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P457 Anti-TNF therapy successfully improves anemia in Inflammatory Bowel Disease - Results from a tertiary referral center

M. Moura*, S. Fernandes, P. Sousa, P. Santos, C. Baldaia, A.R. Gonçalves, A. Valente, P. Moura Santos, L. Correia, F. Serejo, J. Velosa

Hospital de Santa Maria - CHLN, Serviço de Gastrenterologia e Hepatologia, Lisboa, Portugal


BACKGROUND: Anemia is a frequently overlooked complication of inflammatory bowel disease (IBD) but studies have reported a prevalence ranging from 6% to 74%. In IBD, anemia results from a combination of complex mechanisms, though iron deficiency and inflammation play major roles. Anemia has been associated with increased healthcare utilization and reduced quality of life in IBD patients.

AIM: Our primary goal was to determine the prevalence of anemia in active Ulcerative Colitis (UC) and Crohn's Disease (CD) and determine the impact of anti-TNF therapy on hemoglobin levels. We also assessed possible predictors of response.


METHODS: We retrospectively reviewed patients with moderate to severe UC and CD followed in our institution assigned to start anti-TNF therapy. Prevalence of anemia was determined prior to starting Infliximab (IFX) or Adalimumab (ADA) and after one year of therapy. Patients who discontinued anti-TNF therapy before the end of study were excluded. Anemia was defined as a hemoglobin level lower than 12 g/dL in women and 13 g/dL in men.


211 patients (182 CD, 29 UC) met our inclusion criteria. Anti-TNF therapy included IFX in 161 patients (138 CD, 23 UC) and ADA in 50 patients (44 CD, 6 UC). At baseline 85 patients were under immunomodulation (76 CD, 9 UC).

The overall prevalence of anemia in our population at baseline was 33.2%. Hemoglobin levels were inversely correlated with C-reactive-protein (CRP) levels at baseline (Spearman's rho -0.183, p<0.001). A negative CRP (<0.5 mg/dL) had a positive predictive value of 74.7% for the absence of anemia.

There was no statistically significant association between the presence of anemia at baseline and IBD subtype (p=0.31), gender (p=0.4) and immunomodulation therapy (p=0.121).

After one year of therapy there was a statistically significant decrease in the prevalence of anemia (33.2% vs. 11.0%, p<0.005). CRP levels were significantly lower in patients who corrected anemia (1.27 mg/dL vs. 0.62 mg/dL, p=0.002). Combined immunomodulation had no impact on response (p=0.29).


CONCLUSIONS: Anemia is a common complication in IBD. Anti-TNF therapy is associated with a decrease in the prevalence of anemia and levels of CRP in moderate to severe IBD. This effect supports the importance of inflammation in the pathogenesis of anemia.