Effects of anti-TNF-alpha therapy on hemoglobin levels and anemia in patients with inflammatory bowel disease

Background: Tumor necrosis factor-alpha (TNF-alpha) is involved in inducing inflammatory anemia. The potential effect of anti-TNF-alpha agents on anemia in inflammatory bowel diseases (IBD) is still unknown. Methods: Analytical data and disease characteristics from 362 IBD patients [271 CD/91UC) treated with anti-TNF-alpha drugs were retrospectively collected. Effects on disease activity, blood markers and prevalence of anemia were assessed after 6 and 12 months of therapy. Results: 29.3% patients presented anemia at baseline, and significantly reduced to 14.4% and 7.8% after 6 and 12 months of therapy, respectively. Mean +/- SD Hb levels increased significantly at month 6, and this increase was sustained at 12 months. Serum markers of iron metabolism increased significantly compared to baseline, as disease activity measured by C-reactive protein (CRP) was reduced. All these effects were observed independently for CD and UC, and were independent of iron supplementation during treatment. Anemia at baseline (OR 4.09; 95%CI 1.98-8.45) and elevated CRP (OR 3.45; 95CI 1.29-9.22) were independently associated with risk of persistent anemia, as well as iron replacement during therapy (OR 4.36; 95%CI 2.07-9.16). Conclusions: Controlling disease activity with anti-TNF-alpha therapy significantly and independently associated with resolution of anemia in IBD, with no relevant role for iron replacement therapy. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.