Use of Pain, Depression, Anxiety Meds Higher Among Patients With Hemophilia

In addition to ongoing efforts to improve management of bleeds, health care providers should have a greater awareness of pain, depression, and anxiety among their patients with hemophilia, say insights from a new population-based study published in Research and Practice in Thrombosis and Haemostasis.

This analysis found that the 3000 patients with hemophilia had higher rates of pain, depression, and anxiety medication use. Although the prevalence of pain in patients with hemophilia has been well documented, the prevalences of anxiety and depression have been less clear, the study authors highlighted.

The study included over 30,000 person-years’ worth of data from 4 Nordic countries: Denmark, Finland, Norway, and Sweden. Both children and adults with hemophilia had higher rates of medication use associated with pain, depression, and anxiety, including antidepressants, antianxiety medications, neuroleptics, and antiepileptic medications.

The odds ratio of neuroleptic, antidepressant, or antiepileptic use ranged from 1.30 to 2.87 among certain patient groups.

“This pattern was most evident for people with hemophilia with moderate to high factor VIII use, but similar differences were found also for male patients with hemophilia with low factor use and women, including carriers, compared to matched population controls,” explained the researchers. “The population-based study design provides an objective way of describing the presence of pain, depression, and anxiety through analyzing registry data on filled prescriptions for 7 types of drugs over a long study period (11 years).”

Patients with hemophilia used opioids at a higher rate across all age groups, with these use rates 4- to 6-fold higher among patients with moderate to high factor VIII consumption and 2- to 4-fold higher among patients with low factor consumption.

The increased use of opioids, and the volume of use, remained even when adjusting for inhibitors and joint complications.

“Although opioids are an important tool in the short-term treatment of severe pain, increasing prescriptions of opioids have raised concerns related to the risk of dependency among patient groups exposed to pain,” wrote the researchers. “People with hemophilia is one such group at an increased risk. 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.”

In addition to those with moderate to high factor VIII use, women and carriers showed the highest proportion of opioid use (46%-72%), as well as higher use rates of nonopioid analgesic drugs (49%-54%), nonsteroidal anti-inflammatory drugs (47%-70%), steroids (32%-39%), neuroleptics (34%-58%), and antidepressants (27%-37%) and a relatively high rate of antiepileptics (9%-22%) use.

Medications like steroids showed more variable trends. Although steroid use was comparable between people with hemophilia and controls in Finland, use was higher for patients with hemophilia in Sweden.

Reference

Carlsson K, 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 31, 2023. doi:10.1016/j.rpth.2023.100061