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Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD), with iron deficiency and inflammation being the main causes
.
IBD-associated anemia (iron deficiency and anemia of chronic disease) is associated with
impaired physical and cognitive function, increased hospitalization, and reduced quality of life.
The European Crohn's Disease and Colitis Organization (ECCO) recommends high-dose intravenous iron as first-line treatment for iron deficiency anaemia (IDA) in IBD patients, as the bioavailability and efficacy of oral iron are limited
in patients with inflammation.
Iron isomaltose (FDI; Formerly known as iron isomaltoside) and iron carboxymaltose (FCM), they are the most widely used intravenous iron agents in Europe
.
Hypophosphatemia is increasingly recognized as an important side effect
of some intravenous iron preparations.
Hypophosphatemia due to intravenous iron infusion most commonly occurs in the first 2 weeks after infusion and can be mild and asymptomatic, but in some cases can be severe, symptomatic, persistent, and associated with alterations in mineral and bone metabolism that ultimately lead to osteomalacia and fractures
.
To compare the incidence
of hypophosphatemia after treatment with ferric carboxymaltose (FCM) or ferric isomaltose (FDI).
This randomized, double-blind clinical trial was conducted in 20 outpatient hospitals in
Europe.
The researchers randomized adults with IBD and iron deficiency anemia (IDA) to receive FCM or FDI in a 1:1 ratio at baseline and day 35, followed by the same hemoglobin and weight-based dosing regimen
.
The primary outcome to be observed was the incidence of hypophosphatemia (serum phosphate <2.
0 mg/dL) at any time from baseline to day 35 in safety analysis (all patients receiving ≥1 dose of study drug
).
Markers of mineral and bone homeostasis, as well as patient-reported fatigue scores
, were measured.
A total of 156 patients were screened in this study; Ninety-seven (49 FDI, 48 FCM) were included in the analysis
.
The results showed hypophosphatemia (HR: -42.
8% (95% CI –57.
1% to –24.
6%) p< 0.
0001) in 8.
3% (4/48) of patients treated with FDI and 51.
0% (25/49) of patients treated with FCM
.
Both iron preparations correct IDA
.
Patient-reported fatigue scores improved in both groups, but FCM was slower and less severe than FDI; Slower improvement in fatigue is associated with
a greater decrease in phosphate concentration.
This study confirms that the incidence of hypophosphatemia due to FCM is significantly higher than that of FDI,
despite the comparable therapeutic efficacy of IDA.
Further research is needed to support the mechanisms
by which FCM and FDI differ in their effects on patient-reported fatigue.
Original source:
Heinz Zoller.
et al.
Hypophosphataemia following ferric derisomaltose and ferric carboxymaltose in patients with iron deficiency anaemia due to inflammatory bowel disease (PHOSPHARE-IBD): a randomised clinical trial.
GUT.
2022.