Intravenous iron in inflammatory bowel disease

Table 1 Some characteristics of the different intravenous iron formulations

	Iron gluconate	Iron sucrose	Iron dextran (LMWID)	Ferric carboxymaltose
Complex type	Type III	Type II	Type I	Type I
	Labile and weak	Semi-robust and moderately strong	Robust and strong	Robust and strong
Molecular weight (kDa)	38	43	73	150
Initial distribution volume (L)	6	3.4	3.5	3.5
Plasma half-life (h)	1	6	30	16
Labile iron release	+++	±1	-	-
Direct iron donation to transferrin (% injected dose)	5-6	4-5	1-2	1-2
Test dose required	No	Yes/No3	Yes	No
Maximal single dose (mg)	125	300	TDI	1000
Premedication	No	No	TDI only	No
Life-threatening ADE2 (× 106 doses)	0.9	0.6	11.3	??
Death rate (× 106 doses)2	0.25	0.11	0.78	??

¹If the infusion speed > 4 mg Fe³⁺/min or dose > 7 mg Fe³⁺/kg;

²Data from patients with chronic kidney disease;

³Not required at USA and UK. ADE: Adverse drug events; LMWID: Low molecular weight iron dextran; TDI: Total dose infusion.

Table 2 Characteristics of the clinical trials involving IBD patients that compared IV iron administration with oral iron or no intervention included in this review

Study (yr)	n	Study design	Compound	Baseline Hb(g/dL)	Total dose, mg (schedule)	Duration (wk)	Response (%)	DCT (%)
Gasche et al[31] (2001)	103	Multicentre, open-label	Iron sucrose	≤ 10.5	1200 mg (6 × 200 mg)	4	65	0
Bodemar et al[32] (2004)	59	Retrospective	Iron sucrose	< 12	Mean 1400 mg (1-2 × 200 mg/wk)	8	60	0
						12	91
Schröder et al[14] (2005)	46	Multicentre randomized open-label	Iron sucrose (22)	< 10.5 (F)	Mean 1418 mg (7 mg/kg + 5 × 200 mg)	6	55	4.5
			Ferrous sulfate (24)	< 11 (M)	Mean 5600 mg (100-200 mg/d)		53	20.8
García-López et al[35] (2006)	70	Single centre prospective observational	Iron sucrose	< 10.51	Mean 920 mg (200-1800 mg) (200 mg/1-3 times a week)	Mean 5 (1-9 )	67	0
Kulnigg et al[37] (2008)	200	Multicentre randomized open-label	Ferric carboxymaltose (137)	≤ 10	1000-1500 mg (1-2 infusion of 500-1000 mg)	12	77	1.5
			Ferrous sulfate (63)		16 800 mg (200 mg/d)		68	7.9
Lindgren et al[33] (2009)	91	Multicentre randomized investigator-blinded	Iron sucrose (45)	< 11.5	Mean 1700 mg (200 mg/1-2 wk)	20	66	7
			Ferrous sulfate (46)		Mean 38 400 mg (200-400 mg/d)		47	22
Gisbert et al[34] (2009)	100	Multicentre, open-label	Iron sucrose (22)	< 10	Not reported (2 × 200 mg/wk if Hb < 10)	26	77	0
			Ferrous sulfate (78)	> 10	19 000 mg (106 mg/d)		89	5.1

¹Also no response or intolerance to oral iron or clinical need of quick recovery of anemia. ΔHb ≥ 2 g/dL or normal Hb; DCT: Discontinuation due to serious adverse events; F: Female; M: Male.