Anaemia Remains Common in Paediatric IBD

Key Summary:

• Anaemia affected 52% of patients at paediatric IBD diagnosis.
• Anaemia prevalence fell to 25% by year five after diagnosis.
• Iron deficiency anaemia plus anaemia of chronic disease was the most common anaemia subtype at diagnosis.

Anaemia was common among patients with paediatric-onset inflammatory bowel disease (PIBD) at diagnosis and remained associated with disease activity during the following five years, according to a Danish nationwide cohort study. 

Anaemia Common at PIBD Diagnosis 

Researchers investigated the prevalence and subtypes of anaemia among patients aged 6–17 years diagnosed with PIBD between 2014 and 2022. They also examined whether anaemia was associated with disease activity over the five years following diagnosis. 

The study used Danish national health registers to identify 1,266 incident patients with PIBD. Anaemia was defined according to WHO criteria, while anaemia subtypes were classified using guidelines from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition. 

At diagnosis, 660 patients, equivalent to 52% of the cohort, had anaemia. Although prevalence declined during follow-up, anaemia remained present in 25% of patients in year five. 

Mixed Anaemia Subtype Predominates 

The severity of anaemia changed over time. Moderate anaemia was most frequently observed at diagnosis and during the first year, whereas mild anaemia became more common in subsequent years. 

Among patients who had anaemia at diagnosis, 237 could be assigned an anaemia subtype. Iron deficiency anaemia (IDA) was identified in 25 patients, representing 11%, while 44 patients, or 19%, had anaemia of chronic disease (ACD). The largest group had both IDA and ACD, affecting 168 patients, or 71%. 

These findings indicated that combined iron deficiency and chronic disease contributed substantially to the anaemia observed at PIBD diagnosis. 

Anaemia Associated with Disease Activity 

The study also found an association between anaemia and disease activity throughout the five-year follow-up period. Disease activity was assessed using medication use, surgical procedures, and hospitalisation. 

The strongest association was observed in year four, when patients with anaemia had more than twice the risk of disease activity compared with those without anaemia (adjusted risk ratio: 2.3; 95% CI: 1.8–3.0). 

The researchers concluded that anaemia represented a frequent feature of PIBD, particularly at diagnosis, and remained prevalent despite declining over time. The persistent association between anaemia and disease activity further highlighted its relevance during follow-up. The findings also identified IDA combined with ACD as the predominant subtype at diagnosis. 

 

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A targeted therapy to treat inflammatory bowel disease

The biomedical scientists of the University of California, Riverside have found a way for drugs to be more effective against inflammatory bowel disease/ IBD.

IBD, a chronic inflammatory disease of the intestine, includes Crohn’s disease and ulcerative colitis. It is commonly treated with one of several available biological drugs that block an inflammatory molecule called Tumour Necrosis Factor Alpha or TNF-alpha, from binding to two receptors, TNFR1 and TNFR2. Only about 50 % of patients are helped long term by this treatment.

TNF-alpha does drive much of the inflammation and tissue destruction in IBD, said a distinguished Prof., who led the study.

It’s why it is targeted by drugs. Our interest in this study was to look for a more targeted therapy that might have better impact than the existing approach, which is to block all TNF-alpha, he added.

The Prof. explained that people have 2 different receptors, TNFR1 & TNFR2, in each of their cells that bind TNF-alpha. Currently, TNF-alpha-targeted drugs block both TNFR1 & TNFR2. His experiments were done in mice, which have the same 2 receptors. The pattern of inflammation in mice is similar to that seen in humans.

TNF-alpha, produced by the body’s cells, also induced specialized immune and other cells, which both promote inflammation and suppressed it. Thus, TNF-alpha played a role in the destruction and the healing of tissues—a double-edged sword. He said evidence existed that TNFR1 may be driving most of the destructive effects of IBD, and whereas TNFR2 may drive the healing and restorative effects.

If you block both the receptors, you block the destructive effects and the recovery, he said.

To circumvent this, in our work we opted to do selective targeting of TNFR1, he explained.

His group was encouraged by 2 pieces of evidence suggesting that targeting TNFR1 maybe a more beneficial strategy, the researchers used a reagent from Inmune Bio, a biotechnology company that was selective for blocking TNFR1. Mice treated with this reagent were found to benefit from it. The researchers also did genetic targeting of TNFR1 to reduce its signaling. The impact, they found, was dramatic.

When we reduced TNFR1 signalling, the mice showed a significant benefit relative to mice who had the full level of TNFR1 signalling, the Prof. said.

This approach may offer more opportunity to TNFR2 to contribute to the healing, he added.

According to the Prof., mice that have a genetic deficiency in TNFR2 got much more severe disease, suggesting that TNFR2 does indeed have beneficial effects.

Without TNFR2, IBD is a lot worse, he said.

Several diseases, such as rheumatoid arthritis, multiple sclerosis, and psoriasis, are related to the action of TNF-alpha, indeed, different tissues in the body are differently sensitive to the effects of TNF-alpha. The role of the receptors TNFR1 and TNFR2 varied in the different tissues.

TNF-alpha is a very common way in which your body reacts to inflammatory triggers, such as infection, he said.

This protein can mediate several processes in the body to promote inflammation. The inflammation arises to clear an infection or kill a tumour. But in autoimmune diseases, the same inflammation and tissue damage that TNF-alpha provokes are what drive the disease. In other words, you want TNF-alpha at the right time to knock off a certain infection but once that is accomplished, you don’t want this protein to be around any longer. Many diseases are linked to TNF-alpha lingering in tissues, he added.

The prof. said the current research was a combination of testing approved drugs that are used in the clinic as well as examining more detailed questions related to the mechanisms of disease and protection.

It’s about continuously finding better cutting-edge drugs and better targets to treat disease, he said.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.   

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