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Published in: Digestive Diseases and Sciences 8/2010

01-08-2010 | Original Article

Safety and Efficacy of Total-Dose Infusion of Low Molecular Weight Iron Dextran for Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease

Authors: Ioannis E. Koutroubakis, Pantelis Oustamanolakis, Christos Karakoidas, Gerassimos J. Mantzaris, Elias A. Kouroumalis

Published in: Digestive Diseases and Sciences | Issue 8/2010

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Abstract

Background

Intravenous iron has been suggested as a safe and effective treatment of anemia complicating inflammatory bowel disease (IBD). Low molecular weight (LMW) iron dextran has the ability to administer the patient’s total iron requirement in a single infusion.

Aims

The aim of this study was to assess the safety and efficacy of the total dose of LMW iron dextran infusion for the treatment of iron deficiency in IBD.

Methods

Fifty IBD patients (27 female, 35 Crohn’s disease, 15 ulcerative colitis) were included in the study. Mean ± standard deviation (SD) hemoglobin and ferritin levels before the infusion were 9.88 ± 1.42 g/dl and 13.9 ± 10.9 ng/ml, respectively. A 25-mg test dose was followed by infusion of the total dose of LMW iron dextran based on the iron deficit. Several clinical and laboratory parameters were measured before and on week 4 after infusion.

Results

Four patients (8%) developed adverse reactions during the test infusion and did not receive the total-dose infusion. Only one patient developed an allergic reaction during the total-dose infusion. In the remaining 45 patients, the mean ± SD iron dose that was given was 1,075 ± 269 mg. The mean ± SD elevation of hematocrit and hemoglobin on week 4 was 4.9 ± 1.9% and 1.7 ± 0.8 g/dl, respectively. Hematopoietic response was observed in 23 of 45 patients (51.1%).

