P405 Pediatric Crohn's disease with iron deficiency anemia: A follow-up study of intravenous iron treatment
S. Valério de Azevedo*, C. Maltez, A.I. Lopes
Unit of Gastrenterology, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal
Iron deficiency anemia(IDA) is largely recognized as a treatable cause of anemia,in Cronh's Disease(CD)(ault and pediatric patients)Increasing evidence demonstrates the efficacy and safety of several IViron formulas,compared with oral iron.However,in pediatricIBD patients withIDA, this evidence is yet insufficient. As far as we know, no previous prospective studies have reported the use of IViron in pediatric CD.The present study aim's to evaluate the safety,tolerance and short and long term efficacy of these formulas in this patients.
Pediatric patients with CD-IDA(outpatient setting), were prospectively recruited, during a 40-month period(May2011-October2014).Disease activity (PCDAI) determined before and after treatment. Anemia defined according to OMS criteria.Treatment with IV iron (iron sucrose-age<14years or ferric carboxymaltose-age ≥ 14years).Total dose determined according to Ganzoni formula. Hemoglobin(Hb),serum ferritin and transferrin saturation,determined before treatment and, 4weeks after treatment.
Twenty patients (14 female; mean age:17,2 years[25-7,3]) included. Mean disease duration:5,1years(12,3-0,3); mean age at diagnosis:12,1years(17,4-05).Before IV iron treatment, 11 patients were in remission and 9 had mild active disease(mean 12,7 [25-7,5]).Previously to IV iron treatment, mean Hb:10,5 g/dl(11,9-7,9), mean ferritin 20,1 ug/L(90-0,7) and mean transferrin saturation:6%(14-2). Mean Hb in patients < 12 years:11g/dl(11,5-10,3),females ≥ 12years:9,9 g/dl(11,9-7,9) and males ≥ 12 years:11,1g/dl (11,9-10). Considering disease activity,patients in remission: mean Hb of 10,5 g/dl (11,9-7,4)and mean ferritin:6,8ug/dl(18,7-0,7);mild disease patients, mean Hb:10,6 g/dl (11,9-9,6);mean ferritin:43,3ug/dl [133,9-4,9]. Nine patients treated with iron sucrose (mean dose 672,6 mg dl [850-450]) and 11 with ferric carboxymaltose (mean dose 828,6 mg dl [1000-650]). No major adverse reactions were documented.Response to treatment: mean Hb (whole sample) 12,7g/dl(14,5-11,4),mean Hb in patients<12 years:12g/dl(12,6-11,4);females ≥ 12 years: 12,6g/dl (13,6-12,3);males ≥ 12 years: 13,3g/dl(14,5-10). Mean Hb in iron sucrose group: 12,3g/dl (13,2-11,4) and ferric carboxymaltose group: 13,1g/dl (14,5-11,4).Within a mean follow-up period after treatment of 18months(40-1,2), 6 patients needed re-treatment[after a mean period of 15,5 months (25-2)].
Our prospective study, with a significant follow-up period, further demonstrates the efficacy and safety of both IV iron formulas. Although only a small number of patients needed re-treatment in this study, it reinforces the importance of long term follow-up of the iron status in pediatric CD patients, especially in those in remission and/or mild disease activity.