3.3 Effect of erythropoiesis- stimulating agents and iron

3.3.5 Inflammatory bowel disease

Evidence Statements for Inflammatory bowel disease
Evidence Statements –
inflammatory bowel disease
Evidence Consistency Clinical impact Generalisability Applicability
ES3.33 In IBD patients with iron deficiency anaemia, the effect of IV iron versus oral iron on mortality is uncertain. NA NA
ES3.34 In IBD patients with iron deficiency anaemia, it is uncertain whether there is any difference between the effects of IV iron and oral iron on functional or performance status. NA X

ES, evidence statement; IBD, inflammatory bowel disease; IV, intravenous

=B; =C; X=D; NA,not applicable (see Table 2.1)

Practice Point – inflammatory bowel disease
PP15 In patients with IBD, determine the cause of anaemia and treat reversible causes. IV iron may be required in patients who are intolerant of oral iron, or to avoid aggravation of intestinal inflammation.

IBD, inflammatory bowel disease; IV, intravenous; PP, practice point

Intravenous iron – inflammatory bowel disease

Although anaemia in inflammatory bowel disease (IBD) is multifactorial, iron deficiency and anaemia of chronic disease are common aetiological factors. IV iron therapy is frequently used in IBD patients because oral iron has drawbacks (e.g. intolerance, lack of compliance, poor absorption and worsening of inflammation).

The review identified two RCTs (Level II) that evaluated the use of iron therapy in patients with IBD with iron deficiency anaemia.123,124

Kulnigg et al found no significant difference in mortality between IV and oral iron, but the study was underpowered.123 Neither study reported on the incidence or volume of blood transfusion or thromboembolic events.

In Kulnigg et al, patients treated with IV iron had a greater improvement in SF-36 from baseline at follow-up than patients treated with oral iron.123 In Schroder et al, there were similar improvements from baseline at follow-up for IV iron compared with oral iron for Crohn’s Disease Activity Index, Colitis Activity Index (CAI) and SF-36.124 These two studies provided insufficient detail to determine whether the treatment effect on this outcome was statistically significant.