Assessment of Joint Health in Patients Receiving Prophylaxis for Haemophilia A: a Cross-sectional Survey in Five European Countries

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Sep 11

PMID 39260833

Authors

Hortensia De la Corte-Rodriguez

Linda Bystricka

Nathan Ball

Stevie Olsen

Keisha Golden

Zalmai Hakimi

Nana Kragh

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate joint health, pain and health-related quality of life (HRQoL) in patients with moderate/severe haemophilia A in Europe.

Design: Multinational, cross-sectional survey, with retrospective data collection. Data were taken from the Adelphi Real World Haemophilia Disease Specific Programme Wave II, using surveys completed by physicians and patients between February 2020 and May 2021.

Setting: Haematologists/haemato-oncologists and their patients in France, Germany, Italy, Spain and the UK.

Participants: Males aged ≥18 years with moderate or severe haemophilia A (baseline clotting factor level ≤5%), without existing inhibitors and currently receiving prophylaxis. Patients were grouped into those with or without haemophilia-affected joints (HAJs) based on bleeding, radiographic, surgical, mobility and joint pain data.

Primary Outcome Measure: Characterisation of humanistic and clinical outcomes in patients with or without HAJs.

Results: A total of 120 physicians provided data for 351 eligible patients; 209 (59.5%) patients had HAJs and 142 (40.5%) had no HAJs. Pain/discomfort was significantly different (p=0.01) and reported more frequently in the HAJ (85.7%) vs non-HAJ group (53.3%). Pain medication use was significantly higher in the HAJ versus non-HAJ group (73.2% vs 60.6%; p=0.01). Up to half of the patients with HAJs had synovitis (49.8%) or arthropathy (48.4%), and one-third had undergone joint surgery (35.4%). Overall health status was significantly worse in the HAJ versus non-HAJ group (mean (SD) EuroQol Visual Analogue Scale score: 65.5 (19.3) vs 81.1 (14.6); p=0.01).

Conclusions: In this multinational real-world study, nearly two-thirds of adults with moderate/severe haemophilia A without inhibitors experienced HAJs despite prophylaxis. Individuals with HAJs had higher rates of pain and pain medication use, and lower HRQoL compared with those without HAJs. These data indicate that HAJs represent a clinically relevant burden and early identification/monitoring and management of affected joints should be an important consideration to help prevent long-term joint morbidity.

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