Demir Eksikliği Anemisinin Tedavisinde Ferrik Karboksimaltoz ile Demir Glisin Sülfatın Karşılaştırılması ve Bu İki Ajanın B12 Vitamini Ve Folik Asit Üzerine Etkisi: Retrospektif Bir Çalışma

Öz

Amaç: Dünya nüfusunun yaklaşık üçte birini etkilemesiyle önemli bir halk sağlığı sorunu olan anemi, en sık demir eksikliğinden kaynaklanır. Demir eksikliği anemisi, oral veya intravenöz demir replasman tedavisi gerektirir. Bu çalışmanın amacı, oral demir glisin sülfat veya intravenöz ferrik karboksimaltoz tedavileri altında başlangıçtan birinci ay takibine kadar çeşitli hematolojik parametrelerin, vitamin B12 ve folik asidin değişimini incelemektir. Yöntemler: Çalışma, 1 Ocak 2016 ve 31 Aralık 2018 tarihleri arasında oral ferröz glisin sülfat veya iv ferrik karboksimaltoz ile demir eksikliği anemisi nedeniyle tedavi edilen tüm hastaları içermiştir. Hastaların dosyalarından elde edilen yaş ve cinsiyet verilerinin yanısıra, tedavi başlangıcında ve tedaviden sonraki birinci ay kontrollerinde alınan hemoglobin, transferrin satürasyonu, ferritin, ortalama korpüsküler hacim, vitamin B12 ve folik asit değerleri kayıt edildi. Bulgular: Tedavi sonrasında elde edilen laboratuvar değerleri her iki grupta da istatistiksel olarak anlamlı iyileşme göstermiştir (grup içi, p<0,001). Gruplar arasındaki değişim yüzdesi karşılaştırıldığında: Hemoglobin, ortalama korpusküler hacim, transferrin satürasyonu ve ferritin değerlerindeki yüzde bazlı artışlar ferrik karboksimaltoz grubunda anlamlı olarak daha yüksekti (p<0,001). B12 vitamini ve folik asit değerlerindeki yüzde düşüş, oral demir glisin sülfat grubuyla karşılaştırıldığında ferrik karboksimaltoz grubunda daha yüksekti (sırasıyla p=0,005 ve p=0,001). Sonuç: Çalışmamızın bulgularına göre, demir eksikliği anemisi, ferrik karboksimaltoz kullanılarak başarılı bir şekilde tedavi edilebilir; ancak, eritropoezin uygun gelişimi için B12 vitamini ve folik asit gibi faktörlerin eş zamanlı takviyesinin gerekli olduğu unutulmamalıdır.

Anahtar Kelimeler

• Vitamin B12
• Demir
• Demir eksikliği anemisi
• Ferrik karboksimaltoz
• Folik asit
• Ferritin

Ferric Carboxymaltose Versus Ferrous Glycine Sulfate For Treatment of Iron Deficiency Anemia and Their Effect On Vitamin B12 And Folic Acid: A Retrospective Study

Abstract

Aim Anemia is a major public health problem, affecting about one-third of the world's population, and is most commonly caused by iron deficiency. Iron deficiency anemia requires oral or intravenous iron replacement therapy. The purpose of this study was to assess the change in several hematological parameters, vitamin B12, and folic acid from baseline to the first month of follow-up following therapy with oral ferrous glycine sulfate or intravenous ferric carboxymaltose. Methods: All patients who received oral ferrous glycine sulfate or intravenous ferric carboxymaltose for the treatment of iron deficiency anemia between January 1, 2016, and December 31, 2018, were included in the trial. Along with age and gender information, values of hemoglobin, ferritin, transferrin saturation, mean corpuscular volume, vitamin B12, and folic acid were derived from patients’ records at the beginning of treatment and first month follow-up. Results: Laboratory values obtained after treatment showed statistically significant improvement in both groups (intra group, p<0.001). When the percentage of change between groups was compared: Percentage-based increases in hemoglobin, mean corpuscular volume, transferrin saturation and ferritin values were significantly higher in the ferric carboxymaltose group (p<0.001). The percentage decrease in vitamin B12 and folic acid values was higher in the ferric carboxymaltose group (p=0.005 and p=0.01, respectively) when compared with oral ferrous glycine sulfate group. Conclusions: According to the findings of our study, iron deficiency anemia can be treated very successfully using ferric carboxymaltose; however, it should be remembered that concurrent supplementation of elements such vitamin B12 and folic acid is necessary for the appropriate progression of erythropoiesis.

