Ferric carboxymaltose preferred over other iron compounds for IDA in IBD
Ferric carboxymaltose (FCM) remains the most effective intravenous (IV) iron formulation as monotherapy followed by iron sucrose/saccharate (IS) and presented a better safety profile with fewer adverse events (AEs) in patients with inflammatory bowel disease (IBD) with iron deficiency anaemia (IDA), according to an updated meta-analysis presented at AIBD 2018.
In this updated review comprising studies evaluating FCM (n=798), IS (n=508), iron isomaltoside (ISM, n=423), and iron dextran (IDX, n=78), FCM had the highest overall response rate (78 percent), followed by IS (68 percent), ISM (63 percent), and IDX (42 percent). [AIBD 2018, abstract p043]
Moreover, only FCM was more effective when compared against oral iron (odds ratio [OR], 1.9, 95 percent credible interval [CrI], 1.1–3.2).
All IV iron formulations were reported to be well tolerated with low rates of AEs (7.9, 12.0, 15.3, and 12.7 percent for FCM, IDX, IS, and ISM, respectively) and serious AEs (0.1, 0.0, 0.2, and 1.2 percent, respectively).
“[While the findings appear robust and more] studies are unlikely to overturn this result, further studies are needed to improve the level of evidence available to establish the comparative efficacy of different IV iron compounds in IBD patients with IDA,” said the researchers, underscoring the high prevalence rate of IDA in IBD (up to 74 percent) and the associated decline in patients’ quality of life and increased hospitalization rates.
Another meta-analysis comprising 25 studies (four randomized trials and 21 systematic reviews) corroborated the above findings in terms of safety, demonstrating that FCM was associated with lower overall AE rates compared with other iron formulations (8.1 percent vs 16.2, 18.7, and 12.0 percent for FCM vs IS, ISM, and IDX, respectively). Drug-related SAE rates were 0.1, 2.2, 1.1, and 0.0 percent, respectively. [AIBD 2018, abstract p044]
However, despite the numerically low AE rates, its statistical significance remains unproven due to the insufficient data from the randomized trials, the researchers pointed out, hence the need for a more comprehensive investigation to ascertain the comparative safety of various IV iron compounds.
“International guidelines recommend IV administration of iron in IBD patients … [as it facilitates] rapid correction of haemoglobin levels and repletion of body iron stores,” said the researchers. Moreover, previous evidence has shown the limited efficacy of oral iron formulations in IBD due to gastrointestinal side effects and poor compliance, [Aliment Pharmacol Ther 2017; 45: 1303-1318] hence the importance of establishing the safety of IV iron formulations, they added.