IV ferric carboxymaltose superior to ferrous fumarate for Improving anemia in children with IBD

In a research including anemic children with inflammatory bowel disease (IBD), an intravenous (IV) dosage of ferric carboxymaltose was quicker to enhance physical fitness than an oral dose of ferrous fumarate, says an article published in The Journal of Pediatrics.

A common extra-intestinal symptom of inflammatory bowel disease in individuals is anemia. Children have a greater frequency than adults (respectively 70% and 35%). International treatment recommendations advise using oral iron supplements to treat individuals with mild anemia and illness remission and saving intravenous iron for patients with severe anemia or active disease. Therefore, the purpose of this study was to compare the effectiveness of oral vs intravenous iron supplementation in enhancing physical fitness in anemic adolescents with inflammatory bowel disease.

At eleven locations, researchers conducted a clinical experiment. A single IV dose of ferric carboxymaltose or 12 weeks of oral ferrous fumarate were randomly allocated to children aged 8 to 18 with IBD and anemia (defined as hemoglobin (Hb) z-score -2). The primary outcome, measured as a z-score, was the variation in 6-minute walking distance (6MWD) from baseline. A shift in Hb z-score from the starting point was a secondary result.

The key findings of this study were as follows:

64 patients were randomly assigned, with 33 receiving IV iron and 31 receiving oral iron.

Patients in the IV group's 6MWD z-score had increased by 0.71 compared to -0.11 in the oral group a month after the commencement of iron therapy (P=0.01), however this difference was not statistically significant.

There were no discernible variations in 6MWD z-scores at the 3- and 6-month follow-ups.

At 1, 3, and 6 months after starting iron treatment, Hb z-scores steadily increased in both groups, with no difference in the rate of rise between groups (overall P=0.97).

In conclusion, no differences between oral and IV treatment were seen at 3 and 6 months following the start of the therapy. In both therapy groups, the rate of Hb augmentation over time was comparable.

Reference: 

Bevers, N., Van de Vijver, E., Aliu, A., Ardabili, A. R., Rosias, P., Stapelbroek, J., Maartens, I. A. B., van de Feen, C., Escher, J. C., Oudshoorn, A., Teklenburg, S., Velde, S. V., Winkens, B., Raijmakers, M., Vreugdenhil, A., Pierik, M. J., & van Rheenen, P. F. (2022). Ferric carboxymaltose versus ferrous fumarate in anemic children with inflammatory bowel disease: the POPEYE randomized controlled clinical trial. In The Journal of Pediatrics. Elsevier BV. https://doi.org/10.1016/j.jpeds.2022.12.016