Prevalence of Obesity in Young Patients with Severe Haemophilia and Its Potential Impact on Factor VIII Consumption in Germany

Martin Olivieri; Christoph Königs; Christine Heller; Silvia Horneff; Johannes Oldenburg; Susan Halimeh; Karim Kentouche; Ralf Knöfler; Lars Fischer; Christian Pfrepper; Karin Kurnik; Christoph Bidlingmaier

doi:10.1055/s-0039-1677874

Hämostaseologie, Table of Contents

Hamostaseologie 2019; 39(04): 355-359
DOI: 10.1055/s-0039-1677874

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Prevalence of Obesity in Young Patients with Severe Haemophilia and Its Potential Impact on Factor VIII Consumption in Germany

Martin Olivieri

¹Paediatric Haemophilia Centre, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany

,

Christoph Königs

²Department of Paediatrics, Paediatric Haemophilia Centre, Goethe University, University Hospital Frankfurt, Frankfurt, Germany

,

Christine Heller

²Department of Paediatrics, Paediatric Haemophilia Centre, Goethe University, University Hospital Frankfurt, Frankfurt, Germany

,

Silvia Horneff

³Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany

,

Johannes Oldenburg

³Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany

,

Susan Halimeh

⁴Coagulation Centre Rhine-Ruhr, Medical Thrombosis and Haemophilia Treatment Centre and Specialized Laboratory for Coagulation Disorders/Haemophilia, Duisburg, Germany

,

Karim Kentouche

⁵Department of Paediatric Haematology and Oncology, University Hospital for Children and Adolescents, Friedrich Schiller University, Jena, Germany

,

Ralf Knöfler

⁶Department of Paediatric Haemostaseology, University Hospital ‘Carl Gustav Carus’, Technical University, Dresden, Germany

,

Lars Fischer

⁷Department of Paediatric Haematology, Oncology and Haemostaseology, University Childrens Hospital Leipzig, Leipzig, Germany

,

Christian Pfrepper

⁸Centre for Haemostaseology, University Hospital Leipzig, Leipzig, Germany

,

Karin Kurnik

¹Paediatric Haemophilia Centre, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany

,

Christoph Bidlingmaier

¹Paediatric Haemophilia Centre, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany

› Author Affiliations

Abstract

Similar to the general population, overweight and obesity have increasingly become a medical and economic burden also in patients with haemophilia in industrialized nations. In this study in seven German haemophilia centres, we identified a prevalence of overweight and obesity of 25.2% among 254 young patients <30 years (median: 13 years; range: 0–30 years) with severe haemophilia A and without a history of inhibitors. The median FVIII dosage based on bodyweight was significantly higher in normal weight compared with overweight or obese patients (96.9 vs. 72.9 IU/kg/week, respectively; p < 0.0001). This suggests that an individualized dosing regime which might be based on FVIII pharmacokinetics, physical activity and pre-existing haemophilic arthropathy is applied rather than dosing by bodyweight only. The bleeding rates observed in obese (median: 1; range: 0–17) versus normal weight patients (median: 2; range: 0–28) did not differ significantly (p = 0.057). Lower bleeding rates might be due to reduced activity or expected higher FVIII plasma levels in overweight patients. Due to the increasing prevalence of overweight/obesity in patients with haemophilia an interdisciplinary approach for individualized haemophilia treatment and weight loss programmes might be helpful for optimal and economical treatment for this group of patients.

Zusammenfassung

Wie in der allgemeinen Bevölkerung nimmt die Prävalenz von Übergewicht und Adipositas auch bei Patienten mit Hämophilie zu. Für die vorliegende Studie wurden in 7 deutschen Hämophiliezentren 254 Patienten unter 30 Jahren mit schwerer Hämophilie A und negativer Hemmkörperanamnese erfasst. Das mediane Alter der Patienten lag bei 13 Jahren (0–30 Jahre). 25.2% der Patienten waren übergewichtig bzw. adipös. Der mediane FVIII Verbrauch lag bei normalgewichtigen Patienten bei 96.9 IE/kg/Woche und war signifikant höher als bei übergewichtigen/adipösen Patienten (72.9 IE/kg/Woche, P <0.0001). Patienten mit Übergewicht zeigten in der Studie zudem einen Trend zu einer niedrigeren jährlichen Blutungsrate (Median 1, Spanne 0–17) als normalgewichtige Patienten (Median 2, Spanne 0–28, p = 0.057). Diese niedrigeren Blutungsraten könnten durch verminderte sportliche Aktivität und vermutlich höhere Faktorspiegel bei übergewichtigen Patienten bedingt sein. Aufgrund der zunehmenden Prävalenz an Übergewicht/Adipositas bei Patienten mit Hämophilie könnten ein interdisziplinärer Ansatz zur individualisierten Hämophiliebehandlung und Programme zur Gewichtsreduktion helfen, Therapiekosten und das Risiko durch Übergewicht bedingter Folgeerkrankungen zu reduzieren.

Keywords

severe haemophilia - overweight - obesity - economic burden - factor VIII consumption

Schlüsselwörter

Hämophilie - Übergewicht - Adipositas - Wirtschaftliche Belastung - Faktor VIII-Verbrauch

Full Text

References

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