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Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

ABSTRACT: A number of controlled trials and prospective studies have compared intravenous (IV) to oral (PO) iron for the treatment of iron deficiency anemia with mixed results.We conducted a systematic review of trials published on 2014 that compared IV with PO iron to treat in patients with IBD. Meta-analysis was performed to generate effect estimates. Quality assessment was also performed according to GRADE criteria.Five studies met our inclusion criteria, enrolling 694 patients. For the primary outcome of "response" (hemoglobin rise >2 g/dL), there was no significant difference between IV or PO iron; risk ratio for response with IV was 1.08 (95% CI, 0.9-1.2; P = 0.2). For the secondary outcome of mean change in hemoglobin (g/dL), the mean difference between PO and IV iron was not statistically significant (mean difference, 0.6 g/dL, 96% CI, -0.1 to 1.3; P = 0.08). IV iron was associated with a significantly greater initial rise in serum ferritin compared with PO iron (mean difference 89 ng/mL; 95% CI, 29-148, P = 0.003). There was a lower risk of withdrawal due to adverse events in these trials in the IV iron cohorts when compared with PO iron (risk ratio, 0.4; 95% CI, 0.1-1.0; P = 0.05).We found no significant difference between IV and PO iron in correcting iron-deficiency anemia in patients with IBD in this meta-analysis. Patients who received IV iron had a greater rise in serum ferritin and were less likely to stop treatment due to adverse events, when compared with those who received PO iron.

SUBMITTER: Abhyankar A

PROVIDER: S-EPMC4509976 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

Abhyankar Anita A Moss Alan C AC

Inflammatory bowel diseases 20150801 8

<h4>Background</h4>A number of controlled trials and prospective studies have compared intravenous (IV) to oral (PO) iron for the treatment of iron deficiency anemia with mixed results.<h4>Methods</h4>We conducted a systematic review of trials published on 2014 that compared IV with PO iron to treat in patients with IBD. Meta-analysis was performed to generate effect estimates. Quality assessment was also performed according to GRADE criteria.<h4>Results</h4>Five studies met our inclusion criter ...[more]

PMID: 25844962

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Project description:BackgroundOur understanding of coronavirus disease 2019 (COVID-19) and its implications for patients with inflammatory bowel diseases (IBD) is rapidly evolving. We performed a systematic review and meta-analysis to investigate the epidemiology, clinical characteristics, and outcomes in IBD patients with COVID-19.MethodsWe searched PubMed, EMBASE, Cochrane Central, Clinicaltrials.gov, Web of Science, MedRxiv, and Google Scholar from inception through October 2020. We included studies with IBD patients and confirmed COVID-19. Data were collected on the prevalence, patient characteristics, pre-infection treatments for IBD, comorbidities, hospitalization, intensive care unit (ICU), admission, and death.ResultsTwenty-three studies with 51,643 IBD patients and 1449 with COVID-19 met our inclusion criteria. In 14 studies (n = 50,706) that included IBD patients with and without COVID-19, the prevalence of infection was 1.01% (95% confidence interval [CI], 0.92-1.10). Of IBD patients with COVID-19, 52.7% had Crohn's disease, 42.2% had ulcerative colitis, and 5.1% had indeterminate colitis. Nine studies (n = 687) reported outcomes according to IBD therapy received. Compared with patients on corticosteroids, those on antitumor necrosis factor (anti-TNF) therapy had a lower risk of hospitalization (risk ratio [RR], 0.24; 95% CI, 0.16-0.35; P < .01; I2 = 0%) and ICU admission (RR, 0.10; 95% CI, 0.03-0.37; P < .01) but not death (RR, 0.16; 95% CI, 0.02-1.71; P = .13; I2 = 39%). Compared with patients on mesalamine, those on antitumor necrosis factor therapy had a lower risk of hospitalizations (RR, 0.37; 95% CI, 0.25-0.54), ICU admissions (RR, 0.20; 95% CI, 0.07-0.58), and death (0.21; 95% CI, 0.04-1.00). Comparing patients on immunomodulators vs mesalamine or anti-TNF therapy, there was no difference in these outcomes.ConclusionsThe prevalence of COVID-19 in IBD patients was low. Use of corticosteroids or mesalamine was significantly associated with worse outcomes, whereas use of anti-TNFs was associated with more favorable outcomes. Further investigation clarifying the mechanisms of these disparate observations could help identify risk and adverse outcome-mitigating strategies for patients with IBD.

