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P249 What’s the role of anti-TNF α in correcting anemia in Crohn’s disease?

Hassine, A.(1);Hammami, A.(1);Jaziri, H.(1);Elleuch, N.(1);Ksiaa, M.(1);Ben Slama, A.(1);Jmaa, A.(1);

(1)Hôpital universitaire Sahloul, service de gastro-entérologie, Sousse, Tunisia

Background

Anemia is the most common extra intestinal complication in Inflamatory Bowel Diseases (IBD) affecting the quality of life of patients. Iron deficiency and inflammation are the two most common mechanisms. It has been suggested that controlling disease activity is sufficient to correct well-tolerated anemia. Anti-TNF α by their powerful anti-inflammatory action and their role in increasing the growth of erythroid progenitors can lead to correction of anemia. The aim of this work was to determine the effect of anti-TNFα on the course of anemia in Crohn’s disease (CD).

Methods

This is a single-center retrospective study including patients followed for CD, between 2011 and 2017, on anti-TNF. Anemia was tested in these patients before the initiation of anti-TNF. After six months of treatment, a correlation between the achievement of therapeutic efficacy and the correction of the anemia was sought. The judgment criteria adopted were: clinical response (CDAI score <150 points), mucosal healing at endoscopy (absence of ulcerations), and normalization of the C-reactive protein (CRP <5mg / l).

Results

120 patients were included, 60% of whom are female. The mean age at diagnosis was 29.8 years [12-56 years]. The mean duration of the disease was 7.42 ± 4.8 years. The disease phenotype was penetrating in 55% of cases and structuring in 45% of patients. Anoperineal manifestations (PAD) were noted in 20% of patients. 50% of patients were on Adalimumab, 50% on Infliximab and 45% of cases were on combination therapy. The indications for Biotherapy were: the presence of anoperineal manifestations (20%), failure of immunosuppressants (25%), postoperative recurrence (20%), intolerance to immunosuppressants (20%), and extradigestive manifestations in particular articular (15%). Pre-therapy, anemia was noted in 84 patients (70%), most of whom had chronic microcytic hypochromic anemia. The presence of anemia was well correlated with disease activity (p = 0.038). During the control, correction of anemia was obtained in 72 patients (60%), with a statistically significant association with the therapeutic efficacy criteria (clinical response: p <10-3, mucosal healing: p = 0.009, normalization of CRP: p <10-3).

Conclusion

Our study showed the effectiveness of anti-TNF alpha agents in correcting anemia in Crohn's disease. Larger scale studies are needed to confirm our results.

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