Novel findings from the multinational <scp>DOVE</scp> study on geographic and age‐related differences in pain perception and analgesic usage in children with sickle cell anaemia

Kanter, Julie; Heath, Lori E.; Knorr, Jack; Agbenyega, E.T.; Colombatti, Raffaella; Dampier, Carlton; Hassab, Hoda; Manwani, Deepa; Robitaille, Nancy; Brown, Patricia; Jakubowski, Joseph A.; Yao, Suqin; Hoppe, Carolyn

doi:10.1111/bjh.15250

Cited by 14 publications

(10 citation statements)

References 17 publications

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“…Widely varied definitions of SCD and complications across different studies exist in the literature. 1,4,12,18,[20][21][22][23]26,[28][29][30][31][35][36][37][39][40][41][42][43] These data sets typically contain limited, de-identified information on hospitals, clinicians, and patients. These data include demographics and clinical information that is reliant on accurate recording of ICD and/or CPT diagnosis and procedure codes.…”

Section: Limit Limita Ations Tionsmentioning

confidence: 99%

“… 10 Kanter et al (2018) showed that 12-to-18-year-old patients with SCD experienced more frequent pain than their 7-to-12-year-old counterparts. 12 These findings are concerning when reviewing available mortality data in patients <18 years of age. Currently available data from the Dallas Newborn Cohort (DNC) suggest patients aged 16 to 18 years have a higher death rate (2.91/100 patient-years) compared with younger patients.…”

Section: Introductionmentioning

confidence: 98%

“…8 A California and Illinois study in the early nineties showed the cumulative mortality rate was 1.5/100 African-American child with SCD. 9 Adolescent and young adult patients with SCD experience a wide array of acute and chronic complications, [10][11][12][13] with pain or intensive painful episodes (VOC), accounting for the vast majority of these complications. 10 Kanter et al (2018) showed that 12-to-18-year-old patients with SCD experienced more frequent pain than their 7-to-12-year-old counterparts.…”

Section: Intr Introduc Oduction Tionmentioning

confidence: 99%

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High Healthcare Utilization in Adolescents with Sickle Cell Disease Prior to Transition to Adult Care: A Retrospective Study

Kanter

Bhor

et al. 2019

JHEOR

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Background: The transition from pediatric to adult care in the US is often difficult for individuals with sickle cell disease (SCD). Young adults (18 to 25 years of age) have higher acute care utilization and an increased risk of poor outcomes. The current study was designed to provide greater insights into patients (16 to 18 years of age) with SCD prior to their transition to adult care. Objectives: To describe current treatment patterns, pain crises prevalence, SCD-related complications, and healthcare resource utilization (HCRU) in 16-to-18-year-old patients with SCD. Methods: From 1/1/2015-6/30/2017 using MarketScan Databases, patients were included if they were 16 to 18 years old at the index date, had ≥1 inpatient or 2 outpatient SCD diagnosis claims during the identification period, and were continuously enrolled in the database for at least one year prior (baseline) and post index date. Outcomes included medications, disease management interventions, Charlson Comorbidity Index (CCI), vaso-occlusive (VOC) crises requiring healthcare visits, HCRU, and SCD complications. Results: 1,186 patients were included; most (64.3%) were female. The mean CCI was 1.3 (SD: 0.7). In the overall cohort, patients experienced an average of 3.9 (SD: 4.2) VOCs and most patients (61.1%, n=725) had chronic complications during the one-year follow-up. Pulmonary disease (31.1%, n=369) was the most frequent complication; blood transfusions (mean: 8.4 [SD:7.0]) and iron-chelating therapies (mean: 8.6 [SD:10]) were the most common interventions and medications, respectively. In the 16 to 18 year old group, patients with SCD had 2.0 (SD = 2.3) hospital admissions, 3.4 (SD = 4.0) ER visits, and 5.0 (SD = 4.2) office visits. Conclusions: Prior to transition to adult care, adolescents with SCD already have significant acute and chronic disease-related complications, possibly contributing to frequent healthcare visits. Increased attention to this age group, including improvements in disease modifying therapy, are needed prior to transition to adult care systems to improve outcomes.

