Increase of Hemoglobin Levels by Anti-IL-6 Receptor Antibody (Tocilizumab) in Rheumatoid Arthritis

Abstract

ObjectiveTo compare the effect of tocilizumab (TCZ) with other biologic therapies in improving anemia of rheumatoid arthritis (RA) patients.MethodsWe compared the change of hemoglobin (Hb) levels in a cohort of 147 consecutive RA patients who were treated with biologics for more than 12 weeks. Twenty eight patients were treated with TCZ, and 119 patients were treated with biologics other than TCZ (87 with TNF inhibitors and 32 with abatacept). The change of Hb levels from baseline to week 12 was compared between the TCZ and the non-TCZ groups. We performed univariate and multivariate analyses with adjustment of potential confounders such as baseline characteristics, concomitant treatment, and the clinical response to treatment.ResultsHb levels generally increased after biologic therapies both in the TCZ and the non-TCZ groups. The increase of Hb levels was greater in the TCZ group than in the non-TCZ groups (1.1 g/dL in the TCZ group vs 0.3 g/dL in the non-TCZ group, p = 0.009). Univariate analysis revealed that increase of Hb levels was also significantly associated with lower Hb, higher Low Hemoglobin Density, and higher CRP levels at baseline and greater reduction in the clinical disease activity index. TCZ therapy was significantly associated with the increase of Hb levels even after adjustment for these factors by multivariate analysis (p<0.001, effect size 0.08–0.12).ConclusionTCZ therapy is an independent factor associated with the increase of Hb level after biologic therapies in RA patients. It will help in selecting appropriate biologics for RA patients with anemia.

CD26 Expression on T Helper Populations and sCD26 Serum Levels in Patients with Rheumatoid Arthritis

“…Although, baseline levels of the CD45R0 + CD26 - subset were not recovered with any of the therapies at the time of sampling, a correlation with hemoglobin levels was observed in the anti-IL-6R group. IL-6, together with TNF- α [ 35 ], is an inflammatory cytokine critically involved in chronic disease´ anemia, the major reason for the low hemoglobin levels in RA patients. In fact, it has been recently reported that hemoglobin levels increase after biologic therapies, mainly with anti-IL-6R [ 35 ], indicating that anti-IL6R therapy could lead to the recovery of this population.…”

Association of Interleukin 6 Receptor Variant With Cardiovascular Disease Effects of Interleukin 6 Receptor Blocking Therapy

“…These 2 laboratory measurements are known to increase with IL6R antagonist therapy. 5,[22][23][24][25][26] The known reduction in CRP level was observed in the PheWAS, as were findings consistent with a reduced risk of ischemic heart disease, lower levels of troponin I, and lower CK-MB levels ( Table 3).…”

Predictive value of the neutrophil‑to‑lymphocyte ratio and hemoglobin insystemic lupus erythematosus

“…However, hemoglobin is not considered to be a readily available acute phase response biomarker, unlike ESR and CRP, which are routinely used to estimate the activity of systemic inflammation. Previous studies reported that the hemoglobin level was increased after starting targeted rheumatoid arthritis treatment (22,23), but failed to report longitudinal changes in composite disease activity indices (23). To the best of our knowledge, there are no studies on the direct association between hemoglobin and SLE.…”