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The management of iron deficiency in inflammatory bowel disease - an online tool developed by the RAND/UCLA appropriateness method

Reinisch, W.; Chowers, Y.; Danese, S.; Dignass, A.; Gomollon, F.; Nielsen, O. Haagen; Lakatos, P. L.; Lees, C. W.; Lindgren, Stefan LU and Lukas, M., et al. (2013) In Alimentary pharmacology & therapeutics 38(9). p.1109-1118
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... (More)
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/. (Less)
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Alimentary pharmacology & therapeutics
volume
38
issue
9
pages
1109 - 1118
publisher
Wiley-Blackwell
external identifiers
  • wos:000325364700011
  • scopus:84885094330
ISSN
0269-2813
DOI
10.1111/apt.12493
language
English
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yes
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494eaf7a-2e2f-4ec7-a9f1-f63f4de0a226 (old id 4160213)
date added to LUP
2013-12-06 12:22:54
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2019-09-04 02:33:57
@article{494eaf7a-2e2f-4ec7-a9f1-f63f4de0a226,
  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/.},
  author       = {Reinisch, W. and Chowers, Y. and Danese, S. and Dignass, A. and Gomollon, F. and Nielsen, O. Haagen and Lakatos, P. L. and Lees, C. W. and Lindgren, Stefan and Lukas, M. and Mantzaris, G. J. and Michetti, P. and Moum, B. and Peyrin-Biroulet, L. and Toruner, M. and van der Woude, J. and Weiss, G. and Stoevelaar, H.},
  issn         = {0269-2813},
  language     = {eng},
  number       = {9},
  pages        = {1109--1118},
  publisher    = {Wiley-Blackwell},
  series       = {Alimentary pharmacology & therapeutics},
  title        = {The management of iron deficiency in inflammatory bowel disease - an online tool developed by the RAND/UCLA appropriateness method},
  url          = {http://dx.doi.org/10.1111/apt.12493},
  volume       = {38},
  year         = {2013},
}