Photo Credit: Mitrija
Iron deficiency anemia is common in patients with Crohn’s disease and ulcerative colitis, but iron supplementation also could be an effective treatment.
Iron therapy was linked with reduced disease progression and lower healthcare costs for patients with IBD, according to findings published in the European Journal of Gastroenterology & Hepatology.
“Anemia is a high-incidence manifestation of IBD,” Gionata Fiorino, MD, PhD, and colleagues wrote. “About one-third of patients with IBD present with hemoglobin levels below the threshold of 12 g/dl in females and 13 g/dl in males.”
IBD is believed to cause iron deficiency anemia in people with Crohn’s disease and ulcerative colitis due to chronic blood loss through a person’s stool and reduced iron absorption because of inflammation and reduced iron intake.
Among patients with IBD, the most common cause of anemia is iron deficiency, Dr. Fiorino and colleagues note. Iron deficiency anemia (IDA) subsequent to IBD is associated with decreased QOL, higher work absenteeism, an increased frequency of hospitalization, and higher healthcare costs. “Thus, there is a clear need to support [patients with IDA] with pharmacological treatments, to improve their quality of life and physical condition, and alleviate fatigue and cognitive deficits.”
Treatment with iron supplementation is common for patients with IBD and iron-deficiency anemia.
However, the researchers noted that “very limited data on the effect of iron therapy in IBD disease progression and healthcare resource consumption have been collected from real-world clinical practice.”
To examine iron supplementation’s potential impact on disease progression, healthcare resource consumption, and healthcare costs, Fiorino and colleagues performed a retrospective observational study of patients with ulcerative colitis and/or Crohn’s disease. They gathered data on 1,753 patients from the administrative databases of various Italian national healthcare agencies, 1,077 (61.4%) of whom were treated with iron therapy and 676 (38.6%) were not.
The researchers identified iron-deficiency anemia in patient records with at least one prescription for iron therapy, and/or records of hospitalization for iron-deficiency anemia, and/or blood transfusion. They identified disease progression by the occurrence of IBD-related hospitalizations and/or surgeries and examined patients’ consumption of healthcare resources.
Iron Therapy Beneficial for Anemia
According to Dr. Fiorino and colleagues, patients who received iron therapy experienced significantly less disease progression, with 11% seeing their illness progress, compared with 15.7% of those who were not treated (P<0.01). These patients were also reported to be hospitalized at a lower rate than those who were untreated: 10.5% for the treated group and 14.3% in the untreated group (P<0.05).
Those who were treated with iron therapy also had lower healthcare costs than those who did not, Dr. Fiorino and colleagues reported (P<0.01).
“The present real-world data analysis has shown for the first time that iron therapy supplementation in anemic IBD patients could be associated with beneficial effects in terms of IBD disease progression and healthcare resource utilization restraining in the Italian clinical setting,” Dr. Fiorino and colleagues write. “In addition, the high quote of undertreated anemic patients found among the real clinical practice suggests that there is still an unmet need among IBD patients for treatment optimization.”
Addressing Unmet Needs in Crohn’s & Colitis
Abhik Bhattacharya, MD, who was not involved in the current study, notes that the research from Dr. Fiorino and colleagues is insightful because of its large sample size and emphasis on healthcare costs. In particular, he said, while oral supplementation might seem like the obvious low-cost choice, patients living with IBD often cannot absorb iron taken by mouth.
“One of the things that we use for iron repletion is an IV iron, but each infusion costs up to $1,000,” Bhattacharya explains. “You probably need three to five infusions, depending on your levels, so you’re looking at $3,000 to $5,000 per patient for as long as the iron infusion is necessary. That’s a huge amount of money that’s being utilized for these patients. It’s a big burden on the healthcare system.”
Although Dr. Bhattacharya notes that he is lucky to work at a large academic institution with its own bowel disease clinic, he says a well-coordinated interdisciplinary care team would be necessary at smaller centers. “You have to coordinate with hematology and oncology and ensure that patients are given the right infusion.”
Iron deficiency and anemia are useful biomarkers of disease activity even in patients who are not experiencing symptoms, according to Dr. Bhattacharya.
“Let’s say you have a patient who has been asymptomatic for a year or a year and a half,” he says. In the beginning, their hemoglobin and iron stores were fine, and suddenly, you start seeing their iron stores go down even though they are not experiencing symptoms. In these cases, it can raise concern that their IBD is becoming active.”
