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. 2015 Jul;21(7):1587-93.
doi: 10.1097/MIB.0000000000000417.

The Influence of Anti-tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease

Ioannis E Koutroubakis  1 , Claudia Ramos-Rivers, Miguel Regueiro, Efstratios Koutroumpakis, Benjamin Click, Marc Schwartz, Jason Swoger, Leonard Baidoo, Jana G Hashash, Arthur Barrie, Michael A Dunn, David G Binion
Affiliations

The Influence of Anti-tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease

Ioannis E Koutroubakis et al. Inflamm Bowel Dis. 2015 Jul.

Abstract

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.

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Figures

Figure 1
Figure 1
The prevalence of anemia in inflammatory bowel disease patients (N=352) and subgroups of them treated with anti-TNF agents at year 0 and year 1. In all comparisons P>0.05 IBD, inflammatory bowel disease; IBDA, inflammatory bowel disease (whole cohort) with anemia; IBDSA, inflammatory bowel disease with severe anemia (Hb<10g/dL), CDA, Crohn’s disease (all patients) with anemia; CDSA Crohn’s disease with severe anemia; UCA, ulcerative colitis (all patients) with anemia; UCSA, ulcerative colitis with severe anemia
Figure 2
Figure 2
Box and Whisker plots of median changes in minimum hemoglobin levels in groups of inflammatory bowel disease patients treated with anti-TNF agents IBD, inflammatory bowel disease; IBDA, inflammatory bowel disease with anemia; IBDSA, inflammatory bowel disease with severe anemia (Hb<10g/dL); IBDNA, inflammatory bowel disease with non-anemia
See this image and copyright information in PMC

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