Efficacy of Parenteral Iron Supplementation After Gastrointestinal Bleeding in Subjects Over 65 (FerHem)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01690585
Recruitment Status : Completed
First Posted : September 24, 2012
Last Update Posted : August 22, 2017
Information provided by (Responsible Party):
University Hospital, Rouen

Brief Summary:

The upper and lower gastrointestinal bleeding, not related to portal hypertension, is a common disorder in the elderly. Indeed, in 1996, in a French study, the median age of patients hospitalized for upper gastrointestinal bleeding was 68. During the same period in the studies reported in English the median age was 71. If epidemiological data concerning lower gastrointestinal bleeding are rare, the average age of hospitalized patients varies from 63 to 77 depending on the study. Due to improvement in endoscopic haemostatic procedures and current resuscitation methods, gastrointestinal bleeding prognosis has greatly improved, whereas anaemia related to a bleeding episode remains a frequent complication of gastrointestinal bleeding in elderly patients.

Among elderly patients over 65, the prevalence of anaemia varies from 8 to 44% depending on the criteria used and populations studied. The occurrence of a bleeding episode can either induce anaemia or exacerbate pre-existing anaemia. Physicians in charge of gastrointestinal bleeding are often unaware of anaemic consequences in the elderly patients which can often be serious. Various studies have shown that anaemia increases morbidity and mortality rates in the elderly. Life expectancy is independently significantly lower for anaemic patients over 65, than for non-anaemic subjects. Anaemia is also a risk factor for the occurrence of cardiovascular and neurological complications, impairment in cognitive function and increased risk of falling.

Iron deficiency and anaemia induced by bleeding episodes in patients over 65 hospitalized for upper or lower gastrointestinal bleeding should be corrected rapidly and effectively. Currently, the cost and risks of infection or cardiovascular-related complications of transfusions lead to limiting red blood cell transfusion with a goal average of 9 g/dL haemoglobin. It is also necessary to develop alternatives to massive transfusions. The correction of iron deficiency promotes erythropoiesis and can quickly correct anaemia.

In clinical practice, the effectiveness of iron intake by the oral route is limited by the frequent occurrence of significant gastrointestinal side effects that limit patient compliance and limited absorption necessitating prolonged treatment to correct iron deficiency.

The black colour of stools caused by taking oral iron supplements also makes it difficult to detect a possible recurrence of bleeding after hospitalization.

The prescription of intravenous iron seems more suitable for a rapid and complete correction of iron deficiency after gastrointestinal bleeding. The main objective of our study is to evaluate efficacy of intravenous iron for the correction of anaemia, measured by haemoglobin at week 6 (W6) in patients aged over 65, after gastrointestinal bleeding. Secondary objectives were to assess the speed of anaemia correction, the tolerance of intravenous iron supplementation, the rate of re-hospitalization within 6 months after discharge and patients quality of life. This is a prospective multicenter randomized study versus placebo. After obtaining informed consent, all patients aged over 65 admitted with upper or lower gastrointestinal bleeding, with successful outcome, not related to portal hypertension, responsible for persistent anaemia (definition: Hb < 11 g / dL) after hospitalization will be included in the study. Patients will be treated for their bleeding event in the usual manner of each centre with target for transfusion of 9 g / dL haemoglobin. The absence of external bleeding and haematocrit and/or constant haemoglobin levels will be considered as the end of bleeding.

Day 1 was arbitrarily defined as the day the patient left hospital. The protocol at Day - 1 included: obtaining informed consent of the patient, determination of iron and ferritin blood levels and complete blood count. and randomization intravenous iron injection , (Ferinject) versus Placebo. Intravenous iron injection will be performed at Day 0. A complete blood count will be performed at week 6 and month 6. Patients will be reviewed in consultation at week 6 and at month 6 to obtain related intercurrent events and assess their quality of life.

The results of this study could lead to changes in the care of older patients hospitalized for gastrointestinal bleeding.

Condition or disease Intervention/treatment Phase
Gastrointestinal Hemorrhage Anemia Drug: Ferinject 1000 mg Drug: Sodium chlorure 0,9 % Phase 3

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 62 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Efficacy of Parenteral Iron Supplementation After Gastrointestinal Bleeding in Subjects Over 65
Actual Study Start Date : January 2013
Actual Primary Completion Date : July 2017
Actual Study Completion Date : July 2017

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Ferinject 1000 mg
Intravenous Administration of 1000 mg of ferinject Volume of infusion : 250 mL
Drug: Ferinject 1000 mg
Placebo Comparator: Placebo
Intravenous administration of 250 ml of sodium chlorure 0.9 %
Drug: Sodium chlorure 0,9 %

Primary Outcome Measures :
  1. Haemoglobin level [ Time Frame: Week 6 ]

Secondary Outcome Measures :
  1. Assessment of the tolerance of intravenous iron supplementation [ Time Frame: Day 0 ]
    Number of Adverse Event (AE) and Serious Adverse Event(SAE) occurence.

  2. Assessment of the tolerance of intravenous iron supplementation [ Time Frame: Week 6 ]
    Number of Adverse Event (AE) and Serious Adverse Event(SAE) occurence.

  3. re-hospitalization rate [ Time Frame: Month 6 ]

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Ages Eligible for Study:   65 Years and older   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients aged over 65 hospitalized for upper or lower GI bleeding with positve outcome during hospitalization without surgery, and with persistent anaemia (Hb <11g/dL),
  2. Signed informed consent,
  3. Patients with National Health Insurance,

Exclusion Criteria:

  1. Uncontrolled haemorrhage defined by any new externalizing and / or a decrease of haemoglobin and haematocrit levels,
  2. GI bleeding related to portal hypertension or malignancy,
  3. The absence of anaemia,
  4. Cancer evolution,
  5. Patient under guardianship, curatorship or unable to supply consent,
  6. Iron overload,
  7. History of asthma
  8. History of eczema
  9. Hypersensitivity to any component
  10. Decompensated liver cirrhosis
  11. Infection during treatment or uncontrolled infection 12 Rheumatoid arthritis

13. Acute renal failure

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01690585

CHU d'Amiens
Amiens, France, 80054
CHU de Caen
Caen, France, 14000
CH de Vendée
La Roche sur Yon, France, 85000
CH Le Mans
Le Mans, France, 72037
CHI le Raincy Montfermeil
Le raincy, France, 93370
GH du havre
Montivilliers, France, 76290
CH de Montélimar
Montélimar, France, 26216
CHU de Nice
Nice, France, 06202
CH d'Orléans
Orléans, France, 45067
CHU de Pau
Pau, France, 64046
CHU de Rennes
Rennes, France, 35033
CHU de Rouen
Rouen, France, 76031
CH de Valenciennes
Valenciennes, France, 59032
Sponsors and Collaborators
University Hospital, Rouen
Principal Investigator: Guillaume SAVOYE, Pr UH Rouen

Responsible Party: University Hospital, Rouen Identifier: NCT01690585     History of Changes
Other Study ID Numbers: 2011/123/HP
First Posted: September 24, 2012    Key Record Dates
Last Update Posted: August 22, 2017
Last Verified: August 2017

Additional relevant MeSH terms:
Gastrointestinal Hemorrhage
Pathologic Processes
Gastrointestinal Diseases
Digestive System Diseases