Recombinant human erythropoietin for treatment of anemia of chronic disease in children with Crohn's disease,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70503-7Get rights and content

Abstract

We evaluated the efficacy and safety of and compliance with rH-EPO (150 U/kg three times a week subcutaneously for up to 12 weeks) for treatment of anemia in childhood Crohn's disease (n = 4). The mean hemoglobin level before rH-EPO therapy was 109 gm/L (10.9 gm/dl) (range, 103 to 115 gm/L). The mean hemoglobin level in the three compliant children increased to 138 gm/L (13.8 gm/dl) after treatment. Response time for the correction of anemia ranged from 6 to 12 weeks (mean, 9.5 weeks). Resolution of symptoms of lethargy, poor appetite, and irritability occurred with correction of the anemia. The only adverse effect observed was transient local pain at the injection site.(J Pediatr 1998;132:155-9).

Section snippets

Entry Criteria

Children recruited for the study were 1 to 17 years of age with Crohn's disease, with a stable therapy regimen, who had ACD refractory to oral iron therapy. A stable therapy regimen was defined as one with no change in antiinflammatory medications or dosage for at least 3 months before treatment with rH-EPO. Anemia was defined as a hemoglobin level 2.5 SD or more below the mean for age and sex,9 and was considered refractory to iron therapy (6 mg/kg per day) if the elevation of hemoglobin was

Results

A total of 109 children with inflammatory bowel disease were assessed during an 8-month period. Of these, four children with Crohn's disease, ages 2.6 to 17 years (mean age 12.0 year), had ACD and met the inclusion criteria. Crohn's disease had been diagnosed 12 months to 7 years before starting rH-EPO therapy. All had endoscopic and histologic evidence of Crohn's disease involving the colon and terminal ileum, and two had antroduodenitis at the time of diagnosis. All 4 patients were taking

Discussion

Intestinal blood loss and chronic inflammation are regarded as the most important mechanisms in the pathogenesis of anemia in Crohn's disease.13 Patients with Crohn's disease who have anemia may have a combination of both mechanisms in different proportions, and therefore an increased iron intake will correct the anemia in some but not all patients.13 It has been estimated that up to 51% of adults with Crohn's disease had ACD.14

The pathogenesis of ACD is not yet fully established. From in vitro

References (26)

  • L Demirtürk et al.

    Serum erythropoietin levels in patients with severe anemia secondary to inflammatory bowel disease and the use of human recombinant erythropoietin in patients with anemia refractory to treatment

    Dis Colon Rectum

    (1995)
  • KP Morris et al.

    Short term correction of anaemia with recombinant human erythropoietin and reduction of cardiac output in end stage renal failure

    Arch Dis Child

    (1993)
  • Cited by (29)

    • Recombinant human erythropoietin in patients with inflammatory bowel disease and refractory anemia: A 15-year single center experience

      2012, Journal of Crohn's and Colitis
      Citation Excerpt :

      However, in IBD anemic patients this EPO increase is inadequate in relation to the degree of anemia.16,17 Correction of anemia through the administration of oral or intravenous (I.V.) iron and/or supplemental recombinant human EPO or darbepoetin19 in refractory patients has been shown to improve hematologic indices and quality of life.20–22 In this study we aimed to report our experience on patients' response and safety to EPO administration in a cohort of refractory to I.V. iron anemic patients with IBD.

    View all citing articles on Scopus

    From the Division of Gastroenterology and Department of Pathology, University of British Columbia and B.C. Children's Hospital, Vancouver, British Columbia, Canada.

    ☆☆

    Supported by a grant from Ortho-McNeil, North York, Ontario, Canada.

    Reprint requests: David M. Israel, MD, Division of Pediatric Gastroenterology, University of British Columbia, 4480 Oak St., Vancouver, BC, Canada V6H 3V4.

    ★★

    9/22/79704

    View full text