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* = Presenting author

P511 Utilisation and efficacy of oral iron therapy in patients with iron deficiency anaemia in a nationwide cohort of ulcerative colitis patients

D. Patel*1, N. Khan2

1Mercy Catholic Medical Centre, Internal Medicine, Philadelphia, Pennsylvania, United States, 2University of Pennsylvania, Internal Medicine, Philadelphia, Pennsylvania, United States

Background

Anaemia is one of the most common extra-intestinal complications of ulcerative colitis (UC), frequently resulting from iron deficiency. The management of anaemia if often ignored because physicians are more concerned with control of intestinal symptoms.

Methods

A previously validated cohort of newly diagnosed UC patients from the nationwide Veterans Affairs (VA) health care system was utilised as the study population. Charts of all patients were individually reviewed and demographic and clinical data were collected. In this cohort, anaemia was defined: in men as Hb < 13 g/dL, and in women < 12 g/dL. Patients with anaemia were subdivided into 3 groups depending on their Hb level: mild (Hb 11–13 g/dL in males and 11–12 g/dL in females), moderate (Hb 8–11 g/dL), and severe (Hb < 8 g/dL). IDA was defined as per WHO criteria. All outpatient pharmacy data was reviewed to evaluate if patient had received any oral iron therapy after diagnosis of IDA. A retrospective cohort design and time-to-event survival analysis was used to track outcomes of interest. Resolution of anaemia was defined as normalisation of Hb after administration of oral iron. Difference between groups of categorical variables was measured using Chi-square.

Results

In total, 978 patients were included in the analysis. Further, 652 patients (66.6%) were diagnosed with anaemia during their course of disease. Of 652 patients, 445 (68.2%) had iron studies performed upon them, and amongst them, 281 (63.1%) patients were diagnosed with IDA. Of 281 patients with IDA, 61 patients (21.7%) had mild anaemia; 148 patients (52.6%) had moderate anaemia; and 72 patients (25.6%) had severe anaemia. The majority of patients were male 258/281(91.8%) and Caucasian (71.1%). Of 281 patients with IDA, oral iron therapy was administered in 206 patients (73.3%), and resolution of anaemia was observed in 130 patients (63.1%). Administration of oral iron therapy and resolution of anaemia depending on severity of IDA are mentioned in Table 1. Odds of receiving oral iron therapy were 5.6 times higher in severe anaemia compared with mild anaemia (OR 5.61, 95% CI 2.43–12.96, p-value < 0.00001), but conversely, the odds of resolution of anaemia were 4 times higher in mild anaemia than in severe anaemia (OR 4.06, 95% CI 1.46–11.24, p-value 0.007).

Conclusion

Only half the patients with mild IDA received oral iron. However, this number increased amongst those with severe IDA. Conversely, resolution of anaemia was higher amongst those with mild anaemia. Our study indicates that IDA is undertreated in the community.

Table 1

AnaemiaTotal number of IDARx with oral ironResolution of anaemia
< 87262 (86.1%)32 (51.6%)
8–11148112 (75.6%)72 (64.2%)
116132 (52.4%)26 (81.2%)