A recent analysis suggests that clinicians treating patients with Polycythemia Vera (PV) may not be making the most of the medicines that are now available.
The majority of patients began phlebotomy monotherapy, according to the study, which was published in the Annals of Haematology. Thrombotic events were also often observed.
The study’s researchers found that the life expectancy of individuals with PV is 12.4–20 years lower than that of the general population. However, a patient’s age and whether or not they have a history of thrombosis can affect their risk level. According to them, people under 60 who have never experienced thrombosis are typically regarded as “low risk.”
Levels of haematocrit (HCT) are another important risk factor. Patients with an HCT level below 45% had a markedly decreased risk of severe thrombosis, according to a recent study.
The authors added, “Moreover, HCT maintenance of 45% to 50% was associated with 4 times the rate of death from cardiovascular causes or major thrombosis compared with patients with HCT maintenance below 45% in patients with Polycythemia Vera who were receiving phlebotomy and/or hydroxyurea treatment.”
According to current guidelines, low-dose aspirin and the management of cardiovascular risks should be combined with phlebotomy as the initial line of treatment for low-risk individuals. The authors stated that cytoreductive therapy is the first-line treatment for high-risk individuals, and that other therapeutic choices are available for those in need of cytoreduction. The authors also mentioned ruxolitinib (Jakafi) as a second-line treatment option.
They were interested in learning how practitioners were managing Polycythemia Vera cases in the real world and how that management was impacting patient outcomes. Through a retrospective analysis of a medical claims database, they were able to determine the medical and pharmacy claims made by over 28,000 individuals with PV between 2011 and 2019. Patients who had at least two Polycythemia Vera diagnosis codes, at least one year of PV treatment, and at least one prescription claim in 2018 or 2019 were considered for inclusion in the study. For the 4246 individuals for whom at least two HCT test results were available, an HCT subgroup was formed. The patients were divided into low- and high-risk groups by the investigators based on their age and thrombotic history.
The investigators discovered that the primary tactic used in both risk groups was phlebotomy monotherapy. After a median follow-up time of 808 days, 81 percent of high-risk patients and 83 percent of low-risk patients, respectively, who had begun with phlebotomy monotherapy, were still receiving it. The first-line treatment for thirty percent of high-risk individuals was hydroxyurea monotherapy.
“In a community-dwelling population, our study demonstrates a significant gap between recommended treatment and actual treatment patterns,” the authors stated.
When starting phlebotomy monotherapy, 54% of patients in the high-risk group and 64% of patients in the low-risk group had HCT levels exceeding 50% occasionally or consistently.
Following the start of treatment, sixteen percent of the participants (20% of high-risk patients and 8% of low-risk patients) had at least one thrombotic episode.
The researchers stated, “Even though our study design does not establish associations between specific treatment pathways and the risk of thrombotic events, our study results are in line with prior research findings which indicate that Polycythemia Vera patients experience a high rate of thrombotic events irrespective of treatment pathway, highlighting the need to improve patient management.”
Overall, despite the fact that a sizable portion of patients are suffering thrombotic events and a very small percentage of patients are attaining the necessary level of HCT control, the authors concluded that their findings indicate doctors are overly dependent on phlebotomy.
