Patients with and without rheumatoid arthritis benefit equally from preoperative epoetin-alpha treatment.
BACKGROUND
Preoperative epoetin-alpha administration is said to have a limited effect in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA), due to lower iron availability. We studied the effects of preoperative epoetin-alpha treatment in orthopedic surgery patients in a daily life setting in which iron supplementation was assured, and compared the effects in RA and non-RA patients.


METHODS
In an open, naturalistic, randomized controlled trial, 695 orthopedic surgery patients with preoperative hemoglobin (Hb) values of 10-13 g/dL, either with RA (113) or without RA (582), received either preoperative epoetin-alpha treatment added to standard care, or standard care alone. Hb values and transfusions were evaluated from entry into the study until 4-6 weeks after surgery.


RESULTS
Both in RA and non-RA patients, perioperative Hb values were significantly higher and transfusion requirements were significantly lower in epoetin-alpha treated patients than in control patients (p < 0.001). In RA patients, the outcomes regarding Hb values were not significantly or relevantly different from non-RA patients.


CONCLUSIONS
Just as with orthopedic patients in general, RA patients benefit from preoperative epoetin-alpha treatment in combination with iron supplementation. We postulate that iron supplementation during epoetin-alpha therapy in RA patients is important for optimal efficacy.
Slappendel
Robert
R
Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, the Netherlands. r.slappendel@maartenskliniek.nl
Weber
Eric W G
EW
Hémon
Yves J M
YJ
Mähler
Stefan
S
Dalén
Tore
T
Rouwet
Eduard F A M
EF
van Os
Johannes J
JJ
Vosmaer
Alexander
A
van der Ark
Peter D
PD
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011292:Premedication; D011994:Recombinant Proteins; D013122:Spinal Diseases / Q000601:surgery; D016896:Treatment Outcome
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D007501:Iron