High use of pain, depression, and anxiety drugs in hemophilia: more than 3000 people with hemophilia in an 11-year Nordic registry study

Steen Carlsson K, Winding B, Astermark J, Baghaei F, Brodin E, Funding E, Holmström M, Österholm K, Bergenstråle S, Lethagen S

Background
Pain is a common feature of hemophilia, but prevalence of depression and anxiety is less studied. Register data on prescription drugs can give an objective measure of the magnitude of these complications.

Objective
To identify treatment patterns of prescribed pain, anti-depressant, and anti-anxiety medications compared with matched controls in four Nordic countries.

Methods
The MIND study (NCT03276130) analyzed longitudinal individual-level national data 2007–2017. People with hemophilia (PwH) were identified from national health data registers by diagnosis or factor replacement treatment and compared to population controls. Three subgroups were defined by use of factor concentrates and sex (moderate to high factor consumption [factor VIII (FVIII) ≥40 IU/kg/week or factor IX (FIX) ≥10 IU/kg/week]; low factor consumption and women including carriers).

Results
Data for 3,246 PwH, representing 30,184 person-years, were analyzed. PwH (children and adults) used more pain, depression, and anxiety medications compared with controls. This was most accentuated in the moderate to high factor consumption group and notably also observed in men with low factor consumption as well as women including carriers, usually representing a milder phenotype. A higher opioid use was seen 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.

Conclusion
The consistent higher use of pain, depression, and anxiety medications among PwH compared to population controls, regardless of age, sex, or factor consumption, in broad national data suggests a need for improved bleed protection and hemophilia care for all severities including mild hemophilia.

The study is published with open access in Research and Practice in Thrombosis and Haemostasis.

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Research and Practice in Thrombosis and Haemostasis, 2023;7(2):1-15 (2023;7:e100061)
DOI: https://doi.org/10.1016/j.rpth.2023.100061