Guidelines recommend treating inflammatory bowel disease (IBD) for iron-deficiency anemia with oral or parenteral iron. Intravenous iron provides more rapid repletion of iron stores than oral iron. We aimed to examine the prevalence of treatment with prescription oral and intravenous iron among laboratory confirmed iron-deficient IBD patients using Truven Health MarketScan databases, 2010 to 2014.Methods:
We included iron-deficient individuals with at least 2 inpatient or outpatient encounters for Crohn's disease (CD; International Classification of Diseases, Clinical Modification, Ninth Edition [ICD-9-CM] 555) or ulcerative colitis (UC; ICD-9-CM 556), who contributed laboratory results and had a prescription drug benefit. Iron-deficiency was defined according to WHO criteria for anemia (men; hemoglobin <13 g/dL/hematocrit <39%, women; hemoglobin <12 g/dL/hematocrit <36%) combined with ferritin (<30 μg/L) and elevated C-reactive protein if ferritin was between 30 to 100 μg/L. We also excluded individuals whose age at first IBD encounter was less than 18 years, with inconclusive type of IBD, pregnancy, chronic kidney disease, cancer, liver transplant and patients who were not iron-deficient. In addition, we excluded individuals with less than 1 year of enrollment from their first IBD encounter and individuals with less than 60 days of enrollment after iron-deficiency. The following intravenous iron medications were identified using their National Drug Code (NDC) number or Healthcare Common Procedure Coding System (HCPCS); iron sucrose (J1756), iron dextran (J1750), ferric gluconate (J2916) and ferumoxytol (Q0138, Q0139). Oral iron was identified by NDC numbers. The following factors were examined as predictors of treatment with intravenous iron using logistic regression: type of IBD, sex, smoking, hospitalization, outpatient visits and age.Results:
Three hundred sixty-three CD and 272 UC patients met inclusion criteria. The median follow-up from the first documentation of iron-deficiency was 1.5 years (60 d—4.99 yr) in CD and 1.6 years (73 d—4.96 yr) in UC. 24.2% of CD and 12.5% of UC patients were treated with intravenous iron. Among 399 patients with severe iron-deficiency (ferritin <10 μg/L), prevalence of IV iron remained low (30.1% CD, 14.7% UC). Iron sucrose and iron dextran were the most predominant infusions received (45.5% and 23.9% in CD; 35.3% and 35.3% in UC) respectively. Only 10.2% CD and 5.2% UC received prescription oral iron, but it is unknown how many were advised to take over the counter iron supplements. Crohn's disease patients were 2 times as likely to be treated with intravenous iron as UC patients (OR 2.1, 95% CI, 1.3–3.2). Hospitalization was the only predictor for treatment in CD patients (adjusted OR 1.9, 95% CI, 1.1–3.1). None of the examined factors were associated with treatment with IV iron in UC patients.Conclusions:
Only one in 5 IBD patients with iron deficiency anemia received intravenous iron. Hospitalization was the only predictor of treatment suggesting that provider preference might be a factor influencing this treatment disparity. Based upon the database data, iron deficiency anemia is not being adequately treated. Implementation of treatment guidelines for anemia by healthcare providers and organizations should be encouraged.