High Use of Antidepressants, Anxiety, Pain Meds Seen Among Patients With Hemophilia

Individuals with hemophilia consistently have a higher use of pain, depression, and anxiety medications compared with control populations, regardless of age, sex, or factor consumption.

This is according to recent data published in Research and Practice in Thrombosis and Haemostasis.

These findings underscore the need for improved bleed protection and hemophilia care for those with all severities of the disease, including mild hemophilia, the authors wrote.

To better understand treatment patterns of prescribed pain, antidepressant, and antianxiety medications, the researchers compared individuals with hemophilia with matched controls in 4 Nordic countries: Denmark, Sweden, Norway, and Finland.

Data were gleaned from the MIND study, which analyzed longitudinal individual-level data from 2007 to 2017. Hemophilia can be classified as mild, moderate, or severe depending on the level of clotting factor in patients’ blood.

A total of 3246 patients with hemophilia were included in the analysis, representing 30,184 person-years. The higher use of medication for pain, depression, and anxiety was most accentuated in the moderate to high factor consumption group and among men with low factor consumption, data showed.

The results also showed women, including carriers, who usually represent a milder phenotype, had an accentuated use of pain, depression, and anxiety medications. The 7 drug types included in the analysis were opioids, nonopioids, nonsteroidal anti-inflammatory drugs, steroids, neuroleptics, antidepressants, and antiepileptics.

“A higher opioid use was observed across all age groups: 4- to 6-fold higher in the moderate to high factor consumption group and 2- to 4-fold higher in the low factor consumption group,” the authors added.

A total of 886 patients from Denmark were included in the study, in addition to 288 from Finland, 522 from Norway, and 1550 from Sweden. Just over 14,000 control participants were also assessed.

Not only did patients with hemophilia in the 4 countries have a higher use of pain drugs, they also had a longer duration compared with matched controls.

Results showed a higher use of antidepressant, antianxiety, neuroleptics, and antiepileptic drugs in many subgroups of hemophilia, a finding that may be due to the fact these drugs are prescribed as adjuvants to pain medication.

“The higher proportion of opioid use observed across all ages in our data highlights the need for person-centered approaches to pain and hemophilia management,” the researchers wrote, noting patients with hemophilia are at an increased risk of opioid dependency. “Even when adjusting for inhibitors and joint complications, there was a remaining higher likelihood of use and volume of use of pain medications associated with” those with hemophilia than controls.

Previous studies have highlighted associations between pain, functional impairment, depression, and anxiety among individuals with hemophilia.

Although the prevention of bleeds has long served as a primary objective in hemophilia care, authors stress the importance of focusing on awareness of pain, depression, and anxiety in patients with hemophilia, even among women and men with low, no, or irregular factor consumption.

The dataset used in the analysis did not have information on laboratory values that allowed for the classification of disease severity. Instead, researchers relied on observed filled prescriptions for factor concentrates, marking a limitation to the study.

“In summary, our data show that [patients with hemophilia] use more pain, depression, and anxiety drugs compared with population controls,” the authors concluded. “The increased use of these drugs is a sign of possible insufficient treatment and follow-up of hemophilia, irrespective of sex and hemophilia severity, even in those with a milder hemophilia phenotype.”

Reference

Carlsson KS, Winding B, Astermark J, et al. High use of pain, depression, and anxiety drugs in hemophilia: more than 3000 people with hemophilia in an 11-year Nordic registry study. Res Pract Thromb Haemost. Published online January 30, 2023. doi:10.1016/j.rpth.2023.100061