P352 Occurrence of moderate to severe anaemia and utilization and efficacy of intravenous iron therapies in a nationwide cohort of Inflammatory Bowel Disease patients
Khan, N.(1,2)*;Patel, M.(1);Sundararajan, R.(1);
(1)Corporal Michael J Crescenz VA Medical Center, Gastroenterology, Philadelphia, United States;(2)University of Pennsylvania- Perelman School of Medicine, Gastroenterology, Philadelphia, United States;
Background
Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD), and iron deficiency is the leading cause of IBD-associated anaemia. It is associated with impaired physical and cognitive functioning, increased hospitalization rates, and reduced quality of life. With the advent of newer formulations of intravenous (IV) iron the management of anaemia has undergone a transformation. Our aim was to evaluate the percentage of patients with IBD who developed moderate to severe anaemia over the course of their disease as they are the subset who would benefit most from IV iron. We also evaluated the utilization and efficacy of IV iron therapies among this group of patients in a real-world setting.
Methods
We conducted a retrospective cohort study utilizing the Veteran Affairs Healthcare System (VAHS) to identify patients who had IBD and were followed in the VAHS. IBD patients who had moderate to severe anaemia over the course of their disease based on WHO criteria (Hemoglobin level: <10g/dl) were included in this study. Among this group of patients with moderate to severe anaemia, we determined how many patients were treated with different IV iron formulations (ferric carboxymaltose, ferumoxytol, iron dextran, iron sucrose and sodium ferric gluconate). From this set of patients treated with IV iron formulations, improvement of Hb levels post therapy defined as achieving a Hb ≥12 g/dl, was ascertained.
Results
A total of 71,137 patients diagnosed with IBD were identified in the VAHS. Of this group 65, 599 (92.22%) were male. Over the course of their disease the majority were treated with mesalamine (92%) followed by biologics (35%) and thiopurines (25%). Among this group, 21,159 (29.74%) patients developed moderate to severe anaemia over the course of their follow up. Among patients with moderate to severe anaemia, 3,533 (16.7 %) patients received IV iron therapies for the management of their anaemia. 1,132 (32%) of these patients achieved a Hb level ≥12 g/dl post IV iron therapy.
Conclusion
Almost a third of IBD patients develop moderate to severe anaemia over the course of their disease. Less than a fifth of these patients were treated with IV iron, and among those treated, about a third achieved a Hb level ≥ 12g/dl. Our findings suggest that in the real-world setting, moderate to severe anaemia despite being prevalent is not managed aggressively and efforts should be made to rectify this situation as anaemia has a profound effect on multiple aspects of a patient’s life.