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Section: Limit Limita Ations Tionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Intr Introduc Oduction Tionmentioning

confidence: 99%

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High Healthcare Utilization in Adolescents with Sickle Cell Disease Prior to Transition to Adult Care: A Retrospective Study

Kanter

Bhor

et al. 2019

JHEOR

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“…It is possible that children enrolled in the Americas may represent subjects with more severe disease with breakthrough pain despite HU use. Of interest, Kanter et al [12] found that use of opioid, compared to non-opioid, analgesics in DOVE was higher in the Americas than in any other region. It is perhaps surprising that acute pain and ACS were least reported in SSA even though utilization of HU was limited.…”

Section: Discussionmentioning

confidence: 99%

Geographic Differences in Phenotype and Treatment of Children with Sickle Cell Anemia from the Multinational DOVE Study

Inusa

Colombatti

Rees

et al. 2019

JCM

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Background: DOVE (Determining Effects of Platelet Inhibition on Vaso-Occlusive Events) was a Phase 3, randomized, double-blind, placebo-controlled study conducted in children with sickle cell anemia at 51 sites in 13 countries across four continents. Procedure: Data from DOVE were assessed for regional differences in subject phenotype and treatment. Demographics, baseline clinical and laboratory data, hydroxyurea (HU) use, vaso-occlusive crisis (VOCs; composite endpoint of painful crisis or acute chest syndrome (ACS)), serious adverse events (SAEs), hospitalization, and treatments were compared across the Americas, Europe, North Africa/Middle East, and Sub-Saharan Africa (SSA). Results: Race, body mass index, and blood pressures differed by region. Pre-enrollment VOCs were highest in the Americas. For subjects not on HU, baseline hemoglobin was lowest in SSA; reticulocyte count was lowest in the Americas. Within SSA, Kenya subjects presented higher baseline hemolysis. Painful crisis was the most common SAE, followed by ACS in the Americas and infections in other regions. VOC rate and percentage of VOC hospitalizations were highest in Europe. Regardless of region, most VOCs were treated with analgesics; approximately half were treated with intravenous fluids. The proportion of VOC-related transfusions was greatest in Europe. Lengths of hospital stay were similar across regions. Conclusions: Overall differences in SAEs and hospitalization for VOCs may be due to cultural diversities, resource utilization, disease severity, or a combination of factors. These data are of importance for the planning of future trials in SCA in a multinational setting.

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“…Consequently, analgesic prescribing habits vary widely between providers and institutions, both domestically and internationally. The Determining Effects on Platelet Inhibition on Vaso-Occlusive Events (DOVE) study [16] was the first prospective, multinational study conducted in children with SCD and results found that opioid use varied significantly among regions but was the highest in the Americas compared to other regions [17].…”

Section: Introductionmentioning

confidence: 99%

International Differences in Outpatient Pain Management: A Survey of Sickle Cell Disease

El-Amin

Nietert

Kanter

2019

JCM

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Vaso-occlusive pain crises are the hallmark of sickle cell disease (SCD) and the primary reason for health care utilization. Both national and international guidelines recommend aggressive intravenous opioids, intravenous fluids and anti-inflammatory therapy as the mainstay of treatment for acute SCD pain. However, many vaso-occlusive crises are managed at home with oral medication and supportive care. There are no guidelines on home medication management of SCD-related pain, likely due to the lack of well-defined endpoints for acute events and the lack of funding for already approved pain medications. Amplifying this issue is the growing concern for opioid abuse and misuse in the United States (US) and internationally. This study aimed to evaluate differences in opioid prescribing practices among providers treating SCD in the US and internationally. A survey was disseminated electronically to known providers using a combination of purposive and snowball sampling strategy. There were 127 responses and 17 countries represented. US providers were more likely to prescribe opioids (p < 0.001) and were more likely to be “very comfortable” prescribing opioids than non-US prescribers (p < 0.001). US providers also tended to prescribe more tablets per patient of stronger opioids than non-US physicians. US physicians were more likely to be concerned that patients were abusing opioids than non-US physicians (32% vs. 27%, p < 0.05). There are significant variations in how different parts of the world manage pain in the outpatient setting for SCD. Identifying optimal home pain management strategies is necessary to improve care and long-term outcomes in SCD.

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Novel findings from the multinational DOVE study on geographic and age‐related differences in pain perception and analgesic usage in children with sickle cell anaemia

Cited by 14 publications

References 17 publications

High Healthcare Utilization in Adolescents with Sickle Cell Disease Prior to Transition to Adult Care: A Retrospective Study

High Healthcare Utilization in Adolescents with Sickle Cell Disease Prior to Transition to Adult Care: A Retrospective Study

Geographic Differences in Phenotype and Treatment of Children with Sickle Cell Anemia from the Multinational DOVE Study

International Differences in Outpatient Pain Management: A Survey of Sickle Cell Disease

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