Ferric maltol (iron 30mg) capsules

Ulcerative colitis and Crohn's disease, two types of inflammatory bowel disease (IBD), often cause anemia, primarily due to iron deficiency and chronic inflammation. Anemia negatively affects patients' daily functioning and quality of life, causing symptoms including headaches, exhaustion, and dyspnea. In IBD, iron deficiency arises from reduced intake, chronic blood loss, and impaired absorption. While oral iron supplements are commonly used, their poor absorption and gastrointestinal side effects limit their effectiveness, especially in IBD patients. The European Crohn's and Colitis Organization (ECCO) recommends intravenous iron, such as ferric carboxymaltose (FCM), as iron deficiency anemia in IBD can be managed using a safe and efficient substitute. With regard to treating iron deficiency anemia in patients with IBD, the purpose of this study is to investigate the safety and effectiveness of intravenous ferric carboxymaltose. We conducted a thorough search of medical databases, such as the Cochrane library, PubMed, and ResearchGate, to gather relevant literature. Using the databases, we found a total of 297 relevant articles. The identified studies have been screened, eligibility criteria have been introduced, and 14 research studies were selected for inclusion. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, with quality assessments conducted using the Cochrane risk of bias 2 scale for randomized tests and the Newcastle-Ottawa scale for observational examination. We reviewed 14 research articles involving 2,493 patients. Among these, five were randomized controlled trials (RCTs), and the remaining nine were observational studies. The primary outcomes assessed were the therapeutic response (defined as hemoglobin ≥2 g/dL rise or normalization, improvement in iron profile parameters) and any adverse effects after FCM is administered to IBD patients. FCM was found to be highly effective in improving hemoglobin and iron profile parameters, with a generally good safety profile. Ferric carboxymaltose was the most efficient and well-tolerated intravenous (IV) iron formulation, proving safer and more effective than other iron therapies in patients suffering from IBD. However, severe hypophosphatemia can lead to serious complications, including heart failure, pulmonary failure, rhabdomyolysis, fractures, and osteomalacia, which may worsen its long-term impact. Therefore, the risk of hypophosphatemia associated with prolonged FCM use requires careful monitoring and further research to ensure its long-term safety and assess its effects on patients' quality of life.

Abstract licence: CC BY

Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials.

Abstract licence: CC BY-NC

BackgroundIron deficiency anaemia (IDA) is common in inflammatory bowel disease (IBD) and impairs quality of life. Hepcidin, the regulator of systemic iron homeostasis, may predict response to iron therapy; however, its utility in IBD remains unclear. This study evaluated whether baseline hepcidin predicts response to oral and intravenous (IV) iron in active IBD to guide personalised treatment.MethodsNinety adults with active IBD and iron deficiency (with or without anaemia) from two randomised trials received IV iron, oral ferrous fumarate (FF) or oral ferric maltol (FM). Response at 12 weeks was defined as haemoglobin increase ≥ 1.2 mmol/L (19.3 g/L) or normalisation in IDA or ferritin > 100 μg/L and transferrin saturation > 20% in iron deficient patients. Baseline iron indices including ferritin, hepcidin, and soluble transferrin receptor (sTfR) were measured. Logistic regression and receiver operating curve analyses evaluated predictive performance.ResultsBaseline hepcidin strongly predicted response to iron therapy: AUC(FF): 0.86, 95% CI: 0.71-1.00 and AUC(IV): 0.63, 95% CI: 0.30-0.96. Hepcidin > 2.68 μg/mL identified non-responders to FF with 89% sensitivity and 77% specificity. Each twofold increase in baseline hepcidin or ferritin reduced the odds of response [log2(hepcidin) OR: 0.71, 95% CI: 0.56-0.89; log2(ferritin) OR: 0.38, 95% CI: 0.21-0.69]. Higher transferrin/log10(ferritin) (OR: 2.95, 95% CI: 1.38-6.30) and sTfR/log10(ferritin) ratios (OR: 1.29, 95% CI: 1.05-1.59) increased likelihood of response.ConclusionBaseline hepcidin supports route selection for iron therapy: higher levels favour IV iron, while lower levels indicate likely oral response. Ferritin-based indices, notably transferrin/log10(ferritin), offer pragmatic alternatives where hepcidin testing is unavailable.Trial registrationClinicalTrials.gov identifier: NCT05581420 and NCT05456932.

Abstract licence: CC BY