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P381 An observational study of adverse events of patients with inflammatory bowel disease receiving parenteral iron

A. Wilson*, E. Murray, G. B. Turner

Belfast Trust, Belfast, United Kingdom

Background

Intravenous iron is often indicated in inflammatory bowel disease (IBD) because of intolerance or inefficacy of oral therapy. Although safe, IV iron is associated with adverse reactions and hypersensitivity. We observed a higher rate of adverse reactions in IBD patients than in a non-IBD population and set out to formally study this and to report a strategy for delivering IV iron to patients with IBD who have had a hypersensitivity reaction.

Methods

An ambulatory IV iron clinic was set up in the Belfast in 2011, taking referrals from gastroenterology, GI surgery and an intestinal failure clinic from 3 acute hospitals. We collated clinical data from all patients attending our service from 2011 to 2015. We recorded all adverse events in patients that received IV iron and established whether each patient had IBD. Hypersensitivity with IV iron is generally associated with fast infusion rates and higher concentrations of iron. Pre-treating individuals with sensitivity has been used successfully with contrast media and biological agents.

The lack of treatment options for IBD patients with hypersensitivity to IV iron prompted an attempt to re-challenge carefully selected patients with prior moderate-to-severe hypersensitivity reactions. Where no other options were identified for such patients, pre-treatment with 200 mg of IV hydrocortisone and 10mg IV chlorphenamine was administered 1 hour before a reduced 600 mg dose of ferric carboxymaltose in 250 mls over 1 hour.

Results

In total, 455 patients were included, of which 171 had IBD. Further, 22 patients had an adverse event with a statistically significant increase in all adverse events in IBD compared with non-IBD patients: 8.2% v 2.8% (p = 0.0096). There was also a higher rate of hypersensitivity in patients with IBD (5.3%) compared with those without IBD (0%). (p = 0.0001).

Table 1. Adverse reaction data by type and with/without IBD

Type of reactionAll patients 
(n = 455)without IBD 
(n = 284)with IBD 
(n = 171)
Hypersensitivity99
Flu-like illness413
Dermatological422
Vomiting11
Delayed nausea33
Severe coughing11
Total22814

In addition, 6 patients with prior hypersensitivity were re-challenged using the above protocol. Next, 19 infusions were delivered to these 6 patients with only 1 moderate hypersensitivity reaction reported (during second infusion developed transient dyspnoea, flushing, and nausea).

Conclusion

We demonstrate that IBD is associated with a higher rate of adverse events with IV iron, particularly hypersensitivity.

We report successful IV iron delivery to 5 of 6 patients with a history of previous reaction to IV iron. We utilised pre-treatment and delivered a less concentrated solution at a slower rate.

Factors that may contribute to the increased rate of reactions, such as disease activity and the timing of infusion, require further study and could potentially lead to safer practice.