Abstract Number: PB0955
Meeting: ISTH 2020 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Hemophilia - Clinical
Background: People with haemophilia (PwH) have an increased risk of bleeds associated with acute and chronic pain, and long-term disability. In addition, anxiety and depression are other determinants negatively affecting quality of life in PwH. Despite the severity of these co-morbidities, they have not been extensively investigated and associations between them even less.
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 PwH in four Nordic countries, based on patient registry data and surveys. Here we describe registry data of current and retrospective treatment patterns of prescribed medication in PwH from Denmark, Finland, and Sweden compared with the general population.
Methods: This 11-year (2007-2017) retrospective population-based registry study uses international classification systems for diagnosis, surgeries and medicines. In Denmark, Norway and Sweden, the study populations were identified by diagnosis of haemophilia A or B, and or by one prescription of any factor VIII, IX, or bypassing agent. In Finland, the study population was identified by their eligibility for purchasing factor concentrate. For each study subject, five age- and gender-matched control subjects were included, except for Norway (due to local regulations).
Results: Registry data were extracted for a total of 3388 PwH. The country study populations are shown in figure 1. Treatment patterns of PwH compared to controls are shown in Table 1.
Conclusions: There was a significantly higher prescription of analgesics in all PwH cohorts compared to controls in the Nordic countries, which suggest a need for improved bleed protection to prevent arthropathy. In addition, there was a significantly higher prescription of neuroleptics, anti-depressants and anti-epileptics in the majority of PwH cohorts compared to controls, which underscores the importance of applying a holistic and multidisciplinary approach when managing PwH to also identify and address anxiety and depression.
Denmark: | Finland: | Sweden: | ||||
High factor consumptiona (n=221) vs controlsc OR (95% CI) | Low factor consumptionb (n=554) vs controlsc OR (95% CI) | High factor consumptiona (n=200) vs controlsc OR (95% CI) | Low factor consumptionb (n=239) vs controlsc OR (95% CI) | High factor consumptiona (n=419) vs controlsc OR (95% CI) | Low factor consumptionb (n=1016) vs controlsc OR (95% CI) | |
Opioids | 6.57 (4.69 to 9.19) | 2.33 (1.89 to 2.88) | 5.64 (3.75 to 8.50) | 4.33 (3.17 to 5.91) | 4.70 (3.69 to 6.00) | 2.51 (2.17 to 2.90) |
Non-opioids | 3.43 (2.45 to 4.79) | 1.64 (1.34 to 2.02) | 3.35 (2.35 to 4.79) | 2.84 (2.11 to 3.82) | 5.64 (4.44 to 7.17) | 2.19 (1.89 to 2.54) |
NSAID | 1.14 (0.81 to 1.60) | 0.71 (0.59 to 0.87) | 1.48 (1.10 to 2.00) | 1.06 (0.83 to 1.36) | 3.20 (2.59 to 3.96) | 1.26 (1.09 to 1.45) |
Steroids | 1.26 (0.68 to 2.33) | 1.77 (1.30 to 2.42) | 1.01 (0.52 to 1.97) | 1.02 (0.56 to 1.88) | 3.00 (2.28 to 3.96) | 1.62 (1.32 to 1.97) |
Neuroleptics | 1.36 (0.83 to 2.22) | 1.65 (1.29 to 2.12) | 1.97 (1.11 to 3.50) | 1.27 (0.79 to 2.04) | 2.08 (1.55 to 2.80) | 1.61 (1.36 to 1.92) |
Anti-depressant | 2.26 (1.34 to 3.81) | 1.48 (1.09 to 2.01) | 0.78 (0.39 to 1.56) | 0.95 (0.55 to 1.63) | 1.51 (1.00 to 2.30) | 1.30 (1.03 to 1.62) |
Anti-epileptics | 2.01 (0.99 to 4.08) | 0.80 (0.48 to 1.34) | 3.08 (1.27 to 7.47) | 0.69 (0.13 to 3.83) | 2.87 (1.65 to 5.00) | 1.84 (1.31 to 2.58) |
Numbers marked in bold shows significant values. aDefinition of high factor consumption: Total filled prescriptions during one year corresponding to FVIII ≥40 IU/kg/ week and FIX ≥10 IU/kg/week, respectively. Not included if factor use >350 IU/kg/week. bDefinition of low factor consumption: Men with haemophilia not meeting high factor consumption definition. cEach person with haemophilia was matched with five age- and gender-matched controls. OR=Odds Ratio; CI=Confidence Interval; NSAID=Nonsteroidal anti-inflammatory drug. |
[Age-adjusted use of different medication types by country and factor consumption.]
[Country study populations. Norwegian regulations did not allow for age and gender-matched subjects to be included. PwH; People with haemophilia.]
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. Treatment-Based Risk Assessment of Developing Pain, Anxiety, and Depression as Compared to Matched Controls in People with Haemophilia. A Nordic Registry Study Over a Period of 11 Years [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/treatment-based-risk-assessment-of-developing-pain-anxiety-and-depression-as-compared-to-matched-controls-in-people-with-haemophilia-a-nordic-registry-study-over-a-period-of-11-years/. Accessed May 13, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/treatment-based-risk-assessment-of-developing-pain-anxiety-and-depression-as-compared-to-matched-controls-in-people-with-haemophilia-a-nordic-registry-study-over-a-period-of-11-years/