Contributions
Abstract: EP1180
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia (AIHA) that accounts for approximately 20% of all AIHA and is characterized by classical complement pathway–mediated hemolysis. Clinical manifestations of CAD can include complement-mediated chronic hemolytic anemia, profound fatigue, as well as transient agglutination-mediated circulatory symptoms (Swiecicki et al. Blood 2013). CAD (formerly primary CAD) is clinically distinct from secondary cold agglutinin syndrome (CAS), which is caused because of an underlying condition (coexisting diagnosis of overt malignancy or infection). Recent research has shown that patients with anemia are more likely to develop depression and anxiety (Shafi et al. J Coll Physicians Surg Pak 2018; Vulser et al. Acta Psychiatr Scand 2016); however, this has not been studied in patients with CAD.
Aims
To determine the antidepressant (AD) use in patients with CAD (includes patients with both primary CAD and secondary CAS) versus those without CAD in a large United States (US) healthcare system.
Methods
We conducted a matched-cohort comparison study evaluating AD use in patients with and without CAD. All patients with CAD were identified in the Optum Claims-Clinical database by reviewing clinical notes for CAD terms. Patients with CAD were matched (1:10) to patients without CAD by age (±3 years), sex, race, region of residence, and active time and season and year of entry date in the Optum health plan. Patients ≥25 years of age with no history of anxiety or depression were included in the study. Patients were considered to be on ADs if they had at least three medication codes recorded in the database on different dates. Cox regression models were built to estimate time to first medication use, adjusted for age, sex, race, region, comorbidity score, and cluster (matched CAD and non-CAD cohorts). A subset analysis was also performed in patients with primary CAD. Medication use was further described using univariate analyses.
Results
A total of 317 patients with CAD (mean [standard deviation (SD)] age, 70.1 [12.7] years) and 1965 patients without CAD (comparison; mean [SD] age, 69.9 [12.4] years) were identified between 2006 and 2016 and included in the study. Patients with CAD were twice as likely to have medically attended anxiety and depression than their comparisons (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.03–2.75). On average, patients with CAD with medically attended anxiety and depression started ADs 15 months (SD, 17 months) after diagnosis. The top three ADs used in patients with CAD and medically attended anxiety and depression included benzodiazepines (76%), antipsychotics (24%), and selective serotonin reuptake inhibitors (SSRI; 10%). A similar pattern was seen for comparisons, but the proportion using benzodiazepines was less versus patients with CAD (76% vs 60%). Comparisons used more SSRIs versus patients with CAD (31% vs 10%). Patients with and without CAD used a similar proportion of antipsychotics (24% vs 21%, respectively). Sub-analysis of patients with primary CAD reported a higher risk for AD use versus those without CAD (HR, 2.37; 95% CI, 1.34–4.20). A similar pattern for the specific AD use was also reported.
Conclusion
Our study indicates that ADs are used more often in patients with CAD versus patients without CAD. These findings suggest that patients with CAD may experience extra-hematologic manifestations of the disease that potentially have a broader impact on their overall mental health, physical health, and quality of life. Further investigation on this topic is warranted.
Keyword(s): Autoimmune hemolytic anemia (AIHA), Complement, Depression
Abstract: EP1180
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia (AIHA) that accounts for approximately 20% of all AIHA and is characterized by classical complement pathway–mediated hemolysis. Clinical manifestations of CAD can include complement-mediated chronic hemolytic anemia, profound fatigue, as well as transient agglutination-mediated circulatory symptoms (Swiecicki et al. Blood 2013). CAD (formerly primary CAD) is clinically distinct from secondary cold agglutinin syndrome (CAS), which is caused because of an underlying condition (coexisting diagnosis of overt malignancy or infection). Recent research has shown that patients with anemia are more likely to develop depression and anxiety (Shafi et al. J Coll Physicians Surg Pak 2018; Vulser et al. Acta Psychiatr Scand 2016); however, this has not been studied in patients with CAD.
Aims
To determine the antidepressant (AD) use in patients with CAD (includes patients with both primary CAD and secondary CAS) versus those without CAD in a large United States (US) healthcare system.
Methods
We conducted a matched-cohort comparison study evaluating AD use in patients with and without CAD. All patients with CAD were identified in the Optum Claims-Clinical database by reviewing clinical notes for CAD terms. Patients with CAD were matched (1:10) to patients without CAD by age (±3 years), sex, race, region of residence, and active time and season and year of entry date in the Optum health plan. Patients ≥25 years of age with no history of anxiety or depression were included in the study. Patients were considered to be on ADs if they had at least three medication codes recorded in the database on different dates. Cox regression models were built to estimate time to first medication use, adjusted for age, sex, race, region, comorbidity score, and cluster (matched CAD and non-CAD cohorts). A subset analysis was also performed in patients with primary CAD. Medication use was further described using univariate analyses.
Results
A total of 317 patients with CAD (mean [standard deviation (SD)] age, 70.1 [12.7] years) and 1965 patients without CAD (comparison; mean [SD] age, 69.9 [12.4] years) were identified between 2006 and 2016 and included in the study. Patients with CAD were twice as likely to have medically attended anxiety and depression than their comparisons (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.03–2.75). On average, patients with CAD with medically attended anxiety and depression started ADs 15 months (SD, 17 months) after diagnosis. The top three ADs used in patients with CAD and medically attended anxiety and depression included benzodiazepines (76%), antipsychotics (24%), and selective serotonin reuptake inhibitors (SSRI; 10%). A similar pattern was seen for comparisons, but the proportion using benzodiazepines was less versus patients with CAD (76% vs 60%). Comparisons used more SSRIs versus patients with CAD (31% vs 10%). Patients with and without CAD used a similar proportion of antipsychotics (24% vs 21%, respectively). Sub-analysis of patients with primary CAD reported a higher risk for AD use versus those without CAD (HR, 2.37; 95% CI, 1.34–4.20). A similar pattern for the specific AD use was also reported.
Conclusion
Our study indicates that ADs are used more often in patients with CAD versus patients without CAD. These findings suggest that patients with CAD may experience extra-hematologic manifestations of the disease that potentially have a broader impact on their overall mental health, physical health, and quality of life. Further investigation on this topic is warranted.
Keyword(s): Autoimmune hemolytic anemia (AIHA), Complement, Depression