Abstract
Background
Iron-deficiency anaemia (IDA) is a major complication in inflammatory bowel disease (IBD). A European patient survey was conducted to analyse the IDA diagnostic journey and the impact of IDA on patients’ quality of life (QoL).
Methods
This quantitative survey was conducted in the UK, Spain, Italy and Germany between 28 May and 24 August 2020. The questions had been pre-validated by patients in an initial qualitative research phase. Adult patients with IDA associated with IBD and current or last haemoglobin level(s) greater than 8 g/dl, or IDA perceived to be mild or moderate were included. Patients on ferric maltol were excluded due to focus on traditional iron therapies. Selected Short Form-36 measures were used to assess the QoL. Results are presented as the percentage of respondents.
Results
A total of 173 patients were included (54% female; 98% aged ≤67 years). For months before their IDA diagnosis, most patients experienced IDA symptoms such as extreme fatigue 57%, weakness 45%, headache/dizziness 38% and sleeping difficulty 36%. IDA was typically diagnosed during either regular IBD check-ups or when the patient asked about their symptoms (37% each). Patients felt limited in carrying out daily activities such as running (77%), climbing stairs (65%), or walking more than a mile (64%). As a result of being fatigued, most patients (58%) also felt limited in their ability to complete work or college/university activities. Initially most patients (66%) received oral iron, and 34% received intravenous iron (IV). At the time of the survey, 71% were receiving oral iron and 28% IV iron. In 27% patients, side-effects with both oral and IV irons were the main challenge with IDA treatment. The three most frequently experienced side-effects were, with oral iron: black faeces 42%, stomach pain 37% or constipation 30%; and with IV iron: diarrhoea 23% or headache 21%. One in two patients had to wait 2 or more weeks to start their IV treatment. Once given, 57% patients had to return at least every 1–2 months for new IV iron injections. The majority patients who experienced both oral and IV therapies preferred oral treatments over IV (59% versus 41%). Home-based administration was the predominant reason (by 50%) for oral treatment preference. Most patients (64%) who preferred IV treatment valued fewer side-effects versus oral iron.
Conclusion
Patients with IBD and IDA are limited in their daily activities. Enduring IDA symptoms such as extreme fatigue often precede and trigger the IDA diagnosis. While challenges remain with both oral and IV irons, oral iron tablets are preferred due to home-based administration. The ongoing COVID pandemic may thus increase the demand for better oral iron treatments of IDA in patients with IBD.
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