The Influence of Anti-tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease.
BACKGROUND
Anti-tumor necrosis factor (TNF) agents are an important component of inflammatory bowel disease (IBD) treatment, but data on their influence on anemia, a frequent complication of IBD, are limited. The aim of this study was to evaluate the effect of anti-TNF agents on hemoglobin (Hb) levels in a large IBD cohort.


METHODS
Prospectively collected demographic, clinical, laboratory, and treatment data from IBD patients who started anti-TNF treatment at a tertiary referral center during the years 2010 to 2012 were analyzed. Follow-up data including disease activity scores (Harvey-Bradshaw index or ulcerative colitis activity index), quality of life scores (short IBD questionnaire) completed at each visit, and laboratory data were analyzed. Data from the year of anti-TNF initiation (yr 0) to the following year (yr 1) were compared.


RESULTS
A total of 430 IBD patients (324 with Crohn's disease, 51.6% females) started anti-TNF treatment. The prevalence of anemia and median Hb levels did not change between years 0 and 1. Median short IBD questionnaire was significantly improved at year 1 (P = 0.002). IBD patients with anemia had significantly higher median Hb levels at year 1 compared with year 0 (P = 0.0009). Hematopoietic response (increase of Hb ≥2 g/dL) was observed in only 33.6% of the 134 anemic IBD patients, despite iron replacement being administered in 126 anemic patients (oral, 77%). Improvement in Hb levels was independently significantly correlated with change of C-reactive protein levels (P = 0.04) and immunomodulator use (P = 0.03).


CONCLUSIONS
Anemia remains a significant manifestation of IBD 1 year after treatment with anti-TNF agents.
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ioannis E
IE
Koutroubakis
Claudia
C
Ramos-Rivers
Miguel
M
Regueiro
Efstratios
E
Koutroumpakis
Benjamin
B
Click
Marc
M
Schwartz
Jason
J
Swoger
Leonard
L
Baidoo
Jana G
JG
Hashash
Arthur
A
Barrie
Michael A
MA
Dunn
David G
DG
Binion
D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000740:Anemia / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D058085:Iron Compounds / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D006454:Hemoglobins; D058085:Iron Compounds; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab