Sequential treatment of anemia in ulcerative colitis with intravenous iron and erythropoietin.
BACKGROUND
Intravenous iron and erythropoietin have been shown to be effective in Crohn's disease-associated anemia. The aim of this study was to test the sequential treatment of anemia in ulcerative colitis with intravenous iron in the first phase and erythropoietin in the second.


METHODS
Twenty patients with ulcerative colitis-associated anemia (hemoglobin < or = 10.5 g/dl) entered this open-label trial. In the first phase all patients received intravenous iron saccharate for 8 weeks. A response was defined as an increase in hemoglobin > or = 2.0 g/dl; a final hemoglobin >10.5 g/dl was regarded as full response, < or = 10.5 g/dl as partial response. A hemoglobin increase < 2.0 g/dl was regarded as nonresponse. In the second phase (n = 4) erythropoietin was initiated in patients without response. Patients with partial response were continued on iron saccharate for another 8 weeks.


RESULTS
During the first phase the hemoglobin increased from 8.3 to 11.9 g/dl (mean hemoglobin difference 3.6+/-2.3 g/dl, p < 0.001). Fifteen patients (75%) showed a full response (mean hemoglobin difference 4.5+/-1.5 g/dl), 1 (5%) a partial response (hemoglobin difference 2.1 g/dl) and 4 no response (mean hemoglobin difference 0.4+/-1.8 g/dl) with a need for blood transfusions in a single patient. In the second study phase erythropoietin was highly effective in previous nonresponders (mean hemoglobin difference 3.3+/-1.9 g/dl). The single patient with partial response had a minor hemoglobin increase (hemoglobin difference 1.0 g/dl).


CONCLUSIONS
Most patients with ulcerative colitis-associated anemia improve on intravenous iron alone. Erythropoietin is effective in those who do not respond.
Gasche
C
C
University of California, San Diego, La Jolla, Calif., USA. cgasche@ucsd.edu
Dejaco
C
C
Reinisch
W
W
Tillinger
W
W
Waldhoer
T
T
Fueger
G F
GF
Lochs
H
H
Gangl
A
A
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D000077605:Ferric Oxide, Saccharated; D005500:Follow-Up Studies; D005937:Glucaric Acid; D005938:Glucocorticoids / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007275:Injections, Intravenous; D008297:Male; D011994:Recombinant Proteins; D017701:Reticulocyte Count; D016896:Treatment Outcome
D005290:Ferric Compounds; D005938:Glucocorticoids; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D002097:C-Reactive Protein; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid