Management of inflammatory bowel disease-related anemia and iron deficiency with specific reference to the role of intravenous iron in current practice

ABSTRACT

Introduction: Anemia is a common extraintestinal manifestation in patients with inflammatory bowel disease, impacting disease prognosis, morbidity, hospitalization rates and time lost from work. While iron deficiency anemia and anemia of chronic inflammation predominate, combinations of hematimetric and biochemical markers facilitate the diagnosis and targeted therapy of other etiologies according to their underlying pathophysiological causes. Intravenous iron replacement is currently recommended in IBD patients with moderate to severe anemia or intolerance to oral iron.

Areas covered: This review examines the impact, pathophysiology and diagnostics of iron deficiency and anemia, compares the characteristics and safety profiles of available oral and intravenous iron preparations, and highlights issues which require consideration in decision making for therapy administration and monitoring.

Expert opinion: Modern intravenous iron formulations have been shown to be safe and effective in IBD patients, allowing rapid anemia correction and repletion of iron stores. While traditional oral iron preparations are associated with increased inflammation, negative effects on the microbiome, and poor tolerance and compliance, first clinical trial data indicate that newer oral compounds such as ferric maltol and sucrosomial iron offer improved tolerability and may thus offer a viable alternative for the future.

KEYWORDS:

• Anaemia
• inflammatory bowel disease
• deficiency

Article Highlights

• Iron deficiency anemia is the most common systemic complication and extraintestinal manifestation of inflammatory bowel disease.

• There is growing evidence to suggest that an adequate iron supply is essential not only to avoid anemia, but also to maintain a good quality of life, and it is becoming apparent that iron deficiency merits treatment per se, even in nonanemic patients.

• Common biochemical parameters are an inadequate basis for the assessment of iron status in patients who have an inflammatory condition such as IBD.

• Results from several RCTs showed that intravenous iron therapy improved quality of life in significantly more patients than oral iron, even in the absence of anemia.

• Physicians now have a wider choice of intravenous iron preparations than ever before. The structures of new preparations permit far larger doses of iron to be administered safely in a single visit, an important aspect for IBD patients.

This box summarizes key points contained in the article.

Acknowledgement

The authors wish to thank Janet Collins (iCCC Rhein-Main, Frankfurt/Main, Germany) for assistance with manuscript preparation, correction and proofreading.

Declaration of interest

J Stein has received consultancy fees from AbbVie, Fresenius-Kabi, Immunodiagnostik, Merck Sharp & Dohme, Pharmacosmos, Takeda and Vifor; received payment for lectures from AbbVie, Falk Foundation, Ferring, Immunodiagnostik, Merck Sharp & Dohme, Pharmacosmos, Takeda, Thermofischer and Vifor; and has received payment for manuscript preparation from Abbvie, Falk Foundation and Merck Sharp & Dohme. A Askan is under contract for future consultancy work for Vifor Pharma Ltd. A Dignass has received consultancy fees from Abbott, Merck Sharp & Dohme, Ferring, UCB Pharma, Otsuka, Roche/Genentech, Takeda, Pharmacosmos, Holystone Biotech and Falk Foundation; has received grants from Institut für Gemeinwohl and Stiftung Leben mit Krebs as well as payment for lectures including service on speakers’ bureaus from Falk Foundation, Ferring, Merck Sharp & Dohme, Abbott, Otsuka, Vifor, Stiftung Leben mit Krebs, Kompetenznetz CED, Takeda, and Pharmacosmos. Additionally, A Dignass has received payment for manuscript preparation from Falk Foundation and payment for development of education presentations from Abbott, Pharmacosmos, Falk Foundation and Ferring. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.