Clinical significance of C-reactive protein levels in predicting responsiveness to iron therapy in patients with inflammatory bowel disease and iron deficiency anemia

Tariq Iqbal, Jürgen Stein, Naveen Sharma, Stefanie Kulnigg-Dabsch, Senthil Vel, Christoph Gasche, Tariq Iqbal, Jürgen Stein, Naveen Sharma, Stefanie Kulnigg-Dabsch, Senthil Vel, Christoph Gasche

Abstract

Background: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD). In clinical practice, many patients receive initial treatment with iron tablets although intravenous (i.v.) iron supplementation is often preferable.

Aim: This study investigated whether systemic inflammation at initiation of treatment (assessed by C-reactive protein [CRP] and interleukin-6 [IL-6] measurements) predicts response to iron therapy.

Methods: Data from a previously published phase III trial were retrospectively analyzed after stratification of patients according to baseline CRP (> 4 vs. ≤ 4 mg/L) and IL-6 (> 6 vs. ≤ 6 pg/mL) levels. The study population consisted of patients with Crohn's disease or ulcerative colitis and IDA (Hb ≤ 110 g/L and TSAT < 20 % or serum ferritin < 100 ng/mL), randomized to either oral (ferrous sulfate) or i.v. iron (ferric carboxymaltose).

Results: A total of 196 patients were evaluated (oral iron: n = 60; i.v. iron: n = 136). Baseline CRP and IL-6 levels were independent of patients' initial Hb levels and iron status (serum ferritin and TSAT; all p > 0.05). Among iron tablet-treated patients, Hb increase was significantly smaller in the high- versus low-CRP subgroup (1.1 vs. 2.0, 2.3 vs. 3.1, and 3.0 vs. 4.0 g/dL at weeks 2, 4, and 8, respectively; all p < 0.05). Differences were less pronounced with stratification according to baseline IL-6. Response to i.v. iron was mainly independent of inflammation.

Conclusions: Patients with high baseline CRP achieved a lower Hb response with oral iron therapy. Our results suggest that CRP may be useful to identify IBD patients who can benefit from first-line treatment with i.v. iron to improve their IDA.

Figures

Fig. 1
Fig. 1
Responsiveness of IBD patients with high versus low baseline CRP. †Least-squares means ± standard errors, adjusted for gender and baseline Hb. CD Crohn‘s disease, CRP C-reactive protein, Hb hemoglobin, i.v. intravenous, UC ulcerative colitis
Fig. 2
Fig. 2
Responsiveness of IBD patients with high versus low baseline IL-6. †Least-squares means ± standard errors, adjusted for gender and baseline Hb. CD Crohn‘s disease, Hb hemoglobin, IL-6 interleukin-6, i.v. intravenous, UC ulcerative colitis

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