Project description:BackgroundThe risk of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection and clinical outcomes of coronavirus disease (COVID-19) in inflammatory bowel disease are unclear.MethodsWe searched PubMed and Embase with the keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis and COVID-19, novel coronavirus and SARS-CoV-2. We included studies reporting the frequency of COVID-19 infection and outcomes (hospitalisation, need for intensive care unit care and mortality) in patients with inflammatory bowel disease. We estimated the pooled incidence of COVID-19 in inflammatory bowel disease and comparative risk vis-a-vis the general population. We also estimated the pooled frequency of outcomes and compared them in patients who received and did not receive drugs for inflammatory bowel disease.ResultsTwenty-four studies were included. The pooled incidence rate of COVID-19 per 1000 patients of inflammatory bowel disease and the general population were 4.02 (95% confidence interval [CI, 1.44-11.17]) and 6.59 [3.25-13.35], respectively, with no increase in relative risk (0.47, 0.18-1.26) in inflammatory bowel disease. The relative risk of the acquisition of COVID-19 was not different between ulcerative colitis and Crohn's disease (1.03, 0.62-1.71). The pooled proportion of COVID-19-positive inflammatory bowel disease patients requiring hospitalisation and intensive care unit care was 27.29% and 5.33% while pooled mortality was 4.27%. The risk of adverse outcomes was higher in ulcerative colitis compared to Crohn's disease. The relative risks of hospitalisation, intensive care unit admission and mortality were lower for patients on biological agents (0.34, 0.19-0.61; 0.49, 0.33-0.72 and 0.22, 0.13-0.38, respectively) but higher with steroids (1.99, 1.64-2.40; 3.41, 2.28-5.11 and 2.70, 1.61-4.55) or 5-aminosalicylate (1.59, 1.39-1.82; 2.38, 1.26-4.48 and 2.62, 1.67-4.11) use.ConclusionSARS-CoV-2 infection risk in patients with inflammatory bowel disease is comparable to the general population. Outcomes of COVID-19-positive inflammatory bowel disease patients are worse in ulcerative colitis, those on steroids or 5-aminosalicylates but outcomes are better with biological agents.

Project description:BackgroundPlatelet dysfunction plays a critical role in the pathogenesis of inflammatory bowel disease (IBD). Despite clinical observations indicating abnormalities in platelet parameters among IBD patients, inconsistencies persist, and these parameters lack standardization for diagnosis or clinical assessment.MethodsA comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant articles published up to December 16th, 2023. A random-effects model was employed to pool the weighted mean difference (WMD) and 95% confidence interval (95% CI) of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) between IBD patients and healthy controls, and subgroup analyses were performed.ResultsThe meta-analysis included 79 articles with 8,350 IBD patients and 13,181 healthy individuals. The results revealed significantly increased PLT and PCT levels (WMD: 69.910, 95% CI: 62.177, 77.643 109/L; WMD: 0.046%, 95% CI: 0.031%, 0.061%), and decreased MPV levels (WMD: -0.912, 95% CI: -1.086, -0.739 fL) in IBD patients compared to healthy individuals. No significant difference was found in PDW between the IBD and control groups (WMD: -0.207%, 95% CI: -0.655%, 0.241%). Subgroup analysis by disease type and disease activity showed no change in the differences for PLT, PCT, and MPV in the ulcerative colitis and Crohn's disease groups, as well as the active and inactive groups. Notably, the active group exhibited significantly lower PDW levels than the control group (WMD: -1.138%, 95% CI: -1.535%, -0.741%).ConclusionsCompared with healthy individuals, IBD patients display significantly higher PLT and PCT and significantly lower MPV. Monitoring the clinical manifestations of platelet abnormalities serves as a valuable means to obtain diagnostic and prognostic information. Conversely, proactive measures should be taken to prevent the consequences of platelet abnormalities in individuals with IBD.Systematic review registrationPROSPERO CRD42023493848.

Dataset Information

Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

Publications

Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

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