An Analysis of Iron Repletion in Active Inflammatory Bowel Disease

Abstract

Purpose: Iron deficiency is the most common cause of anemia in the Inflammatory Bowel Disease (IBD) population with poor iron reserves linked to general impairments in quality of life, mucosal healing and mucosal regeneration. Currently, there are few studies examining the efficacy and impact of iron repletion on overall disease activity and hemoglobin stores in clinically active disease. Our aim is to analyze iron repletion in patients with active Ulcerative Colitis (UC) and Crohn's Disease (CD). Methods: We performed a retrospective analysis of 61 adult patients with iron deficiency anemia and active (CD) or (UC) seen at our referral center between 2003 and 2010. Inclusion criteria were based on available metrics of iron deficiency: Iron < 60ug/dl; transferrin saturation <20%; ferritin < 100ng/ml. Anemia was defined by WHO criteria as Hemoglobin < 12g/dl for women and <13g/dl for men. Data was analyzed from date of onset of iron deficiency anemia until date of resolution or most recent outpatient encounter. Clinical activity scores (UC: Mayo Score; CD: Harvey Bradshaw Index (HBI)) were recorded in a prospective manner. The primary outcome was improvement in clinical activity score. Multivariate regression analysis was performed to determine the degree to which iron repletion improved clinical activity scores. Secondary analysis was done to ascertain hemoglobin correction (M>13, F>12.). Results: The study population average age was 38.4 and predominantly female (63%). There were 63% with UC and 37% with CD, with Mayo score 5.5 (range 1-13) and HBI 7.3 (range 2-20), respectively. The majority (88%) received IV Fe repletion with the most common formulation being Fesucrose; 5 patients (8%) received oral repletion with Fe-sulfate. There were no reports of intolerance or adverse reactions. Multivariate analysis controlling for concurrent IBD medications showed a non-significant relationship between iron repletion and improvement in clinical activity (P=.12). Additionally, iron repletion did not have significant relationship with hemoglobin correction (P=.28). Conclusion: The impact of iron repletion in improving the clinical activity of IBD is not fully understood. Iron repletion does improve hemoglobin and it has been previously correlated with improvement in quality of life. However, our retrospective analysis in a subset of patients with active disease did not reveal a significant improvement in overall disease activity or hemoglobin correction. These findings necessitate prospective evaluation of the efficacy of IV Fe repletion in active disease with regard to quality of life via IBDQ, endoscopic healing and regeneration and concomitantly hemoglobin correction.