Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia

OBJECTIVE: Inflammatory bowel disease (IBD)-associated anemia responds to i .v. iron therapy. However, because of concurrent chronic inflammation, some patients do not respond adequately. Erythropoietin therapy has been shown to be effective in the latter cohort. Our goal was to find parameters that can predict the effectiveness of iron sucrose in IBD-associated anemia. METHODS: One hundred three patients with severe IBD-associated anemia (Hb l ess than or equal to 10.5 g/dl) were treated prospectively for 4 wk with ir on sucrose (total iron dose = 1.2 g) in an open label, multicenter trial. T reatment response was defined as an increase in Hb of greater than or equal to2.0 g/dl. A logistic regression analysis was performed with treatment re sponse as the dependent variable and the following independent variables: s erum erythropoietin, mean corpuscular Hb, transferrin, ferritin, soluble tr ansferrin receptor (sTfR), C-reactive protein, interleukin 6 (IL-6), and di sease activity. RESULTS: Sixty-seven of 103 patients (65%) responded to iron sucrose. From the variables under investigation, erythropoietin, sTfR, transferrin, and I L-6 were significantly associated with treatment response. The R-2 values s howed that erythropoietin (8.0%), sTfR (11.4%), and transferrin (10.4%), bu t not IL-6 (1.3%), contribute a relevant amount of information to the model . An estimated 80% probability of treatment response was found at erythropo ietin levels of > 166 U/L, sTfR levels of > 75 nmol/L, or transferrin level s of >3.83 g/L. CONCLUSIONS: Serum erythropoietin, STIR, and transferrin concentrations hav e the potential to predict the response to iron sucrose therapy in IBD-asso ciated anemia. These parameters may help to identify individuals who benefi t the most from additional erythropoietin treatment. (C) 2001 by Am. Coll. of Gastroenterology.