Abstract Number: PB0951
Meeting: ISTH 2020 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Hemophilia - Clinical
Background: Females with haemophilia (FwH) including carriers may have increased risk of bleeds due to low factor levels and may be at risk of pain due to joint bleeds. Swedish MIND study data of carriers identified increased prescription of pain medication, neuroleptics and anti-depressants suggesting a need for further attention and research.
Aims: The MIND study (NCT03276130) aims to identify patterns of prescribed pain, anti-depressive and anti-anxiety medication and management of pain, depression and anxiety in people with haemophilia (PwH) in four Nordic countries, based on patient registry data and surveys. Here we describe registry data of current and retrospective patterns of prescribed medication from Denmark, Finland and Sweden focused on FwH, compared with the general female population.
Methods: This 11-year (2007-2017) retrospective population-based registry study, uses international classification systems for diagnoses, surgeries and medications. The study population includes females of all ages identified by diagnosis of haemophilia A or B, or at least one prescription of any factor VIII, IX, or bypassing agent. For each study subject, five age- and gender-matched controls were included.
Results: Data were extracted for 720 FwH (study population in figure 1). The probability of being prescribed analgesics, neuroleptics and anti-depressants in FwH compared to controls are shown in Table 1.
Conclusions: A substantially higher prescription of analgesics in Nordic FwH as compared to controls suggests a need for increased focus on bleed and pain management in FwH including improved bleed protection and prevention of, e.g. arthropathy. The increased prescription of neuroleptics in Denmark and Sweden and anti-depressants in Sweden indicates that anxiety and depression may be overrepresented in FwH and underscores the importance of identifying and managing the female haemophilia population including non-frequent health care users. The data suggests a need for high medical attention and further research to address knowledge gaps and unmet needs.
[Study population]
| Denmark: FwH (n=320) vs Controls (n=1600) | Finland: FwH (n=8) vs Controls (n=40) | Sweden: FwH (n=392) vs Controls (n=1935) | ||||
| OR (95% CI) | % diff (p-value) if use>0* | OR (95% CI) | % diff (p-value) if use>0* | OR (95% CI) | % diff (p-value) if use>0* | |
| Opioids | 2.58 (1.97 to 3.39) | 57.8 ( 0.003) | 8.68 (2.24 to 33.65) | 85.6 ( 0.344) | 2.40 (1.93 to 2.99) | -0.4 ( 0.981) |
| Non-opioids | 1.40 (1.10 to 1.80) | 17.9 ( 0.069) | 4.87 (1.92 to 12.33) | 25.8 ( 0.338) | 2.13 (1.74 to 2.60) | 15.0 ( 0.007) |
| NSAID | 0.77 (0.60 to 0.98) | -3.4 ( 0.710) | 1.86 (0.71 to 4.90) | 70.2 ( 0.002) | 1.17 (0.96 to 1.41) | 50.0 (<0.001) |
| Steroids | 2.26 (1.56 to 3.27) | 79.1 ( <0.001) | 0.48 (0.14 to 1.71) | -69.8 ( 0.246) | 2.42 (1.86 to 3.16) | 44.9 ( 0.004) |
| Neuroleptics | 1.61 (1.17 to 2.21) | 18.2 ( 0.282) | 1.95 (0.39 to 9.66) | 29.2 ( 0.706) | 1.56 (1.24 to 1.95) | -0.7 ( 0.952) |
| Anti-depressant | 1.29 (0.92 to 1.81) | -9.6 ( 0.494) | 0.60 (0.17 to 2.09) | -157.3 ( 0.007) | 1.41 (1.09 to 1.82) | 8.0 ( 0.573) |
| Anti-epileptics | 1.24 (0.70 to 2.19) | -61.3 ( 0.026) | 0.69 (0.13 to 3.83) | -166.2 ( 0.096) | 1.59 (0.96 to 2.63) | -4.2 ( 0.855) |
| Numbers marked in bold shows significant values. *Percentage difference in annual volume of medication compared to controls, for women using the respective medications. OR=Odds ratio; CI=Confidence interval; FwH=Females with haemophilia; NSAID=Nonsteroidal anti-inflammatory drug. | ||||||
[Age-adjusted probability of analgesics, neuroleptics or anti-depressant prescriptions, and difference (%) in annual volume of medication*]
To cite this abstract in AMA style:
Steen Carlsson K, Winding B, Astermark J, Baghaei F, Brodin E, Funding E, Holmström M, Österholm K, Bergenstråle S, Andersson E, Lethagen S. Females with Haemophilia in Nordic Countries Have a Higher Risk of Developing Pain, Anxiety and Depression Based on Treatment Patterns as Compared to Matched Controls: Data from a Registry Study over a Period of 11 Years [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/females-with-haemophilia-in-nordic-countries-have-a-higher-risk-of-developing-pain-anxiety-and-depression-based-on-treatment-patterns-as-compared-to-matched-controls-data-from-a-registry-study-over/. Accessed November 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/females-with-haemophilia-in-nordic-countries-have-a-higher-risk-of-developing-pain-anxiety-and-depression-based-on-treatment-patterns-as-compared-to-matched-controls-data-from-a-registry-study-over/