Iron Deficiency Anemia has negative impact on disease progression in IBD

A recent study revealed that a co-diagnosis of iron deficiency anemia in inflammatory bowel disease patients worsened the disease by increasing the progression in turn leading to increased admission to hospitals thus causing a burden on the health care system. The study was published in the journal Therapeutic Advances in Gastroenterology. 

Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory disorders of the gastrointestinal tract characterized by recurrent bouts of inflammation. A frequent extraintestinal symptom of inflammatory bowel disease (IBD) is iron deficiency anemia (IDA) affecting around one-third of patients. Literature has shown that the majority of patients with IBD patients have IDA which may sometimes go undiagnosed and undertreated leading to further complications. Hence researchers conducted a study to compare IBD progression and healthcare resource utilization in patients with and without a co-diagnosis of IDA in a real-world setting between January 2010 and September 2017. 

A retrospective comparative study was carried out on adult IBD patients diagnosed with ulcerative colitis and/or Crohn’s disease using Italian entities’ administrative databases, covering 9.3 million health-assisted individuals. Within 12 months from IBD diagnosis, IDA was identified by at least one prescription for iron and/or IDA hospitalization and/or blood transfusion (proxy of diagnosis). Based on the presence/absence of IDA, the IBD population was divided. Propensity score matching (PSM) was applied to wane off potential unbalances between the groups owing to the nonrandom patients’ allocation. Before and after PSM, IBD progression (in terms of IBD-related hospitalizations and surgeries), and healthcare resource costs were assessed. 

Findings: 

• Overall, 13,475 IBD patients were included, with an average age at diagnosis of 49.9 years, and a 53.9% percentage of male gender.
• Before PSM, 1753 (13%) patients were IBD–IDA, and 11,722 (87%) were IBD–non-IDA.
• Post-PSM, 1753 IBD–IDA patients were matched with 3506 IBD–non-IDA.
• IBD progression was significantly higher in IBD–IDA (12.8%) than in IBD–non-IDA (6.5%) before PSM.
• After PSM, IBD progression and IBD-related hospitalizations were significantly more frequent in IBD–IDA patients (12.8% and 12.0%, respectively) compared to IBD–non-IDA (8.7% and 7.7%).
• There was a consistent and significant increase in healthcare expenditures among IDA patients, with an overall mean annual cost of €5317 compared to €2798 for patients without IDA.
• PSM matching confirmed similar results as the mean annual total cost/patient in IBD–IDA versus IBD–non-IDA were €3693 and €3046, respectively.  

Thus, according to real-world data, a co-diagnosis of IDA in IBD patients appears to be linked to a greater risk of disease progression and higher hospitalization rates, resulting in a significant burden in terms of healthcare use and associated expenditures.

Further reading: Fiorino G, Colombel JF, Katsanos K, et al. Iron deficiency anemia impacts disease progression and healthcare resource consumption in patients with inflammatory bowel disease: a real-world evidence study. Therap Adv Gastroenterol. 2023;16:17562848231177153. Published 2023 May 30. doi: 10.1177/17562848231177153