Conclusion

Total parenteral iron replacement with LMW iron dextran is an easy, safe, and effective alternative method for treating iron deficiency anemia in IBD. Harmless adverse reactions may develop in a minority of patients.
Literature
1.
go back to reference Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004;53:1190–1197.CrossRefPubMed Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004;53:1190–1197.CrossRefPubMed
2.
go back to reference Wilson A, Reyes E, Ofman J. Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):44S–49S.CrossRefPubMed Wilson A, Reyes E, Ofman J. Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):44S–49S.CrossRefPubMed
3.
go back to reference Kulnigg S, Gasche C. Systematic review: managing anaemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;24:1507–1523.CrossRefPubMed Kulnigg S, Gasche C. Systematic review: managing anaemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;24:1507–1523.CrossRefPubMed
4.
go back to reference Tsiolakidou G, Koutroubakis IE. Stimulating erythropoiesis in inflammatory bowel disease associated anemia. World J Gastroenterol. 2007;13:4798–4806.PubMed Tsiolakidou G, Koutroubakis IE. Stimulating erythropoiesis in inflammatory bowel disease associated anemia. World J Gastroenterol. 2007;13:4798–4806.PubMed
5.
go back to reference Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13:1545–1553.CrossRefPubMed Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13:1545–1553.CrossRefPubMed
6.
go back to reference Gasche C, Waldhoer T, Feichtenschlager T, Male C, Mayer A, Mittermaier C, et al. Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia. Am J Gastroenterol. 2001;96:2382–2387.PubMed Gasche C, Waldhoer T, Feichtenschlager T, Male C, Mayer A, Mittermaier C, et al. Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia. Am J Gastroenterol. 2001;96:2382–2387.PubMed
7.
go back to reference Bodemar G, Kechagias S, Almer S, Danielson BG. Treatment of anaemia in inflammatory bowel disease with iron sucrose. Scand J Gastroenterol. 2004;39:454–458.CrossRefPubMed Bodemar G, Kechagias S, Almer S, Danielson BG. Treatment of anaemia in inflammatory bowel disease with iron sucrose. Scand J Gastroenterol. 2004;39:454–458.CrossRefPubMed
8.
go back to reference Schröder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, et al. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease—a randomized, controlled, open-label, multicenter study. Am J Gastroenterol. 2005;100:2503–2509.CrossRefPubMed Schröder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, et al. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease—a randomized, controlled, open-label, multicenter study. Am J Gastroenterol. 2005;100:2503–2509.CrossRefPubMed
9.
go back to reference Erichsen K, Ulvik RJ, Nysaeter G, Johansen J, Ostborg J, Berstad A, et al. Oral ferrous fumarate or intravenous iron sucrose for patients with inflammatory bowel disease. Scand J Gastroenterol. 2005;40:1058–1065.CrossRefPubMed Erichsen K, Ulvik RJ, Nysaeter G, Johansen J, Ostborg J, Berstad A, et al. Oral ferrous fumarate or intravenous iron sucrose for patients with inflammatory bowel disease. Scand J Gastroenterol. 2005;40:1058–1065.CrossRefPubMed
10.
go back to reference Koutroubakis IE, Karmiris K, Makreas S, Xidakis C, Niniraki M, Kouroumalis EA. Effectiveness of darbepoetin-alfa in combination with intravenous iron sucrose in patients with inflammatory bowel disease and refractory anaemia: a pilot study. Eur J Gastroenterol Hepatol. 2006;18:421–425.CrossRefPubMed Koutroubakis IE, Karmiris K, Makreas S, Xidakis C, Niniraki M, Kouroumalis EA. Effectiveness of darbepoetin-alfa in combination with intravenous iron sucrose in patients with inflammatory bowel disease and refractory anaemia: a pilot study. Eur J Gastroenterol Hepatol. 2006;18:421–425.CrossRefPubMed
11.
go back to reference Reddy CM, Kathula SK, Ali SA, Bekal R, Walsh M. Safety and efficacy of total dose infusion of iron dextran in iron deficiency anaemia. Int J Clin Pract. 2008;62:413–415.CrossRefPubMed Reddy CM, Kathula SK, Ali SA, Bekal R, Walsh M. Safety and efficacy of total dose infusion of iron dextran in iron deficiency anaemia. Int J Clin Pract. 2008;62:413–415.CrossRefPubMed
12.
go back to reference Auerbach M, Winchester J, Wahab A, Richards K, McGinley M, Hall F, et al. A randomized trial of three iron dextran infusion methods for anemia in EPO-treated dialysis patients. Am J Kidney Dis. 1998;31:81–86.CrossRefPubMed Auerbach M, Winchester J, Wahab A, Richards K, McGinley M, Hall F, et al. A randomized trial of three iron dextran infusion methods for anemia in EPO-treated dialysis patients. Am J Kidney Dis. 1998;31:81–86.CrossRefPubMed
13.
go back to reference Anuradha S, Singh NP, Agarwal SK. Total dose infusion iron dextran therapy in predialysis chronic renal failure patients. Ren Fail. 2002;24:307–313.CrossRefPubMed Anuradha S, Singh NP, Agarwal SK. Total dose infusion iron dextran therapy in predialysis chronic renal failure patients. Ren Fail. 2002;24:307–313.CrossRefPubMed
14.
go back to reference Sinha S, Chiu DY, Peebles G, Kolakkat S, Lamerton E, Fenwick S, et al. Comparison of intravenous iron sucrose versus low-molecular-weight iron dextran in chronic kidney disease. J Ren Care. 2009;35:67–73.CrossRefPubMed Sinha S, Chiu DY, Peebles G, Kolakkat S, Lamerton E, Fenwick S, et al. Comparison of intravenous iron sucrose versus low-molecular-weight iron dextran in chronic kidney disease. J Ren Care. 2009;35:67–73.CrossRefPubMed
15.
go back to reference Bhandari S, Naudeer S. Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice. J Eval Clin Pract. 2008;14:996–1001.CrossRefPubMed Bhandari S, Naudeer S. Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice. J Eval Clin Pract. 2008;14:996–1001.CrossRefPubMed
