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Intravenous iron administration in restless legs syndrome

An observational study in geriatric patients

Intravenöse Eisengabe bei Restless-legs-Syndrom

Eine Beobachtungsstudie bei geriatrischen Patienten

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Abstract

Background

This observational study was carried out to investigate the effect of intravenous (i.v.) iron administration on the clinical symptoms of restless legs syndrome (RLS) in geriatric outpatients over 65 years old.

Methods

In this study geriatric outpatients (mean 4.5 ± 3.4 comorbidities and 5.7 ± 4.4 drugs taken) were recruited according to the following inclusion criteria: ≥ 65 years, diagnosis of RLS due to iron deficiency, i.e. ferritin < 50 µg/l or transferrin saturation (TFS) < 16 %) as well as no other iron therapy within 2 weeks prior to the study. Of the patients 7 (41 %) received 500 mg ferric carboxymaltose (FCM) and 10 patients (59 %) received iron gluconate (62.5 mg) based on the degree of iron deficiency. As assessed by the international RLS severity scale (IRLS) symptoms were recorded 3 times: at the beginning of iron therapy (t0), after 2 weeks (t1) and after 12 weeks (t2).

Results

A total of 17 patients (13 female, 4 male, mean age 73.2 ± 5.9 years) were included. The IRLS score significantly improved in all patients as shown by an average decrease from 30.2 (± 4.3) to 20.2 (± 4.7) (p < 0.001) after 2 weeks of i.v. iron treatment and to 23.2 ± 6.6 (p < 0.001) after 12 weeks. There was a high correlation between ferritin values and the IRLS score (C 0.729, p < 0.001). The part of the IRLS referring to activities of daily living (ADL) improved from a median of 3 (scores 3–4) to 2 (scores 2–3, p = 0.001) after 2 weeks (effect size − 0.6).

Conclusion

In this study group of geriatric outpatients i.v. administration of iron was associated with a significant improvement of symptoms in RLS as assessed by the IRLS score 2 weeks after treatment. In geriatric patients with RLS associated with iron deficiency, i.v. iron administration should be considered regarding improvement of RLS symptoms and ADL.

Zusammenfassung

Hintergrund

Es wurde eine Beobachtungstudie zur Untersuchung der Wirkung der intravenösen (i.v.) Eisengabe auf die klinischen Symptome des Restless-legs-Syndroms (RLS) bei geriatrischen ambulanten Patienten über 65 Jahren durchgeführt.

Methoden

Eingeschlossen wurden Patienten (4,5 ± 3,4 Komorbiditäten, 5,7 ± 4,4 eingenommene Wirkstoffe) gemäß folgender Einschlusskriterien: ≥ 65 Jahre, Eisenmangel assoziiertes RLS (Ferritin < 50 µg/l oder Transferrinsättigung (TFS) < 16 %) sowie keine Eisengabe 2 Wochen vor Studieneinschluss. Sieben Patienten (41 %) erhielten 500 mg Eisencarboxymaltose (FCM) und 10 Patienten (59 %) erhielten Eisenglukonat (62,5 mg) basierend auf der Höhe des Eisenmangels. Mittels International RLS Severity Scale (IRLS), wurde der Schweregrad des RLS dreimal bewertet: zu Beginn der Eisengabe (t0), nach 2 Wochen (t1) und nach 12 Wochen (t2).

Ergebnisse

Siebzehn Patienten (13 weiblich, 4 männlich, mittleres Alter 73,2 ± 5,9 Jahre) wurden eingeschlossen. Der IRLS-Score verbesserte sich signifikant bei allen Patienten, basierend auf einer Abnahme des IRLS-Score von 30,2 (± 4,3) auf 20,2 (± 4,7) (p < 0,001) 2 Wochen nach der i.v. Eisenbehandlung und auf 23,2 ± 6,6 (p < 0,001) nach 12 Wochen. Der Schweregrad des RLS zeigte eine hohe Korrelation mit den gemessenen Ferritinwerten (C 0,729, p < 0,001). Der Teil des IRLS, welcher die Aktivitäten des täglichen Lebens (ADL) abbildet verbesserte sich im Median von 3 [3–4] auf 2 [2–3; p = 0,001)] nach 2 Wochen (Effektgröße − 0,6).

Schlussfolgerung

In diesem geriatrischen ambulanten Kollektiv ist eine i.v. Eisengabe mit einer signifikanten Besserung der RLS Symptome nach 2 Wochen verbunden. Bei geriatrischen Patienten mit Eisenmangel assoziiertem RLS sollte immer auch eine i.v. Eisengabe zur Besserung von RLS und ADL erwogen werden.

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Authors and Affiliations

  1. Department of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany

    Benjamin Lieske, Ralf Joachim Schulz & Gabriele Roehrig MD, MPH

  2. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

    Ingrid Becker

  3. Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Maria Cristina Polidori & Jan Kassubek

  4. Ageing Clinical Research, Department II of Internal Medicine, University of Cologne, Herderstraße 52, 50931, Cologne, Germany

    Gabriele Roehrig MD, MPH

Authors
  1. Benjamin Lieske
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  2. Ingrid Becker
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  3. Ralf Joachim Schulz
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  4. Maria Cristina Polidori
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  5. Jan Kassubek
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  6. Gabriele Roehrig MD, MPH
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Corresponding author

Correspondence to Gabriele Roehrig MD, MPH.

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Conflict of interest

G. Roehrig and R. J. Schulz have received honoraria for academic lectures from viforpharma. J. Kassubek has received personal compensation for activities with UCB Pharma, GlaxoSmithKline, Teva, Medtronic and Boehringer Ingelheim Pharmaceuticals as a consultant and honoraria for academic lectures from Merz and Bayer. M. C. Polidori, I. Becker and B. Lieske declare that there are no conflicts of interest.

The study was approved by the local ethics committees of the University Hospital Cologne (reference nr. 12–273) and the University of Ulm (reference nr. 309/13). All included patients gave written informed consent to participate.

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Lieske, B., Becker, I., Schulz, R. et al. Intravenous iron administration in restless legs syndrome. Z Gerontol Geriat 49, 626–631 (2016). https://doi.org/10.1007/s00391-015-0984-y

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  • DOI: https://doi.org/10.1007/s00391-015-0984-y

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