Conflict of interest: Consultant, Luitpold Pharma
Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia
Article first published online: 18 JAN 2013
Copyright © 2012 Wiley Periodicals, Inc.
American Journal of Hematology
Volume 88, Issue 2, pages 97–101, February 2013
How to Cite
Bregman, D. B., Morris, D., Koch, T. A., He, A. and Goodnough, L. T. (2013), Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia. Am. J. Hematol., 88: 97–101. doi: 10.1002/ajh.23354
Author Contribution DBB, DM, and TAK designed the research and analyzed the data; DM also performed statistical analysis; LTG designed the research, participated in the analysis of the data, and the writing of the manuscript; AH analyzed the data and generated the initial draft of the manuscript. DBB and TAK are employees of Luitpold Pharmaceuticals, the Sponsor of the study. AH is an employee of St. John's University. DM and LTG are consultants for Luitpold Pharmaceuticals.
- Issue published online: 24 JAN 2013
- Article first published online: 18 JAN 2013
- Accepted manuscript online: 17 NOV 2012 03:06AM EST
- Manuscript Accepted: 15 OCT 2012
- Manuscript Received: 11 OCT 2012
Levels of hepcidin, a major regulator of iron homeostasis, may identify patients with iron deficiency anemia (IDA) who will not respond to oral iron therapy. In this study, IDA patients underwent a 14-day trial (run-in) course of ferrous sulfate therapy. Nonresponders (Hgb increase <1 g/dL with 67% compliance rate) were randomized to IV ferric carboxymaltose (FCM; two injections of 750 mg) or further oral iron for 14 days. Screening hepcidin levels were 38.4 versus 11.3 ng/mL, P = 0.0002 in nonresponders versus responders to a trial of oral iron. Hepcidin of > 20 ng/mL, showed sensitivity of 41.3%, specificity of 84.4%, and positive predictive value of 81.6% for predicting nonresponsiveness to oral iron. PPVs for ferritin> 30 ng/mL or transferrin saturation (TSAT)>15% were 59.2 and 55%, respectively. Negative predictive values for hepcidin, ferritin, and TSAT were 46.3, 22.7, and 19.7, respectively. FCM versus oral iron showed Hgb increases of ≥1 gm/dL in 65.3% versus 20.8% (P < 0.0001) and Hgb increases of 1.7 ± 1.3 versus 0.6 ± 0.9 g/dL (P = 0.0025), respectively. We conclude that hepcidin predicts nonresponsiveness to oral iron in patients with IDA and is superior to TSAT or ferritin for this purpose. Nonresponse to oral iron therapy does not rule out IDA, since two-thirds of patients subsequently responded to intravenous iron. Am. J. Hematol. 88:97–101, 2013. © 2012 Wiley Periodicals, Inc.