16.
go back to reference Ayub R, Tariq N, Adil MM, Iqbal M, Junaid A, Jaferry T. Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy. J Coll Physicians Surg Pak. 2008;18:424–427.PubMed Ayub R, Tariq N, Adil MM, Iqbal M, Junaid A, Jaferry T. Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy. J Coll Physicians Surg Pak. 2008;18:424–427.PubMed
17.
go back to reference Mamula P, Piccoli DA, Peck SN, Markowitz JE, Baldassano RN. Total dose intravenous infusion of iron dextran for iron-deficiency anemia in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;34:286–290.CrossRefPubMed Mamula P, Piccoli DA, Peck SN, Markowitz JE, Baldassano RN. Total dose intravenous infusion of iron dextran for iron-deficiency anemia in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;34:286–290.CrossRefPubMed
18.
go back to reference Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;24:2–6.CrossRef Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;24:2–6.CrossRef
19.
go back to reference Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology. 1976;70:439–444.PubMed Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology. 1976;70:439–444.PubMed
20.
go back to reference Walmsley RS, Ayres RC, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43:29–32.PubMedCrossRef Walmsley RS, Ayres RC, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43:29–32.PubMedCrossRef
21.
go back to reference Ganzoni AM. Intravenous iron-dextran: therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301–303.PubMed Ganzoni AM. Intravenous iron-dextran: therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301–303.PubMed
22.
go back to reference Kulnigg S, Stoinov S, Simanenkov V, Dudar LV, Karnafel W, Garcia LC, et al. A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial. Am J Gastroenterol. 2008;103:1182–1192.CrossRefPubMed Kulnigg S, Stoinov S, Simanenkov V, Dudar LV, Karnafel W, Garcia LC, et al. A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial. Am J Gastroenterol. 2008;103:1182–1192.CrossRefPubMed
23.
go back to reference Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69:739–756.CrossRefPubMed Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69:739–756.CrossRefPubMed
24.
go back to reference Singh A, Patel T, Hertel J, Bernardo M, Kausz A, Brenner L. Safety of ferumoxytol in patients with anemia and CKD. Am J Kidney Dis. 2008;52:907–915.CrossRefPubMed Singh A, Patel T, Hertel J, Bernardo M, Kausz A, Brenner L. Safety of ferumoxytol in patients with anemia and CKD. Am J Kidney Dis. 2008;52:907–915.CrossRefPubMed
25.
go back to reference Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmén J. On the relative safety of parenteral iron formulations. Nephrol Dial Transplant. 2004;19:1571–1575.CrossRefPubMed Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmén J. On the relative safety of parenteral iron formulations. Nephrol Dial Transplant. 2004;19:1571–1575.CrossRefPubMed
26.
go back to reference Auerbach M, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007;369:1502–1504.CrossRefPubMed Auerbach M, Ballard H, Glaspy J. Clinical update: intravenous iron for anaemia. Lancet. 2007;369:1502–1504.CrossRefPubMed
27.
go back to reference D’Arienzo A, Manguso F, Astarita C, D’Armiento FP, Scarpa R, Gargano D, et al. Allergy and mucosal eosinophil infiltrate in ulcerative colitis. Scand J Gastroenterol. 2000;35:624–631.CrossRefPubMed D’Arienzo A, Manguso F, Astarita C, D’Armiento FP, Scarpa R, Gargano D, et al. Allergy and mucosal eosinophil infiltrate in ulcerative colitis. Scand J Gastroenterol. 2000;35:624–631.CrossRefPubMed
28.
go back to reference Engkilde K, Menné T, Johansen JD. Inflammatory bowel disease in relation to contact allergy: a patient-based study. Scand J Gastroenterol. 2007;42:572–576.CrossRefPubMed Engkilde K, Menné T, Johansen JD. Inflammatory bowel disease in relation to contact allergy: a patient-based study. Scand J Gastroenterol. 2007;42:572–576.CrossRefPubMed
29.
go back to reference Blaustein DA, Schwenk MH, Chattopadhyay J, Singh H, Daoui R, Gadh R, et al. The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease. Kidney Int Suppl. 2003;87:S72–S77.CrossRefPubMed Blaustein DA, Schwenk MH, Chattopadhyay J, Singh H, Daoui R, Gadh R, et al. The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease. Kidney Int Suppl. 2003;87:S72–S77.CrossRefPubMed
30.
go back to reference Hollands JM, Foote EF, Rodriguez A, Rothschild J, Young S. Safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease. Am J Health Syst Pharm. 2006;63:731–734.CrossRefPubMed Hollands JM, Foote EF, Rodriguez A, Rothschild J, Young S. Safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease. Am J Health Syst Pharm. 2006;63:731–734.CrossRefPubMed
31.
go back to reference Wall GC, Pauly RA. Evaluation of total-dose iron sucrose infusions in patients with iron deficiency anemia. Am J Health Syst Pharm. 2008;65:150–153.CrossRefPubMed Wall GC, Pauly RA. Evaluation of total-dose iron sucrose infusions in patients with iron deficiency anemia. Am J Health Syst Pharm. 2008;65:150–153.CrossRefPubMed
Metadata
Title
Safety and Efficacy of Total-Dose Infusion of Low Molecular Weight Iron Dextran for Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease
Authors
Ioannis E. Koutroubakis
Pantelis Oustamanolakis
Christos Karakoidas
Gerassimos J. Mantzaris
Elias A. Kouroumalis
Publication date
01-08-2010
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 8/2010
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-009-1022-y

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