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Ferric Carboxymaltose Versus Ferrous Fumarate in Anemic Children with Inflammatory Bowel Disease: The POPEYE Randomized Controlled Clinical Trial - 05/05/23

Doi : 10.1016/j.jpeds.2022.12.016 
Nanja Bevers, MD 1, , Els Van de Vijver, PhD, MD 2, Arta Aliu 1, Ashkan Rezazadeh Ardabili, MD 3, Philippe Rosias, MD, PhD 1, Janneke Stapelbroek, MD, PhD 4, Imke A. Bertrams Maartens, MD 5, Cathelijne van de Feen, MD 6, Hankje Escher, MD, PhD 7, Annemarie Oudshoorn, MD 8, Sarah Teklenburg, MD, PhD 9, Saskia Vande Velde, MD, PhD 10, Bjorn Winkens, PhD 11, Maarten Raijmakers, PhD 12, Anita Vreugdenhil, MD, PhD 13, Marieke J. Pierik, MD, PhD 14, Patrick F. van Rheenen, MD, PhD 15
1 Department of Paediatrics, Zuyderland Medical Center, Sittard, The Netherlands 
2 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Edegem, Belgium 
3 Maastricht University Medical Center [MUMC], Department of NUTRIM, Maastricht, The Netherlands 
4 Department of Paediatrics, Catharina Hospital, The Netherlands 
5 Department of Paediatrics, Maxima Medical Centre, Veldhoven, The Netherlands 
6 Department of Paediatrics, Jeroen Bosch Medical Centre, Den Bosch, The Netherlands 
7 Erasmus Medical Center, Children's Hospital Department of Paediatric Gastroenterology, Rotterdam, The Netherlands 
8 Department of Paediatrics, Gelre Hospital, Apeldoorn, The Netherlands 
9 Department of Paediatrics, Isala Hospitals, Zwolle, The Netherlands 
10 Ghent University Hospital, Ghent University, Ghent, Belgium 
11 Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands 
12 Laboratory of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands 
13 Department of Paediatrics and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands 
14 Division of Gastroenterology-Hepatology and NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands 
15 University of Groningen, University Medical Centre Groningen - Beatrix Children's Hospital, Department of Paediatric Gastroenterology Hepatology and Nutrition, Groningen, The Netherlands 

Reprint requests: Nanja Bevers, MD, Department of Paediatrics, Zuyderland Medical Centre Dr. H. van der Hoffplein 1, 6162 BG Sittard, The NetherlandsDepartment of PaediatricsZuyderland Medical CentreDr. H. van der Hoffplein 1Sittard6162 BGThe Netherlands

Abstract

Objective

To determine whether intravenous (IV) or oral iron suppletion is superior in improving physical fitness in anemic children with inflammatory bowel disease (IBD).

Study design

We conducted a clinical trial at 11 centers. Children aged 8-18 with IBD and anemia (defined as hemoglobin [Hb] z-score < −2) were randomly assigned to a single IV dose of ferric carboxymaltose or 12 weeks of oral ferrous fumarate. Primary end point was the change in 6-minute walking distance (6MWD) from baseline, expressed as z-score. Secondary outcome was a change in Hb z-score from baseline.

Results

We randomized 64 patients (33 IV iron and 31 oral iron) and followed them for 6 months. One month after the start of iron therapy, the 6MWD z-score of patients in the IV group had increased by 0.71 compared with −0.11 in the oral group (P = .01). At 3- and 6-month follow-ups, no significant differences in 6MWD z-scores were observed. Hb z-scores gradually increased in both groups and the rate of increase was not different between groups at 1, 3, and 6 months after initiation of iron therapy (overall P = .97).

Conclusion

In this trial involving anemic children with IBD, a single dose of IV ferric carboxymaltose was superior to oral ferrous fumarate with respect to quick improvement of physical fitness. At 3 and 6 months after initiation of therapy, no differences were discovered between oral and IV therapies. The increase of Hb over time was comparable in both treatment groups.

Trial registration

NTR4487 [Netherlands Trial Registry].

Le texte complet de cet article est disponible en PDF.

Keywords : children, anemia, iron suppletion, Crohn's disease, ulcerative colitis

Abbreviations : AEs, FCM, Hb, IBD, ICC, IV, I2, MCID, NNTB, PUCAI, PCDAI, RCT, RR, sTfR, TSAT, 6MWD


Plan


 Presented as an e-poster at ECCO congress 2021.
 Supported through an unrestricted grant from Vifor Pharma, Glattbrugg, Switzerland; they had no role in the design nor in the collection, analysis, and interpretation of data, the writing of the report or the decision to submit the paper for publication.
 The authors declare no conflicts of interest.


© 2022  The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 256

P. 113 - mai 2023 Retour au numéro
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