P0659 Exploring Ferric Maltol: A Promising Alternative to IV Iron for Managing Chronic Iron Deficiency Anaemia in Inflammatory Bowel Disease Patients
Authors: Wong F , Kamperidis N , Angela C , Young L , Tyrrell T , Passos D , Al-Zarrad D 
Published: January 2025

Abstract

Background
Around 500,000 people in the UK have inflammatory bowel disease (IBD), with one in three affected by iron deficiency anemia (IDA), which leads to fatigue and increased hospital admissions1. Literature recommends timely treatment based on haemoglobin (HB) and ferritin levels4.
First-line treatment with iron salts cause side effects, while intravenous (IV) options with IV iron are logistically challenging. Feraccru (oral ferric maltol) offers a promising alternative, improving HB levels in IBD patients, supported by clinical trial data in AEGIS and FRESH study2,3.
This study evaluates the safety, tolerability and effectiveness of Feraccru for managing IDA in IBD patients.

Methods
Patients with mild to moderate IDA secondary to Crohn’s Disease (CD) or Ulcerative Colitis (UC) after failing oral iron salts, were included and prescribed Feraccru 30 mg twice daily. Data was retrospectively collected from electronic records between January 1, 2021, and April 2024. Baseline Hb and ferritin levels were recorded at the start of treatment and at 12 weeks with follow-up between 6–12 months to assess the need for IV iron or blood transfusions. Clinical response was defined as normalisation of HB levels (Male ≥130g/l, female ≥120g/l) and serum ferritin levels (&gt;30 µg/L).

Results
A total of 83 patients (31 males, 52 females) were enrolled in the study. Of these, 70% (n=58/83) achieved normalisation of HB levels, and 55% (n=44/80) achieved normalisation of serum ferritin. A higher rate of male patients (77%, n=24/31) achieved Hb normalisation compared to females (65%, n=34/52), while females exhibited a higher rate of serum ferritin normalisation (59%, n=29/49) compared to males (48%, n=15/31) as shown in Figure 1. Of the 25 patients who did not achieve clinical response by week 12, 5 discontinued treatments due to adverse events (AEs) and 30% (n=6) who continued for an additional 24 weeks, achieving HB normalisation. A total of 8 AEs were reported which included: 64% stomach cramps (n=5), 12% (n=1) loose stools, 12% (n=1) constipation and 12% (n=1) rectal bleeding as displayed in Figure 2. No serious adverse events (SAEs) were observed. Additionally, only 23% (n=19/83) of patients received IV iron 6–12 months following Feraccru treatment.

Conclusion
Feraccru was effective in treating IDA in patients with IBD, with 70% achieving HB normalisation and 55% normalising serum ferritin. Adverse events were mild, with no serious events. Only 23% of patients required IV iron, reducing the risk of adverse events, lowering costs, and avoiding the logistical challenges of hospital-based treatments. Feraccru should be considered as an option for IBD patients prior to referring for IV iron.

References
Crohn’s & Colitis UK. Crohn’s & Colitis UK [Internet]. www.crohnsandcolitis.org.uk. 2022. Available from: https://crohnsandcolitis.org.uk/Gasche C, Berstad A, Befrits R, Beglinger C,
Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflammatory Bowel Diseases. 2007 Dec;13(12):1545–53.Howaldt S, Domènech E, Martinez N, Schmidt C, Bokemeyer B. Long-Term Effectiveness of Oral Ferric Maltol vs Intravenous Ferric Carboxymaltose for the
Treatment of Iron-Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Randomized Controlled Noninferiority Trial. Inflammatory Bowel Diseases. 2021 May 14.NICE.
Anaemia - Iron deficiency [Internet]. NICE. 2021. Available from: https://cks.nice.org.uk/topics/anaemia-iron-deficiency/