Siqueira Natália Souza Nunes, Pascoal Livia Bitencourt, Rodrigues Bruno Lima, de Castro Marina Moreira, Martins Alan Sidnei Corrêa, Araújo Dante Orsetti Silva, Gomes Luis Eduardo Miani, Camargo Michel Gardere, Ayrizono Maria de Lourdes Setsuko, Leal Raquel Franco
Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil.
World J Clin Cases. 2023 Apr 26;11(12):2740-2752. doi: 10.12998/wjcc.v11.i12.2740.
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.
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.
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.
After treatment with FCM, parameters of IDA assessment significantly improved, serum hemoglobin (Hb) levels increased in 93% of patients ( < 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 ( < 0.0001) and ferritin ( = 0.0008) and 50% in transferrin saturation ( = 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.
This study demonstrated that FCM is an important therapeutic strategy for treating IDA in CD patients, achieving satisfactory results in refractory cases.
尽管胃肠道是受克罗恩病（CD）影响最严重的部位，但该疾病会引发其他后续表现，缺铁性贫血（IDA）是最常见的表现之一。目前可通过多种药物进行静脉铁剂补充，如氢氧化铁蔗糖和羧麦芽糖铁（FCM）。然而，这些疾病的临床管理可能具有挑战性。
为阐明药物的有效性，本研究通过病历分析了一组接受静脉注射FCM治疗IDA的活动性CD患者的临床和流行病学数据。
这项回顾性观察性研究纳入了25例活动性CD、严重贫血且对先前常规治疗无效的患者。对患者进行了两次评估：在最后一次使用氢氧化铁蔗糖治疗期间以及使用FCM治疗期间。
使用FCM治疗后，IDA评估参数显著改善，93%的患者血清血红蛋白（Hb）水平升高（<0.0001），44%的患者单次应用后升高≥2 g/dL。此外，86%的患者血清铁（<0.0001）和铁蛋白（=0.0008）升高，50%的患者转铁蛋白饱和度升高（=0.01）。基线血清铁水平与回肠和结肠CD以及生物制剂的使用呈负相关，与40岁以后（A3）晚发型CD患者以及狭窄（B2）和瘘管形成（B3）表型呈正相关。氢氧化铁蔗糖治疗后的Hb和血细胞比容值与治疗前相似。
本研究表明，FCM是治疗CD患者IDA 的重要治疗策略，在难治性病例中取得了满意的结果。
