IBD Watch^®

^{Timely Information for Practicing Physicians}

 SEPTEMBER 2004

Iron deficiency anemia.  Christophe Gasche and coworkers at the Medical University of Vienna (Vienna, Austria) review their clinical experience in IBD patients with anemia.  They report that one third of patients with IBD suffer from recurrent anemia and that anemia-induced fatigue can be as debilitating to patients as abdominal pain or diarrhea.  The authors have found that combination therapy with iron sucrose and erythropoietin successfully treats IBD-associated anemia in virtually all cases.  Measurements of iron stores should be monitored to guide the need for continued iron therapy.  (Gasche C, et al. Gut 2004;53:1190-1197)

Correlation of azathioprine thioguanine nucleotide (TGN) metabolite levels and disease activity.  S. Wright and colleagues measured serial TGN levels over 2 years in 159 patients with IBD to investigate the relationship between TGN concentrations and disease activity.  There were 131 evaluable patients.  Patients who remained in remission had higher mean TGN levels than those who developed active disease (p = 0.04).  Intrapatient TGN concentration variation was found to be 1-5 fold.  Methylmercaptopurine nucleotide concentrations were not related to azathioprine efficacy or toxicity.  This study showed that lower TGN concentrations were associated with the development of active disease in IBD patients.  However, TGN measurements were not advocated for routine clinical use due to the high intrapatient variability in TGN concentration.  (Wright S, et al. Gut 2004;53: 123-1128)

Enteric infection at relapse.  Maria Mylonaki and others retrospectively obtained stool microbiology results in 237 flares among 213 patients with IBD during the period of 1997 to 2001.  Enteric infection was detected in 25 (10.5%) relapses in 24 patients.  Thirteen relapses were associated with Clostridium difficile infection. All relapses resolved with antibiotic treatment with or without corticosteroids.  These findings indicate that IBD patients with relapse should have stool examined microbiologically.  (Mylonaki M, et al. Eur J Gastroenterol Hepatol 2004;16:775-778)

Elevated vitamin D levels in CD.  Maria Abreu et al. retrospectively reviewed the medical records of 138 patients with CD and 29 patients with ulcerative colitis (UC) for measurements of vitamin D metabolites and immunoreactive parathyroid hormone (iPTH).  Bone mineral density (BMD) results were available for 88 CD patients and 20 UC patients.  Although there were no differences in the mean iPTH levels between the CD and UC patients, inappropriately high levels of serum 1,25(OH)(2)D were found in 42% of CD patients compared to 7% of UC patients.  A negative correlation between 1,25(OH)(2)D levels and lumbar BMD that was independent of glucocorticoid use was observed in CD patients (r = -0.301, p = 0.005).  In addition, 1,25(OH)(2)D serum levels correlated with CD activity and increased expression of intestinal 1 alpha-hydroxylase was also seen in CD patients.  These findings demonstrated that elevated 1,25(OH)(2)D serum levels were commonly found in CD patients and were independently associated with low BMD.  Inflamed intestine may be the source of the inappropriately secreted vitamin D and treatment of the inflammation may improve metabolic bone disease in these patients.  (Abreu MT, et al. Gut 2004;53:1129-1136)

Experience with infliximab in childhood UC.  George Russell and Aubrey Katz report their infliximab experience in pediatric patients with UC.  Fourteen infliximab-treated children were categorized into 3 groups: (1) newly diagnosed fulminant colitis refractory to intravenous steroids (n = 5); (2) relapse with fulminant colitis refractory to intravenous steroids (n = 4); and (3) colitis chronically dependent on steroids and refractory to medical management (n = 5).  Patients received infliximab 5 mg/kg at 0, 2, and 6 weeks and every 6 to 8 weeks thereafter.  All group 1 and 3 of 4 group 2 children responded to infliximab; however, only one child in group 3 responded to infliximab.  These data suggest that infliximab therapy is effective for acute UC in children, but is less effective for those children dependent on steroids.  (Russell GH and Katz AJ. J Pediatr Gastroenterol Nutr 2004;39:166-170)

CDC warns physicians who prescribe TNF-alpha antagonists to monitor patients for TB.  In its Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention noted there were 12 reported tuberculosis (TB) cases associated with the use of tumor necrosis factor (TNF)-alpha drugs in California between January 2002 and August 2003. Eleven of the patients were diagnosed with TB after receiving treatment with Remicade® (infliximab), while one patient was given the same diagnosis after being treated with Enbrel® (etanercept).  However, 11 patients had at least one risk factor for latent TB infection, and eight patients were also taking other immunosuppressive therapies at the time of diagnosis.  The CDC said it is not known whether the higher TB rate was caused by interactions among immunosuppressive therapies. Additionally, the Food and Drug Administration's adverse-event reporting system includes several hundred reports, mostly from foreign countries, of TB in patients who had been treated with TNF-alpha antagonists as of January 2004. As a result, the CDC advised that physicians who prescribe TNF-alpha antagonists "should educate their patients about the symptoms of TB disease, with added emphasis on extrapulmonary symptoms, which can include fever, malaise or development of a mass." Prior to prescribing immunosuppressive drugs, patients should be screened for TB risk factors and tested for infection.  Physicians should consider delaying TNF-alpha therapy until patients with latent TB infection or TB disease complete treatment for the condition.  If active TB develops during TNF-alpha-antagonist treatment, the therapy should be stopped until an anti-TB regimen has been initiated and the patient's condition has improved. (MMWR August 5, 2004/53(30);683-686)

This web site is supported through educational grants from     

Note: By clicking on the above logos you are leaving this educational site

Comments or requests to unsubscribe can be e-mailed to info@ibdwatch.com