Erythropoietin plus iron relieves arthritis-related anemia of chronic disease


NEW YORK (Reuters Health) – Recombinant human erythropoietin (rHu-Epo), in combination with intravenous iron replacement, corrects the anemia of chronic disease associated with rheumatoid arthritis, according to a report in the November Journal of Rheumatology.

Anemia of chronic disease affects 20% to 50% of rheumatoid arthritis patients, the authors explain, but functional iron deficiency limits their responsiveness to rHu-Epo.

Dr. Joachim Kaltwasser from J.W. Goethe-Universitat in Frankfurt/Main, Germany and colleagues investigated, for the first time, intravenous iron supplementation during rHu-Epo treatment in 23 patients with rheumatoid arthritis.

These 23 patients developed functional iron deficiency during treatment with rHu-Epo and were treated with 200 mg iron-sucrose weekly, in addition to 150 IU/kg rHu-Epo, the report indicates. Treatment was continued until hemoglobin concentrations increased above 13 g/dL (women) or 14 g/dL (men).

All patients experienced a correction of their anemia after a mean treatment period of 8.7 weeks, the authors report. Erythrocyte sedimentation rates (ESR) also fell from 35.1 mm/h to 19.3 mm/h during treatment.

Treatment also brought a significant increase in muscle strength and improvements in disease activity scores, the researchers note, both of which were reflected by an increase in vitality as measured by the SF-36VT component of the health related quality of life assessment.

After rHu-Epo treatment was terminated, the results indicate, hemoglobin levels fell to 12.6 g/dL after 1 month and to 11.6 g/dL after 3 months. Muscle strength and vitality also decreased in the months after termination of treatment.

"Epo can correct the anemia of chronic inflammatory diseases like RA due to its stimulating effect on the hypoplastic erythropoiesis in those patients and due to [a poorly understood] effect on cytokine mediated inflammation," Dr. Kaltwasser told Reuters Health.

"We would recommend that physicians should consider the use of rHu-Epo (or the new AraNESP) for treatment of patients with anemia of chronic disease in inflammatory active RA and other inflammatory autoimmune diseases (including also SLE, Crohn's disease, ankylosing spondylitis, and others)," Dr. Kaltwasser concluded.

"EPO induces a dramatic increase of erythropoietic proliferation and iron requirements of the erythropoiesis," Dr. Kaltwasser said. "In a significant proportion of patients, [this] can not be supplied by the endogenous iron reserve and therefore requires parenteral iron supplementation in order to achieve an optimum result."

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