Keywords

• Ferric carboxymaltose
• Ferritin
• Folate
• Iron
• Iron deficiency anemia
• folic acid

Kaynakça

1. 1. World Health Organization. Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. Edited by Bruno de Benoist, Erin McLean, Ines Egli and Mary Cogswell. World Health Organization. 2008. https://apps.who.int/iris/handle/10665/43894
2. 2. Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615-24.
3. 3. Stoltzfus RJ, Dreyfuss ML. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. International Nutritional Anemia Consultative Group (INACG), World Health Organization. 1998. https://motherchildnutrition.org/nutrition-protection-promotion/pdf/mcn-guidelines-for-iron-supplementation.pdf
4. 4. Tolkien Z, Stecher L, Mander AP, Pereira DIA, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One 2015;10:e0117383.
5. 5. Van Wyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: a randomized controlled trial. Obstet Gynecol 2007;110:267–78.
6. 6. Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folic acid, vitamin B12, and iron. Annu Rev Nutr. 2004;24:105-31.
7. 7. Yildirim T, Yalcin A, Atmis V, Cengiz OK, Aras S, Varlı M, et al. The prevalence of anemia, iron, vitamin B12, and folic acid deficiencies in community dwelling elderly in Ankara, Turkey. Arch Gerontol Geriatr. 2015;60:344-8.
8. 8. Wong CW, Ip CY, Leung CP, Leung CS, Cheng JN, Siu CY. Vitamin B12 deficiency in the institutionalized elderly: A regional study. Exp Gerontol. 2015;69:221-5.

9. 9. Shulpekova Y, Nechaev V, Kardasheva S, Sedova A, Kurbatova A, Bueverova E, et al. The Concept of Folic Acid in Health and Disease. Molecules. 2021;26:3731.
10. 10. Agarwal R, Rizkala AR, Bastani B, Kaskas MO, Leehey DJ, Besarab A. A randomized controlled trial of oral versus intravenous iron in chronic kidney disease. Am J Nephrol. 2006;26:445-54.
11. 11. Bisbe E, García-Erce JA, Díez-Lobo AI, Muñoz M; Anaemia Working Group España. A multicentre comparative study on the efficacy of intravenous ferric carboxymaltose and iron sucrose for correcting preoperative anaemia in patients undergoing major elective surgery. Br J Anaesth. 2011;107:477-8.
12. 12. Qunibi WY, Martinez C, Smith M, Benjamin J, Mangione A, Roger SD. A randomized controlled trial comparing intravenous ferric carboxymaltose with oral iron for treatment of iron deficiency anaemia of non-dialysis-dependent chronic kidney disease patients. Nephrol Dial Transplant. 2011;26:1599-607.
13. 13. Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Am J Hematol. 2016;91:31-8.
14. 14. Kitsati N, Liakos D, Ermeidi E, Mantzaris MD, Vasakos S, Kyratzopoulou E, et al. Rapid elevation of transferrin saturation and serum hepcidin concentration in hemodialysis patients after intravenous iron infusion. Haematologica. 2015;100:e80-3.
15. 15. Garbowski MW, Bansal S, Porter JB, Mori C, Burckhardt S, Hider RC. Intravenous iron preparations transiently generate non-transferrin-bound iron from two proposed pathways. Haematologica. 2021;106:2885-96
16. 16. Maas LA, Krishna M, Parian AM. Ironing It All Out: A Comprehensive Review of Iron Deficiency Anemia in Inflammatory Bowel Disease Patients. Dig Dis Sci. 2022 Aug 5. doi: 10.1007/s10620-022-07599-1.
17. 17. Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage--a placebo-controlled study. Aliment Pharmacol Ther. 2014;39:176-87.
18. 18. Onken JE, Bregman DB, Harrington RA, Morris D, Buerkert J, Hamerski D, et al. Ferric carboxymaltose in patients with iron-deficiency anemia and impaired renal function: the REPAIR-IDA trial. Nephrol Dial Transplant. 2014;29:833-42.
19. 19. Lichtenstein GR, Onken JE. Improved Hemoglobin Response with Ferric Carboxymaltose in Patients with Gastrointestinal-Related Iron-Deficiency Anemia Versus Oral Iron. Dig Dis Sci. 2018;63:3009-19.
20. 20. Ferrer-Barceló L, Sanchis Artero L, Sempere García-Argüelles J, Canelles Gamir P, P Gisbert J, Ferrer-Arranz LM, et al. Randomised clinical trial: intravenous vs oral iron for the treatment of anaemia after acute gastrointestinal bleeding. Aliment Pharmacol Ther. 2019;50:258-68.
21. 21. Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, et al. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep. 2021;11:7463.
22. 22. Cotter J, Baldaia C, Ferreira M, Macedo G, Pedroto I. Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review. World J Gastroenterol. 2020;26:7242-57.
23. 23. Ballester-Clau R, Torres Vicente G, Voltà-Pardo T, López-Barroso L, Cucala-Ramos M, Reñé-Espinet JM, et al. Clinical experience with ferric carboxymaltose in the management of anemia in acute gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2019;31:116-22.
24. 24. Mak LY, Lau CW, Hui YT, Ng C, Shan E, Li M, et al. Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong. Hong Kong Med J. 2018;24:416-22.
25. 25. Shirish MK. Megaloblastic Anaemias. In: Essentials of Haematology. New Delhi: Jaypee Brothers Medical Publishers; 2013. pp.83-87.
26. 26. Venturini E, Iannuzzo G, DI Lorenzo A, Cuomo G, D'Angelo A, Merone P, et al. Short-term treatment of iron deficiency anemia after cardiac surgery. Int J Cardiol Heart Vasc. 2022;40:101038.
27. 27. Huguet JM, Cortés X, Boscá-Watts MM, Muñoz M, Maroto N, Iborra M, et al. Ferric Carboxymaltose Improves the Quality of Life of Patients with Inflammatory Bowel Disease and Iron Deficiency without Anaemia. J Clin Med. 2022;11:2786.