- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01690585
Efficacy of Parenteral Iron Supplementation After Gastrointestinal Bleeding in Subjects Over 65 (FerHem)
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.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Amiens, France, 80054
- CHU d'AMIENS
-
Caen, France, 14000
- CHU de Caen
-
La Roche sur Yon, France, 85000
- CH de Vendée
-
Le Mans, France, 72037
- CH Le Mans
-
Le raincy, France, 93370
- CHI Le Raincy Montfermeil
-
Montivilliers, France, 76290
- GH du havre
-
Montélimar, France, 26216
- CH de Montelimar
-
Nice, France, 06202
- Chu de Nice
-
Orléans, France, 45067
- CH d'Orleans
-
Pau, France, 64046
- CHU de PAU
-
Rennes, France, 35033
- CHU de Rennes
-
Rouen, France, 76031
- CHU de Rouen
-
Valenciennes, France, 59032
- CH de Valenciennes
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 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),
- Signed informed consent,
- Patients with National Health Insurance,
Exclusion Criteria:
- Uncontrolled haemorrhage defined by any new externalizing and / or a decrease of haemoglobin and haematocrit levels,
- GI bleeding related to portal hypertension or malignancy,
- The absence of anaemia,
- Cancer evolution,
- Patient under guardianship, curatorship or unable to supply consent,
- Iron overload,
- History of asthma
- History of eczema
- Hypersensitivity to any component
- Decompensated liver cirrhosis
- Infection during treatment or uncontrolled infection 12 Rheumatoid arthritis
13. Acute renal failure
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ferinject 1000 mg
Intravenous Administration of 1000 mg of ferinject Volume of infusion : 250 mL
|
|
Placebo Comparator: Placebo
Intravenous administration of 250 ml of sodium chlorure 0.9 %
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Haemoglobin level
Time Frame: Week 6
|
Week 6
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of the tolerance of intravenous iron supplementation
Time Frame: Day 0
|
Number of Adverse Event (AE) and Serious Adverse Event(SAE) occurence.
|
Day 0
|
Assessment of the tolerance of intravenous iron supplementation
Time Frame: Week 6
|
Number of Adverse Event (AE) and Serious Adverse Event(SAE) occurence.
|
Week 6
|
re-hospitalization rate
Time Frame: Month 6
|
Month 6
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Guillaume SAVOYE, Pr, UH Rouen
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2011/123/HP
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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