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Rheumatology International

, Volume 17, Issue 2, pp 67–73 | Cite as

Availability of iron and degree of inflammation modifies the response to recombinant human erythropoietin when treating anemia of chronic disease in patients with rheumatoid arthritis

  • D. Nordström
  • Y. Lindroth
  • L. Marsal
  • I. Hafström
  • C. Henrich
  • S. Rantapää-Dahlqvist
  • F. Fyhrquist
  • C. Friman
  • E. Engström-Laurent
ORIGINAL ARTICLEORIGINAL ARTICLE

Abstract

Forty-six patients with rheumatoid arthritis (RA) and documented anemia of chronic disease (Hb <100/110 g/l) were randomized to receive either human recombinant erythropoietin (r-HuEPO, n = 36, 300 U/kg body weight) or placebo (n = 10) for 12 weeks in a multicenter study. An adequate response was defined as elevation of Hb≥120 g/l. Relevant clinical and laboratory assessments were made to evaluate efficacy and secure safety. A significant elevation in Hb from week 10 onwards was noted in twenty-six patients (five drop-outs) out of nine patients receiving placebo (one drop-out) (12±1.2 g/l vs 4±0.5 g/l; Hb elevation from 95 g/l to 107 g/l vs 93 g/l to 97 g/l, P<0.05). Only 14.6%, however, were considered responders according to preset criteria. In the responders a lower initial CRP, a significant reduction in ESR but not in CRP was seen compared to the remaining r-HuEPO group. A significant elevation of energy level was noted in the r-HuEPO group; otherwise, no differences in clinical variables were seen. No serious adverse effects were noted. When analyzing patients receiving oral iron in combination with r-HuEPO and adding five additional, openly selected patients receiving both adequate iron supplementation and r-HuEPO, there was a significant weekly elevation of Hb from week 8 onwards in favor of combination therapy over the ones only receiving r-HuEPO (18±1.1 g/l vs 7±1.1 g/l, P<0.05). The initial six responders had now reached ten of whom seven belonged to the combination therapy group. Response to r-HuEPO in RA patients appears to be dependent on availability of iron and on the degree of inflammation. If r-HuEPO treatment is considered, iron deficiency should always be corrected and strenous efforts should have been made to control the disease itself.

Key words Anemia of chronic disease Rheumatoid arthritis Erythropoietin Iron supplementation Inflammation 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • D. Nordström
    • 1
  • Y. Lindroth
    • 2
  • L. Marsal
    • 3
  • I. Hafström
    • 4
  • C. Henrich
    • 5
  • S. Rantapää-Dahlqvist
    • 6
  • F. Fyhrquist
    • 8
  • C. Friman
    • 1
  • E. Engström-Laurent
    • 7
  1. 1.Department of Rheumatology, Helsinki University Central Hospital, Kaserngatan 11 – 13, FIN-00130, Helsinki, Finland Tel: +358+0+4711, fax: int+358+0+4714048, e-mail: dan.nordstrom@huch.fiFI
  2. 2.Department of Rheumatology, General Hospital, Malmö, SwedenSE
  3. 3.Slottstadens Läkargrupp, Malmö, SwedenSE
  4. 4.Department of Rheumatology, Southern Hospital, Stockholm, SwedenSE
  5. 5.Department of Rheumatology, Central Hospital, Eskilstuna, SwedenSE
  6. 6.Department of Rheumatology, University Hospital, Umeå, SwedenSE
  7. 7.Department of Rheumatology, Falu Hospital, SwedenSE
  8. 8.Department of Medicine, Helsinki University, Helsinki, FinlandFI

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