Systematic review with network meta-analysis: comparative efficacy and tolerability of different intravenous iron formulations for the treatment of iron deficiency anaemia in patients with inflammatory bowel disease.
BACKGROUND
Iron deficiency anaemia (IDA) is a common complication of inflammatory bowel disease (IBD) associated with reduced quality of life and increased hospitalisation rates. While the best way of treating IDA in IBD patients is not clearly established, current European guidelines recommend intravenous iron therapy in IBD patients with severe anaemia or intolerance to oral iron compounds.


OBJECTIVE
To compare the efficacy and tolerability of different intravenous iron formulations used to treat IDA in IBD patients in a systematic review and Bayesian network meta-analysis (NMA), PROSPERO registration number: 42016046565.


METHODS
In June 2016, we systematically searched for studies analysing efficacy and safety of intravenous iron for IDA therapy in IBD. Primary outcome was therapy response, defined as Hb normalisation or increase ≥2 g/dL.


RESULTS
Five randomised, controlled trials (n = 1143 patients) were included in a network meta-analysis. Only ferric carboxymaltose was significantly more effective than oral iron [OR=1.9, 95% CrI: (1.1;3.2)]. Rank probabilities showed ferric carboxymaltose to be most effective, followed by iron sucrose, iron isomaltose and oral iron. Pooled data from the systematic review (n = 1746 patients) revealed adverse event rates of 12.0%, 15.3%, 12.0%, 17.0% for ferric carboxymaltose, iron sucrose, iron dextran and iron isomaltose respectively. One drug-related serious adverse event (SAE) each was reported for ferric carboxymaltose and iron isomaltoside, and one possibly drug-related SAE for iron sucrose.


CONCLUSIONS
Ferric carboxymaltose was the most effective intravenous iron formulation, followed by iron sucrose. In addition, ferric carboxymaltose tended to be better tolerated. Thus, nanocolloidal IV iron products exhibit differing therapeutic and safety characteristics and are not interchangeable.
Hacettepe University, Faculty of Health Sciences, Ankara, Turkey.|Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.
A
http://orcid.org/0000-0003-2819-3484
A
Aksan
Hacettepe University, Faculty of Sciences, Ankara, Turkey.
H
H
Işık
Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.|Pharmazentrum frankfurt, Institute of Pharmacology and Toxicology, Hospital of the Goethe University, Frankfurt/Main, Germany.
H H
http://orcid.org/0000-0002-4499-2510
HH
Radeke
Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.|Agaplesion Markus Krankenhaus, Department of Gastroenterology, Frankfurt/Main, Germany.
A
http://orcid.org/0000-0002-9724-054X
A
Dignass
Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.|DGD Clinics Sachsenhausen, Department of Gastroenterology and Clinical Nutrition, Frankfurt/Main, Germany.
J
http://orcid.org/0000-0003-3558-3341
J
Stein
D061605:Administration, Intravenous; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology; D004339:Drug Compounding; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D007501:Iron / Q000008:administration & dosage*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D007501:Iron