Rapid Recurrence of IBD-Associated Anemia and Iron Deficiency After Intravenous Iron Sucrose and Erythropoietin Treatment

OBJECTIVES: Anemia is a common complication of inflammatory bowel disease (IBD) and iron deficiency (ID) is its predominant cause. Therefore, oral and intravenous iron replacements are widely used. This study was performed to evaluate the frequency and timing of anemia and ID recurrence after a successful treatment cycle. METHODS: Medical records of patients who had received iron sucrose with or without erythropoietin (EPO) in one of three prospective clinical trials that had been conducted at our center (Ann Intern Med 1997, Digestion 1999, and Am J Gastroenterol 2001) were analyzed for a 5-year follow-up period. The risk for recurrence of anemia (hemoglobin (Hb) <12/13 g per 100 ml) and ID (ferritin <30 mu g/l) was evaluated by Kaplan-Meier analysis using the log-rank test. RESULTS: Eighty-eight patients were available for analysis. Patients had received a mean iron dose of 2,500 mg (range 600-3,600 mg); 33 (37.1%) patients had also received EPO. Anemia recurred in a median of 10 months (95% confidence interval (CI) 8-12) and ID recurred within 19 months (95% CI 11-28). The iron dose had no influence on recurrence of ID or anemia. ID (but not anemia) recurred faster in patients with a post-treatment ferritin level <100 mu g/l (median 4 months, 95% CI 1-7) than in patients with ferritin level between 100 and 400 mu g/l (median 11 months, 95% CI 6-16) and >400 mu g/l (median 49 months, 95% CI 32-66; P<0.001). CONCLUSIONS: IBD-associated ID and anemia recur surprisingly fast, indicating that maintenance treatment may be needed in a portion of the patient population. Recurrence of ID (but not anemia) can be delayed by aiming for high post-treatment ferritin levels.