iron turn-over and blood loss. IDA leads to impaired quality of life with increased financial burden and disruption of school attendance. Oral iron supplementation can take up to 6 months to replenish stores with an increased side effect profile. Ferric carboxymaltose (FC) offers the advantage of using higher single doses and less hospital attendances. Very few studies exist in the use of FC in Paediatrics. The aim of this study was to assess the safety and efficacy of FC in treating iron deficiency with or without anaemia in children with IBD.
We retrospectively reviewed our electronic database (disease phenotype, gender, age) on paediatric IBD patients with IDA treated with FC over a 2 year period. IDA was confirmed by combining haemoglobin, haematocrit, MCV, Ferritin and iron levels as well as clinical symptom of tiredness and lethargy. Patients were given a 15-30 minute FC infusion; bloods were repeated after 4-6 weeks. Safety was assessed by identified adverse events, efficacy by improvement of symptoms and laboratory Results.
102 children/adolescents with IBD were identified who had received FC, 59 male, 43 female; however due to the lack of complete data only 56 patients were included in the study, 34 male, 22 female, age range 7-19 years, median 16 years. The disease phenotypes were Crohn’s disease (n=46) and Ulcerative colitis (n=10). Complete data were available in 40 patients. Commonest presenting complain was tiredness and lethargy (n=12/40). Each patient received one dose of FC. Haemoglobin (Hb) pre FC, range 69-118 g/L, median 104, Hb post FC 83-136, median 123; Haematocrit (HCT) pre FC, range 0.233-0.36 L/L, median 0.329, HCT post FC 0.28-0.41, median 0.375; Mean corpuscular volume (MCV) pre FC, range 58.2-79 fL, median 73.6, MCV post FC, range 60.3-85.4, median 81.1; Iron Pre FC, range 1.7-7.5 mcg/L, median 4.5, iron post FC, range 3.1-22.6, median 13; Ferritin Pre FC, range 6-475 mg/L, median 58, ferritin post FC, range 12-2658, median 175. Significant improvements of blood indices were seen, Hb rise of 19 g/L, HCT rise of 0.04 L/L, MCV rise of 7.5 fL, iron rise of 8.5 mcg/L and ferritin rise of 117mg/L. 2/40 patients (5%) developed an allergic reaction with fever, shivering and vomiting, no other allergic reactions were seen. Clinical symptoms improved in 11/12 (92%) patients reporting tiredness.
Paediatric patients with IBD seem to benefit from receiving intravenous ferric carboxymaltose(Ferinject ®) with improvement of their subjective symptoms and their blood indices.