O-022 Intravenous Iron Sucrose for Treatment of Iron Deficiency Anemia in Pediatric Inflammatory Bowel Disease

Abstract

Iron deficiency anemia (IDA) is a common complication of pediatric inflammatory bowel disease (IBD). The effectiveness of oral iron supplementation in the treatment of IDA is limited by its slow onset of action, daily dosing, gastrointestinal side effects, and potential for exacerbation of intestinal inflammation. Intravenous iron sucrose (IS) is an effective and safe alternative treatment for IDA in adults with IBD, but its role in the treatment of IDA in pediatric IBD is unclear. The primary aim of this study was to evaluate the use of IS in pediatric IBD patients with IDA and determine the clinical response measured by improvement in hemoglobin. Secondary aim was to describe adverse events associated with IS use in this population. A retrospective chart review of all pediatric IBD patients receiving IS infusions for IDA at The Children's Hospital of Philadelphia between January 2011 and August 2015 was performed. The diagnosis of IDA was based on low hemoglobin for age and sex, although serum concentrations of iron, ferritin, mean corpuscular volume, total iron-binding capacity, and red blood cell distribution width were also referenced to confirm the diagnosis. Patients who had a transfusion of blood products within 2 months of an IS infusion or who had no follow-up laboratory evaluation within 2 months of the last IS infusion were excluded from the efficacy analysis. Adverse events were reported descriptively. Repeated measures ANOVA was used to evaluate paired continuous variables with post-hoc testing performed using Tukey's test. Seventy-five patients (57 with Crohn disease, 10 with ulcerative colitis, and 8 with indeterminate colitis) received a total of 280 IS infusions with 4 patients receiving multiple treatment courses. Patients were administered 200 mg per dose, 2 mg/kg per dose, or dosing calculated based on total iron deficit. The mean treatment course (±SD) was 3.5 ± 1.6 doses. Fifty-two patients qualified for analysis. The mean age (±SD) was 14.6 ± 3.1 years. There was a statistically significant increase in hemoglobin over the treatment course, with mean hemoglobin increasing from 9.6 ± 1.2 g/dL at baseline to 12.0 ± 1.3 g/dL after IS treatment (P < 0.0001). Post-hoc analysis revealed that change in hemoglobin was greatest after 4 infusions with subsequent dosing having no increased benefit. There were no statistically significant differences in change in hemoglobin between the 3 different IS doses. Twenty-two adverse events were reported in 15 patients (7.9% of the total number of infusions), including blood pressure (8/22) and pulse fluctuations (6/22), pain at IV site (6/22), chills (1/22), and IV infiltration (1/22). No anaphylaxis reactions occurred. The patient with IV infiltration required IS infusion discontinuation. Otherwise, none of the adverse events resulted in IS discontinuation and none were life-threatening, required treatment, or hospitalization. This is one of the first reported studies on IS therapy in a cohort of children with IBD and suggests that IS is a safe and potentially efficacious treatment for IDA in pediatric IBD.