Older Hemophilia Patients have Lower Rates of Multiple Medication Use than Their Peers, Study Reports

Older patients with hemophilia have lower rates of polypharmacy, or use of multiple medications, and of drug-drug interactions than people of the same age without the disease, a review study reports.

This is likely due to their regular risk assessments at hemophilia treatment centers (HTCs) and coordination of care with their practitioners.

The review study,  “Aging with Hemophilia: The Challenge of Appropriate Drug Prescription,” appeared in the Mediterranean Journal of Hematology and Infectious Diseases.

The wider availability, safety, and efficacy of new therapies as well as the establishment of HTCs have resulted in a similar life expectancy of these patients to that of men in the general population, at least in high-income countries, the study found.

However, the increasing number of older patients means more frequent comorbidities associated with aging, such as cardiovascular and neurodegenerative diseases. Also, older patients typically need multiple medications (called polypharmacy when using five or more), which could increase the risk for side effects and drug-drug interactions, and lead to more hospital admissions and poor treatment adherence.

The study assessed the extent to which patients with hemophilia take multiple therapies, besides the medications they use to prevent and treat bleeding episodes and viral infections. The researcher, Pier Mannuccio Mannucci, MD, from the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center at IRCCS Ca’ Granda Maggiore Policlinico Hospital Foundation, in Italy, also explored if polypharmacy is appropriate for older patients, who could be susceptible to related adverse events.

The review found that, although data on aging and hemophilia are still scarce, existing studies consistently indicate that older patients with hemophilia have a lower prevalence of morbidity and mortality from atherothrombotic cardiovascular diseases than found in the general population. In contrast, hypertension is more common in these patients, as is arthritis and associated chronic pain.

Still, data from prospective studies — some ongoing in the U.S. and Europe — are needed to better assess the burden of complications associated with aging in hemophilia, which could lead to new guidelines, the scientists noted.

Research on treatment prescription and usage by people with hemophilia is also limited, but suggests that polypharmacy, similar to the risk of drug-drug interaction, is lower in older hemophilia patients than their peers without the disease who are treated by general practitioners.

As reported in the ongoing S +P HERA prospective study, hemophilia patients (mean age of 64 years) took fewer statins, and antihypertensive and antithrombotic medications, but they more frequently used non-steroidal anti-inflammatory drugs and proton pump inhibitors than their non-hemophiliac peers.

According to Mannucci, the lower rate of drug-drug interactions in hemophilia patients may be “related to the fact that they are regularly followed not only by their practitioners but also by the specialized HTC,” which have “implemented deprescribing in order to limit drug use.” However, whether this benefit persists as patients age remains to be determined.

“This report shows that at least in high-income countries and in the specialized HTC there is awareness that [hemophilia patients] are aging, and that this obviously favorable event demands a change in the practice of the specialized care of these patients,” Mannucci wrote.

He also commented that close collaboration with pharmacists and clinical pharmacologists is needed to address the likely increased rate of polypharmacy associated with further aging in these patients.

“To my knowledge, there is at the moment no centenarian with hemophilia, but the more and more successful aging of these patients makes this event no longer unrealistic,” the scientist added.