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P403 Intravenous iron infusion in inflammatory bowel disease: efficacy and ferro-economics

R. Ranjan*1, D. Rayner1, F. Maw1, A. Dhar1

1County Durham and Darlington NHS Foundation Trust, Gastroenterology, Durham, UK

Background

Iron deficiency anaemia (IDA) is a common association of inflammatory bowel disease (IBD). The mechanism of IDA in IBD is multifactorial and includes blood loss, systemic inflammation causing anaemia of chronic disease as well as malabsorption. Patients with active IBD do not respond to oral iron due to the hepcidin block and need intravenous iron. Inactive IBD patients do not tolerate oral iron and need parenteral iron. The aim was to assess the efficacy and cost of IV iron treatment in IBD patients.

Methods

Retrospective case note and haematology tests review of all patients who received IV Iron as Ferric Carboxymaltose (Ferrinject®) infusion for IDA at Darlington Memorial Hospital between March and August 2017 was done. Data were inputted into an Excel spreadsheet for analysis; patients who received Iron infusion for non-gastrointestinal diseases were excluded from analysis. Patients with IBD were classified into ulcerative colitis (UC), Crohn’s disease (CD) and unclassified/indeterminate colitis (IBDU). The reasons for IV iron were classified as intolerance, active disease or no response to oral Iron preparations. Response to iron therapy was determined by target haemoglobin being achieved within 3 months post infusion. Patients who needed more than one infusion of Ferinject were noted. Costs were calculated using national tariff for drug acquisition and day care treatment costs.

Results

Of 78 patients with IDA, 36 had iron infusion for gastrointestinal diseases. Twenty-four of these had IBD (10 UC, 13 CD, and 1 IBDU). Of the IBD patients, 5 had active disease, 13 were intolerant of oral iron, 3 had no response to oral iron, and 3 patients by clinician choice. Mean weight of the patients was 72.69 kg (range 51.6–119.4 kg). Mean haemoglobin (Hb) prior to iron infusion was 102.79 g/l (range 49–142). Nineteen patients (79%) required 2 infusions of Ferrinject based on calculated dose. Mean Ferrinject dose required was 1479 mg (range 1000–2000 mg). Post Ferrinject, 15/24 (62.5%) patients achieved target Hb (>120). Mean Hb level post infusion was 130.4 g/l, range 90–156. None of the patients had any allergic reactions. Cost of treatment ranged from £2000 for the 5 patients who needed a single infusion to £15200 for the remaining 19 patients, indicating that there is a significant cost for IV iron treatment in IBD using Ferinject.

Conclusion

Intolerance to oral iron is very common in patients with IBD. IV Iron replacement is an effective therapy with good response in patients for whom oral Iron is not appropriate. A significant number of patients require more than one infusion to achieve desired haemoglobin levels requiring increased use of resources such as bed space in day units and treatment costs. Single total dose iron infusions could reduce these costs.