The following article is a part of conference coverage from the 2019 Advances in Inflammatory Bowel Diseases (AIBD) Meeting, being held in Orlando, Florida. The team at MPR will be reporting on the latest news and research conducted by leading experts gastroenterology. Check back for more from the 2019 AIBD Meeting.
The safety profiles of various intravenous (IV) iron products were compared in a study involving patients with inflammatory bowel disease (IBD) being treated for iron deficiency anemia. Findings from this review were presented at the AIBD 2019 Annual Meeting in Orlando, FL.
To investigate the safety of different IV iron preparations, study authors searched PubMed, SCOPUS, Web of Science and the Cochrane Library for randomized controlled trials (RCTs) up to July 2019. A total of 8086 publications were identified, of which 171 were relevant full-text articles on IBD. Study authors identified 5 eligible RCTs (N=1143) that focused on 3 different IV iron products (ferric carboxymaltose [FCM]; iron sucrose [IS]; iron isomaltoside [IIM]) and oral iron. The primary outcome measure was the pooled total of drug-related adverse events (AEs) and serious adverse events (SAEs) in proportion to the safety population. The secondary outcome measure was identification of the most common AEs. A Bayesian network meta-analysis was performed using a fixed effects model.
Results showed that there were no statistically significant differences between the different IV iron products and oral iron.
- Compared with oral iron: Odds ratio (OR) 0.69, 95% CrI [0.29; 1.7] for FCM; OR 0.52, 95% CrI [0.22; 1.2] for IS; OR 1.5, 95% CrI [0.80; 3.1] for IIM
- Compared with FCM: OR 0.74, 95% CrI [0.45; 1.2] for IS; OR 2.2, 95% CrI [0.74; 6.7] for IIM; OR 1.4, 95% CrI [0.60; 3.4] for oral iron
- Compared with IS: OR 1.3, 95% CrI [0.82; 2.2] for FCM; OR 3.0, 95% CrI [1.0; 9.1] for IIM; OR 1.9, 95% CrI [0.80; 4.6] for oral iron
- Compared with IIM: OR 0.45, 95% CrI [0.15; 1.3] for FCM, OR 0.33, 95% CrI [0.11; 1.0] for IS; OR 0.65, 95% CrI [0.32; 1.3] for oral iron
The most common AEs reported were headache and transient hyperferritinemia for FCM; headache, hyperferritinemia and rigors for IS; flushing, hypersensitivity and increased hepatic enzymes for IIM; and diarrhea and abdominal pain for oral iron. “Hyperphosphatemia, a much-debated complication of IV iron treatment, was reported in only 1 RCT of FCM, in this case transient and clinically asymptomatic,” the authors reported. With regard to ferumoxytol and iron dextran, no eligible RCTs were identified for the analysis.
Based on their findings, the study authors concluded that, “while FCM, IS and IIM are all safe, they have differing safety characteristics which should be borne in mind when choosing suitable therapy options.”
Aksan A, Işık H, Tuğal D, et al. Safety Profiles of Different Intravenous Iron Preparations for Therapy of Iron Deficiency Anemia: Preliminary Results From the IBD Subgroup Analysis. Presented at: 2019 AIBD Annual Meeting; December 12-14 in Orlando, FL.