Ferric carboxymaltose for anemia in Crohn's disease patients at a tertiary center: A retrospective observational cohort study

Natália Souza Nunes Siqueira; Livia Bitencourt Pascoal; Bruno Lima Rodrigues; Marina Moreira de Castro; Alan Sidnei Corrêa Martins; Dante Orsetti Silva Araújo; Luis Eduardo Miani Gomes; Michel Gardere Camargo; Maria de Lourdes Setsuko Ayrizono; Raquel Franco Leal

doi:10.12998/wjcc.v11.i12.2740

Ferric carboxymaltose for anemia in Crohn's disease patients at a tertiary center: A retrospective observational cohort study

World J Clin Cases. 2023 Apr 26;11(12):2740-2752. doi: 10.12998/wjcc.v11.i12.2740.

Affiliations

¹ Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil.
² Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil. rafranco.unicamp@gmail.com.

Abstract

Background: Although the gastrointestinal tract is the most affected by Crohn's disease (CD), the condition triggers other consequent manifestations, and iron deficiency anemia (IDA) is one of the most common. Intravenous (IV) iron replacement is currently available through several drugs, such as ferric hydroxide sucrose and ferric carboxymaltose (FCM). However, the clinical management of these conditions can be challenging.

Aim: To elucidate the drug's effectiveness, the present study analyzed, through medical records, the clinical and epidemiological data of a cohort of patients with active CD who received IV FCM for the IDA treatment.

Methods: This retrospective observational study included 25 patients with active CD, severe anemia, and refractory to previous conventional treatments. Patients were evaluated two times: During the last treatment with ferric hydroxide sucrose and treatment with FCM.

Results: After treatment with FCM, parameters of IDA assessment significantly improved, serum hemoglobin (Hb) levels increased in 93% of patients (P < 0.0001), and in 44%, there was an increase of ≥ 2 g/dL in a single application. In addition, 86% of the patients showed an increase in serum iron (P < 0.0001) and ferritin (P = 0.0008) and 50% in transferrin saturation (P = 0.01). The serum iron levels at baseline showed a negative association with the ileal and colonic CD and use of biologics and a positive association with patients who developed CD later in life after the age of 40 (A3) and with a stenosing (B2) and fistulizing (B3) phenotype. The values of Hb and hematocrit after ferric hydroxide sucrose treatment remained similar to those found before treatment.

Conclusion: This study demonstrated that FCM is an important therapeutic strategy for treating IDA in CD patients, achieving satisfactory results in refractory cases.

Keywords: Anemia; Clinical management; Crohn’s disease; Ferric carboxymaltose; Inflammatory bowel disease; Iron deficiency anemia.