Background/Purpose:   Anemia in rheumatoid arthritis (RA) patients (pts) has a prevalence of 16%-64% depending on population and severity of disease^1,2,3 and is more common in women, pts with seropositive and erosive disease, and pts treated with systemic corticosteroids.² This post hoc analysis was performed to determine prevalence of anemia in a contemporary cohort of RA pts treated with conventional disease-modifying antirheumatic drugs (cDMARDs).

Methods:   Data were pooled from screening for 2 phase 3 trials conducted from Oct 2012 to Sept 2015 in RA pts inadequately responsive to cDMARDs. Eligibility included ≥6/68 tender and ≥6/66 swollen joints. One study required erosions on radiographs and high-sensitivity C-reactive protein (hsCRP) ≥6 mg/L; the other required hsCRP ≥1.2x upper limit of normal (ULN), or 3.6mg/dL. Prior biologic disease-modifying antirheumatic drugs were prohibited. Analysis included data from pts who failed screening for any reason, such as hsCRP or number of tender or swollen joints below threshold for study entry. Anemia was defined as hemoglobin (Hgb) <8 g/dL, <10 g/dL, or below the age- and gender-adjusted lower limit of normal (gaLLN).

Results:   Analysis included 3925 screened pts: 3159 women and 766 men, including 1591 women and 345 men who failed screening. Hgb <8 g/dL was observed in 8 women (0.3%). Hgb <10 g/dL was seen 10x more frequently in women, occurring in 128 women (4.1%) and 3 men (0.4%). When the less stringent definition of <gaLLN was used, anemia was identified in 718 women (22.7%) and 185 men (24.2%). Prevalence of Hgb <gaLLN was 24% among pts ≤65 years and 16% among pts >65 years. Anemia (<gaLLN definition) was more prevalent among pts with more active disease. Using Simplified Disease Activity Index, prevalence of Hgb <gaLLN in pts who met screening criteria was 0% in pts in remission or with low disease activity, 3.37% in pts with moderate disease activity, and 21.8% in pts with high disease activity. Analysis by tertiles of acute phase reactant levels (hsCRP or erythrocyte sedimentation rate) yielded similar findings.

Conclusion:   In a contemporary population of pts with active RA treated with cDMARDs, prevalence of Hgb <10 g/dL was low, but 10x more frequent in women. When anemia was defined as Hgb <gaLLN (rather than as Hgb <10), prevalence was higher in men and women, regardless of age. Hgb <gaLLN was observed more often in pts with more active RA. Inclusion of pts with RA who failed to meet entry criteria of these clinical trials allows assessment of the prevalence of anemia in an RA population treated with cDMARDs. References

1. Short CL, Bauer W, Reynolds WE. Red-cell, white-cell, and differential counts. In: Rheumatoid Arthritis. Cambridge, MA: Harvard University Press, 1957:349-356.
2. Peeters HR, Jongen-Lavrencic M, Raja AN, et al. Course and characteristics of anaemia in patients with rheumatoid arthritis of recent onset. Ann Rheum Dis 1996;55(3):162-8
3. Furst DE, Chang H, Greenberg JD, et al. Prevalence of low hemoglobin levels and associations with other disease parameters in rheumatoid arthritis patients: Evidence from the CORRONA registry. Clin Exp Rheumatol 2009;27(4):560-6.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-anemia-among-rheumatoid-arthritis-patients-treated-with-conventional-disease-modifying-antirheumatic-drugs/