1. The management of iron deficiency in inflammatory bowel disease – an online tool developed by the RAND/UCLA appropriateness method
- Author
-
O. Haagen Nielsen, Milan Lukas, Gerassimos J. Mantzaris, Axel Dignass, Yehuda Chowers, Peter L. Lakatos, Silvio Danese, H. Stoevelaar, Bjørn Moum, Murat Törüner, Pierre Michetti, Günter Weiss, Fernando Gomollón, Walter Reinisch, Stefan Lindgren, J. van der Woude, Laurent Peyrin-Biroulet, Charlie W. Lees, Department Internal Medicine III [Medizinische Universität Wien], Medizinische Universität Wien = Medical University of Vienna, Rambam Health Care Campus, Department of Gastroenterology [Humanitas Research Hospital], Humanitas Research Hospital, Department of Gastroenterology, Oncology, Infectious Diseases and Metabolism [Agaplesion Markus Hospital], Agaplesion Markus Krankenhaus = Agaplesion Markus Hospital [Frankfurt], Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Liver Unit, Clínica Universitaria, CIBER-EHD, Herlev and Gentofte Hospital, Semmelweis University [Budapest], Western General Hospital, Edinburgh, Skane University Hospital [Lund], Charles University in Prague, First Faculty of Medicine, Department of Gastroenterology [Evangelismos Athens General Hospital], Evangelismos Athens General Hospital, Division of Gastroenterology and Hepatology [CHU Vaudois], Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Oslo University Hospital [Oslo], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Hépato-gastro-entérologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Ankara University School of Medicine [Turkey], Erasmus University Medical Center [Rotterdam] (Erasmus MC), Department of Internal Medicine III (Dep Med Int - INNSBRUCK), Innsbruck Medical University [Austria] (IMU), Ismar Healthcare NV, Charles University [Prague] (CU), Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), UL, NGERE, Reinisch, W, Chowers, Y, Danese, S, Dignass, A, Gomollon, F, Nielsen, Oh, Lakatos, Pl, Lees, Cw, Lindgren, S, Lukas, M, Mantzaris, Gj, Michetti, P, Moum, B, Peyrin-Biroulet, L, Toruner, M, van der Woude, J, Weiss, G, and Stoevelaar, H
- Subjects
medicine.medical_specialty ,Blood transfusion ,Anemia ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Iron ,Alternative medicine ,MEDLINE ,Inflammatory bowel disease ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Blood Transfusion ,Hematinic ,Practice Patterns, Physicians' ,Internet ,Hepatology ,Anemia, Iron-Deficiency ,Dose-Response Relationship, Drug ,business.industry ,Gastroenterology ,Iron deficiency ,Iron Deficiencies ,medicine.disease ,Decision Support Systems, Clinical ,Inflammatory Bowel Diseases ,3. Good health ,Surgery ,[SDV] Life Sciences [q-bio] ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Hematinics ,030211 gastroenterology & hepatology ,Administration, Intravenous ,Drug Therapy, Combination ,Iron Deficiency Anaemia and Ibd ,business - Abstract
BackgroundIron deficiency is a common and undertreated problem in inflammatory bowel disease (IBD).AimTo develop an online tool to support treatment choice at the patient-specific level.MethodsUsing the RAND/UCLA Appropriateness Method (RUAM), a European expert panel assessed the appropriateness of treatment regimens for a variety of clinical scenarios in patients with non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA). Treatment options included adjustment of IBD medication only, oral iron supplementation, high-/low-dose intravenous (IV) regimens, IV iron plus erythropoietin-stimulating agent (ESA), and blood transfusion. The panel process consisted of two individual rating rounds (1148 treatment indications; 9-point scale) and three plenary discussion meetings.ResultsThe panel reached agreement on 71% of treatment indications. ‘No treatment’ was never considered appropriate, and repeat treatment after previous failure was generally discouraged. For 98% of scenarios, at least one treatment was appropriate. Adjustment of IBD medication was deemed appropriate in all patients with active disease. Use of oral iron was mainly considered an option in NAID and mildly anaemic patients without disease activity. IV regimens were often judged appropriate, with high-dose IV iron being the preferred option in 77% of IDA scenarios. Blood transfusion and IV+ESA were indicated in exceptional cases only.ConclusionsThe RUAM revealed high agreement amongst experts on the management of iron deficiency in patients with IBD. High-dose IV iron was more often considered appropriate than other options. To facilitate dissemination of the recommendations, panel outcomes were embedded in an online tool, accessible via http://ferroscope.com/.
- Published
- 2013