The effectiveness of etanercept and adalimumab on anemia of chronic disease and serum hepcidin in patients with rheumatoid arthritis, a comparative study

Aim of the work: To evaluate the effect of etanercept and adalimumab on anemia of chronic disease (ACD) and serum hepcidin in rheumatoid arthritis (RA) patients. Patients and methods: Our study included 90 patients with active RA; all of them had anemia of chronic disease and 30 controls. RA patients were divided into 3 equal groups. Group I received methotrexate (MTX) plus placebo. Group II received MTX plus etanercept. Group III received MTX plus adalimumab. Assessments was done using disease activity score-28, serum hepcidin, hemoglobin, iron, total iron binding capacity, ferritin, transferrin saturation, soluble transferrin receptor before and 16 weeks after treatment. Results: There was a significant decrease in the disease activity variables after 16 weeks of treatment in all Groups (P < 0.05) and this decrease was significant when comparing MTX group and both TNF-α inhibitors groups, but nonsignificant when comparing between TNF-α inhibitors groups. In both TNF-α inhibitors groups the ACD parameters of these patients significantly improved (P < 0.05) without significant differences between these two groups, but in Group I the results were nonsignificant. A dramatic decrease in serum hepcidin-25 levels after 16 weeks of treatment occurred in both Groups II and III; serum hepcidin-25 levels showed significant positive correlation with disease activity variables. There were nonsignificant differences between Group II and III. Conclusions: Treatment with etanercept or adalimumab plus MTX significantly improved ACD in RA patients without significant differences between them. Serum hepcidin is a potential indicator for anemia of chronic disease and disease activity in RA patients. Keywords: Adalimumab, Anemia, Arthritis, Etanercept, Hepcidin