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P719 Update of a network meta-analysis of efficacy and safety of different intravenous iron compounds in patients with IBD and anaemia

A. Aksan*1,2, H. Işık2, H. H. Radeke1,3, A. Dignass4, J. Stein1,5

1Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany, 2Hacettepe University, Ankara, Turkey, 3Pharmazentrum Frankfurt, Hospital of the Goethe University, Institute of Pharmacology and Toxicology, Frankfurt/Main, Germany, 4Agaplesion Markuskrankenhaus, Frankfurt/Main, Germany, 5DGD Clinics Sachsenhausen, Frankfurt/Main, Germany

Background

Iron deficiency anaemia (IDA) is a frequent complication of IBD and associated with reduced quality of life and increased hospitalisation rates. Modern intravenous (IV) iron compounds are evidentially safe and effective in IBD patients, facilitating rapid correction of haemoglobin (Hb) levels and iron store repletion. ECCO guidelines recommend IV iron therapy in IBD patients with IDA. Slight variances in core size, composition and density of the carbohydrate shell cause variances in the efficacy and tolerability of IV iron formulations. Here, we searched for new data to augment a first network metaanalysis (NMA) and systematic review of IV iron preparations [ferric carboxymaltose (FCM), ferumoxytol (FOX), iron sucrose/saccharate (IS), iron isomaltoside (ISM) and iron dextran (IDX)] approved in IBD, carried out in 2016.1

Methods

Using the same methodology, we searched PUBMED, SCOPUS, Web of Science and Cochrane databases to identify articles published from Jul 2016 to August 2018. Primary outcome measure was haematopoietic response (% of patients), defined as Hb normalisation increase of ≥2 g/dl. Secondary outcomes included total adverse events (AEs) as % of safety population.

Results

We found 151 studies including 4 prospective observational studies (2 FCM, 2 ISM) which were added to the systematic review, making 18 in total. Eligible studies on FOX were not found. No new studies eligible for the NMA of 4 studies were identified. The updated systematic review included 7 studies (n = 798) for FCM, 2 (n = 78) for IDX, 8 (n = 508) for IS, and 3 (n = 423) for ISM. Overall response rates were FCM; 599/798(78%), IDX; 33/78(42%), IS; 344/508(68%), ISM; 265/423(63%). All IV iron products were reported to be well tolerated: overall rates of AEs and serious AEs were 66/836 (7.9%) and 1/836 (0.1%) for FCM; 10/83 (12%) and 0/83 for IDX; 72/471 (15.3%) and 1/471 (0.2%) for IS; 54/454 (12.7%) and 5/424 (1.2%) for ISM, respectively. Only FCM was significantly more effective than oral iron (OR = 1.9, 95% CrI [1.1;3.2]). IS and ISM also had better response rates than oral iron (insignificant). p-values of < 0.05 for the node-splitting analysis of the Bayesian analyses indicated insignificant inconsistency.

Conclusion

Our findings indicate that FCM remains the most effective IV iron formulation as monotherapy, followed by iron sucrose. In addition, FCM tended to have a better safety profile, with fewer AEs. The totality of evidence showed that further studies are unlikely to overturn this result. Nevertheless, evidence from comprehensive head-to-head studies is needed to establish the comparative efficacy of different IV iron compounds in IBD patients with IDA.

Reference

1. Aksan et al. Aliment Pharmacol Ther 2017;45:1303–18