Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab

Authors

  • Jürgen Braun,

    Corresponding author
    1. Rheumazentrum Ruhrgebiet, Herne, Germany
    • Rheumazentrum Ruhrgebiet, Landgrafenstr.15, 44652 Herne, Germany
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    • Dr. Braun has received honoraria for talks, advisory boards, and grants (less than $10,000 each) from Centocor, Schering-Plough, Wyeth, Amgen, Abbott, Roche, Bristol-Myers Squibb, Novartis, Pfizer, and Merck Sharp & Dohme.

  • Désirée van der Heijde,

    1. Leiden University Medical Center, Leiden, The Netherlands
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    • Dr. van der Heijde has received research grants and/or consulting fees (less than $10,000 each) from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Chugai, Novartis, Pfizer, Schering-Plough, Roche, and Wyeth, and has received research grants and/or consulting fees (more than $10,000) from UCB.

  • Mittie K. Doyle,

    1. Centocor Research and Development, Malvern, Pennsylvania, and the University of Pennsylvania School of Medicine, Philadelphia
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    • Drs. Doyle, Han, Visvanathan, and Rahman and Mr. Xu own stock in Johnson & Johnson, of which Centocor is a wholly owned subsidiary.

  • Chenglong Han,

    1. Centocor Research and Development, Malvern, Pennsylvania
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    • Drs. Doyle, Han, Visvanathan, and Rahman and Mr. Xu own stock in Johnson & Johnson, of which Centocor is a wholly owned subsidiary.

  • Atul Deodhar,

    1. Oregon Health and Science University, Portland
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    • Dr. Deodhar has received payments for educational lectures, teleconferences, and serving on advisory boards (less than $10,000 each) from Genentech and Centocor (this potential conflict of interest has been reviewed and managed by Oregon Health & Science University).

  • Robert Inman,

    1. University Health Network, Toronto, Ontario, Canada
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    • Dr. Inman has received consultancies, speaking fees, and/or honoraria (less than $10,000 each) from Schering-Plough, Centocor, Abbott, and Amgen.

  • Kurt de Vlam,

    1. University Hospital Leuven, Leuven, Belgium
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    • Dr. de Vlam has received consulting fees (less than $10,000 each) from Schering-Plough, Centocor, UCB, and Wyeth.

  • Gerd R. Burmester,

    1. Charité-University Hospital Berlin, Berlin, Germany
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    • Dr. Burmester has received honoraria for consulting and lectures (less than $10,000 each) from Centocor and Essex.

  • Filip Van den Bosch,

    1. University Hospital Gent, Gent, Belgium
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  • Stephen Xu,

    1. Centocor Research and Development, Malvern, Pennsylvania
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  • Sudha Visvanathan,

    1. Centocor Research and Development, Malvern, Pennsylvania
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    • Drs. Doyle, Han, Visvanathan, and Rahman and Mr. Xu own stock in Johnson & Johnson, of which Centocor is a wholly owned subsidiary.

  • Mahboob U. Rahman

    1. Centocor Research and Development, Malvern, Pennsylvania, and the University of Pennsylvania School of Medicine, Philadelphia
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Abstract

Objective

Anemia is a common complication in patients with inflammatory diseases such as ankylosing spondylitis (AS). This post hoc analysis of a large, randomized, placebo-controlled trial examined the effect of infliximab on hemoglobin levels, physical function, and fatigue in patients with AS.

Methods

Patients received infliximab 5 mg/kg (n = 188) or placebo (n = 68) at weeks 0, 2, 6, 12, and 18. Hemoglobin, interleukin-6 (IL-6), and C-reactive protein (CRP) levels, fatigue (visual analog scale [VAS]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), and disease activity were evaluated at baseline and week 24. Anemia was defined as a hemoglobin level <12 gm/dl for women and <13 gm/dl for men.

Results

At baseline, 11 placebo group patients (16.2%) and 37 infliximab group patients (19.7%) had anemia. Of these, more infliximab-treated patients achieved normal hemoglobin levels at week 24 compared with patients receiving placebo (70.3% versus 27.3%; P = 0.0155). Infliximab-treated patients had significant improvements in mean hemoglobin concentration (0.7 gm/dl versus −0.3 gm/dl), BASFI score (−2.1 versus −0.2), and fatigue VAS score (−2.4 versus −0.4) compared with placebo patients (P < 0.001). Multiple regression analyses showed that improvements in hemoglobin level were significantly and independently associated with improvements in physical function and fatigue. Infliximab-treated patients with elevated CRP or IL-6 levels at baseline were more likely than those with low levels to have improvement in hemoglobin levels.

Conclusion

Infliximab treatment significantly decreased the proportion of AS patients with anemia and improved hemoglobin levels compared with placebo. Improvement in hemoglobin level was independently associated with improvements in physical function and fatigue.

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