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P328 Patient and physician perspectives on managing iron deficiency with or without anaemia in inflammatory bowel disease: findings from a European online survey

Danese S.1, Gisbert J.P.2, Lobo A.J.3, Dignass A.4, Peyrin-Biroulet L.5, Kokot M.*6, Avedano L.7

1Humanitas University, Department of Biomedical Sciences, Milan, Italy 2Hospital Universitario de la Princesa, IIS-IP and CIBEREHD, Gastroenterology Unit, Madrid, Spain 3Royal Hallamshire Hospital and University of Sheffield, Sheffield, United Kingdom 4Agaplesion Markus Hospital, Goethe University, Department of Medicine I, Frankfurt, Germany 5University Hospital of Nancy, Lorraine University, Department of Hepato-Gastroenterology and Inserm U954, Vandoeuvre-lès-Nancy, France 6Vifor Pharma Ltd., Glattbrugg, Switzerland 7European Federation of Crohn's and Ulcerative Colitis Associations, Brussels, Belgium

Background

Iron deficiency (ID) and iron deficiency anaemia (IDA) are conditions frequently observed in patients with inflammatory bowel disease (IBD) and require appropriate treatment. This study investigated patient and physician perspectives on the management of these conditions.

Methods

Online surveys were conducted between July and September 2016 across France, Germany, Italy, Spain and the UK. Participating patients had to be diagnosed with IBD and have a history of oral or intravenous (IV) iron treatment for ID or IDA.

Results

In total, 1503 patients and 500 physicians (410 gastroenterologists, 90 internal medicine specialists) participated. According to physicians, approximately two-thirds (66%) of their patients with IBD were currently suffering from ID (33%) or IDA (33%), yet treatment was not thought necessary for 34% of patients with ID (versus 14% of patients with IDA). Only 71% of patients felt their treating physician was proactively checking for ID whereas 85% of physicians stated they monitor for it throughout IBD remission and flare. Of the patients surveyed, 60% waited >1 year from symptom onset to diagnosis. While patients tended to be less accurate than physicians in assigning symptoms, one-third (29%) of the participating physicians felt they cannot tell whether a symptom is caused by IBD or ID. Patients considered “weakness”, “tiredness” and “paleness” as symptoms most clearly associated with ID, whereas physicians most frequently identified “paleness”, “breathlessness” and “dizziness”. Although there were differences between patient and physician perspectives on symptom assignment, survey responders agreed that ID severely impacts quality of life, with constant fatigue and exhaustion impeding normal daily function. In terms of treatment, 67% of patients waited >3 months from diagnosis before receiving iron treatment. Distinct factors were found to influence the choice of iron therapy: “convenience” and “low cost” were the main reasons to choose oral iron treatment while “efficacy” and “speed of response” were key to choosing IV iron therapy. Overall, patients were satisfied with their iron therapy (mean score 7.0; range 0–10 where 10 is extremely satisfied) and treatment significantly improved patient daily wellbeing during both IBD remission and flare (p<0.05), especially for patients who were severely affected by ID.

Conclusion

Our findings indicate gaps in patient and physician perspective and awareness of ID. Uncertainties in recognizing symptoms associated with ID may lead to undertreatment in the clinical setting. Patients and physicians agree that once ID or IDA is managed effectively with iron therapy, the quality of life for the IBD patient can significantly improve.