IV Versus Oral Iron in Children with Anemia –POPEYE Study

N Bevers et al. J Pediatr 2023; 256: 113-119. Open Access! Ferric Carboxymaltose Versus Ferrous Fumarate in Anemic Children with Inflammatory Bowel Disease: The POPEYE Randomized Controlled Clinical Trial

Methods: Children aged 8-18 (n=64) with IBD and anemia (defined as hemoglobin [Hb] z-score < −2) were randomly assigned to a single IV dose of ferric carboxymaltose (15 mg/kg up to 750 mg) or 12 weeks of oral ferrous fumarate (9 mg/kg/day up to 600 mg in BID divided dosing). This study excluded patients with severe disease activity (eg. PUCAI >65, or PCDAI >30).

Key findings:

One month after the start of iron therapy, the 6-minute walking distance (6MWD) z-score of patients in the IV group had increased by 0.71 compared with −0.11 in the oral group (P = .01).
At 3- and 6-month follow-ups, no significant differences in 6MWD z-scores were observed.
Hb z-scores gradually increased in both groups and the rate of increase was not different between groups at 1, 3, and 6 months after initiation of iron therapy (overall P = .97).
The authors did not detect hypophosphatemia which has been described with ferric carboxymaltose

This “POPEYE” study prompted me to review how much iron is in spinach. Apparently, it is a little more than in red meat. However, red meat iron is “heme” and is better absorbed than “non-heme” iron found in spinach.

My take: In this study, more rapid improvement in 6MWD was noted in first month of treatment but there were no other significant advantages of IV iron in this group which predominantly had quiescent disease or mildly active disease; hemoglobin improvement was comparable in both groups.

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