title: Oral Iron Treatment Response and Predictors in Anaemic Adolescents and Adults with IBD: A Prospective Controlled Open-Label Trial.
abstract: BACKGROUND
  Because of previous concerns about the efficacy and safety of oral iron for treating iron deficiency anaemia in inflammatory bowel disease [IBD], particularly in young people, we compared the effects of ferrous sulphate on haemoglobin response, disease activity and psychometric scores in adolescents and adults with IBD. We also assessed the relation of baseline serum hepcidin to haemoglobin response.
  
  
  METHODS
  We undertook a prospective, open-label, 6-week non-inferiority trial of the effects of ferrous sulphate 200 mg twice daily on haemoglobin, iron status, hepcidin, disease activity (Harvey-Bradshaw Index, Simple Colitis Clinical Activity Index, C-reactive protein [CRP]), faecal calprotectin and psychometric scores in 45 adolescents [age 13-18 years] and 43 adults [>18 years].
  
  
  RESULTS
  On intention-to-treat analysis, ferrous sulphate produced similar rises in haemoglobin in adolescents {before treatment 10.3 g/dl [0.18] (mean [SEM]), after 11.7 [0.23]: p < 0.0001} and adults (10.9 g/dl [0.14], 11.9 [0.19]: p < 0.0001); transferrin saturation, ferritin [in adolescents] and hepcidin [in adults] also increased significantly. On per-protocol univariate analysis, the haemoglobin response was inversely related to baseline haemoglobin, CRP and hepcidin. Oral iron did not alter disease activity; it improved Short IBDQ and Perceived Stress Questionnaire scores in adults.
  
  
  CONCLUSIONS
  Oral ferrous sulphate was no less effective or well-tolerated in adolescents than adults, and did not increase disease activity in this short-term study. The inverse relation between baseline CRP and hepcidin levels and the haemoglobin response suggests that CRP or hepcidin measurements could influence decisions on whether iron should be given orally or intravenously. [ClinTrials.gov registration number NCT01991314].
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Rampton
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: James R
authors.initials: JR
authors.lastname: Goodhand
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: Neerav M
authors.initials: NM
authors.lastname: Joshi
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: Abu-Bakarr
authors.initials: AB
authors.lastname: Karim
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Koodun
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: Farah M
authors.initials: FM
authors.lastname: Barakat
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: Lucia
authors.initials: L
authors.lastname: Macken
authors.affiliation: Department of Gastroenterology, University Hospital Birmingham, Birmingham, UK.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Ward
authors.affiliation: Department of Gastroenterology, University Hospital Birmingham, Birmingham, UK.
authors.forename: Tariq H
authors.initials: TH
authors.lastname: Iqbal
authors.affiliation: Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Epstein
authors.affiliation: Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK.
authors.forename: John M
authors.initials: JM
authors.lastname: Fell
authors.affiliation: Centre for Immunobiology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London,UK.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Sanderson
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D005243:Feces / Q000737:chemistry; D005260:Female; D005293:Ferritins / Q000097:blood; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D064451:Hepcidins / Q000097:blood; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D057194:Intention to Treat Analysis; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014168:Transferrin / Q000378:metabolism
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; D064451:Hepcidins; D039841:Leukocyte L1 Antigen Complex; D014168:Transferrin; C020748:ferrous sulfate; D005293:Ferritins
keywords: hepcidin; inflammatory bowel disease; iron deficiency anaemia