Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report

on behalf of the, International Restless Legs Syndrome Study Group (IRLSSG)

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children. Methods A literature search was performed to identify papers appearing in MEDLINE from its inception to July 2016. The following inclusion criteria were used: human research on the treatment of RLS or periodic limb movements (PLM) with iron, sample size of at least five, and published in English. Two task force members independently evaluated each paper and classified the quality of evidence provided. Results A total of 299 papers were identified, of these 31 papers met the inclusion criteria. Four studies in adults were given a Class I rating (one for IV iron sucrose, and three for IV ferric carboxymaltose); only Class IV studies have evaluated iron treatment in children. Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children. Conclusions Consensus recommendations based on clinical practice are presented, including when to use oral iron or IV iron, and recommendations on repeated iron treatments. New iron treatment algorithms, based on evidence and consensus opinion have been developed.

Original languageEnglish (US)
Pages (from-to)27-44
Number of pages18
JournalSleep Medicine
Volume41
DOIs
StatePublished - Jan 2018

Fingerprint

Restless Legs Syndrome
Advisory Committees
Practice Guidelines
Consensus
Iron
Therapeutics
Nocturnal Myoclonus Syndrome
saccharated ferric oxide
Ferritins
Guidelines
Serum

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{294b9d9fb54f43db9a97ddf108cdf032,
title = "Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report",
abstract = "Background Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children. Methods A literature search was performed to identify papers appearing in MEDLINE from its inception to July 2016. The following inclusion criteria were used: human research on the treatment of RLS or periodic limb movements (PLM) with iron, sample size of at least five, and published in English. Two task force members independently evaluated each paper and classified the quality of evidence provided. Results A total of 299 papers were identified, of these 31 papers met the inclusion criteria. Four studies in adults were given a Class I rating (one for IV iron sucrose, and three for IV ferric carboxymaltose); only Class IV studies have evaluated iron treatment in children. Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children. Conclusions Consensus recommendations based on clinical practice are presented, including when to use oral iron or IV iron, and recommendations on repeated iron treatments. New iron treatment algorithms, based on evidence and consensus opinion have been developed.",
author = "{on behalf of the} and {International Restless Legs Syndrome Study Group (IRLSSG)} and Allen, {Richard P.} and Picchietti, {Daniel L.} and Michael Auerbach and Cho, {Yong Won} and Connor, {James R.} and Earley, {Christopher J.} and Diego Garcia-Borreguero and Suresh Kotagal and Mauro Manconi and William Ondo and Jan Ulfberg and Winkelman, {John W.}",
year = "2018",
month = "1",
doi = "10.1016/j.sleep.2017.11.1126",
language = "English (US)",
volume = "41",
pages = "27--44",
journal = "Sleep Medicine",
issn = "1389-9457",
publisher = "Elsevier",

}

Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children : an IRLSSG task force report. / on behalf of the; International Restless Legs Syndrome Study Group (IRLSSG).

In: Sleep Medicine, Vol. 41, 01.2018, p. 27-44.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children

T2 - an IRLSSG task force report

AU - on behalf of the

AU - International Restless Legs Syndrome Study Group (IRLSSG)

AU - Allen, Richard P.

AU - Picchietti, Daniel L.

AU - Auerbach, Michael

AU - Cho, Yong Won

AU - Connor, James R.

AU - Earley, Christopher J.

AU - Garcia-Borreguero, Diego

AU - Kotagal, Suresh

AU - Manconi, Mauro

AU - Ondo, William

AU - Ulfberg, Jan

AU - Winkelman, John W.

PY - 2018/1

Y1 - 2018/1

N2 - Background Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children. Methods A literature search was performed to identify papers appearing in MEDLINE from its inception to July 2016. The following inclusion criteria were used: human research on the treatment of RLS or periodic limb movements (PLM) with iron, sample size of at least five, and published in English. Two task force members independently evaluated each paper and classified the quality of evidence provided. Results A total of 299 papers were identified, of these 31 papers met the inclusion criteria. Four studies in adults were given a Class I rating (one for IV iron sucrose, and three for IV ferric carboxymaltose); only Class IV studies have evaluated iron treatment in children. Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children. Conclusions Consensus recommendations based on clinical practice are presented, including when to use oral iron or IV iron, and recommendations on repeated iron treatments. New iron treatment algorithms, based on evidence and consensus opinion have been developed.

AB - Background Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children. Methods A literature search was performed to identify papers appearing in MEDLINE from its inception to July 2016. The following inclusion criteria were used: human research on the treatment of RLS or periodic limb movements (PLM) with iron, sample size of at least five, and published in English. Two task force members independently evaluated each paper and classified the quality of evidence provided. Results A total of 299 papers were identified, of these 31 papers met the inclusion criteria. Four studies in adults were given a Class I rating (one for IV iron sucrose, and three for IV ferric carboxymaltose); only Class IV studies have evaluated iron treatment in children. Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children. Conclusions Consensus recommendations based on clinical practice are presented, including when to use oral iron or IV iron, and recommendations on repeated iron treatments. New iron treatment algorithms, based on evidence and consensus opinion have been developed.

UR - http://www.scopus.com/inward/record.url?scp=85038843253&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038843253&partnerID=8YFLogxK

U2 - 10.1016/j.sleep.2017.11.1126

DO - 10.1016/j.sleep.2017.11.1126

M3 - Article

C2 - 29425576

AN - SCOPUS:85038843253

VL - 41

SP - 27

EP - 44

JO - Sleep Medicine

JF - Sleep Medicine

SN - 1389-9457

ER -