Late-treated, untreated HAE attacks tied to lower quality of life: Study
Connection to decreased work productivity also found
Late-treated and untreated swelling attacks in people with hereditary angioedema (HAE) are associated with a lower health-related quality of life and work productivity.
That’s according to a U.S. study, which also found that as attack severity and time to treatment increased, patients’ quality of life and work productivity decreased.
“The negative impact of attacks on [health-related quality of life], work productivity, and activity impairment may be reduced by increasing compliance with HAE guidelines, which recommend treating attacks as early as possible (i.e., upon recognition), and by addressing barriers to [on-demand therapy] in general and early treatment in particular,” researchers wrote.
The study, “Impact of hereditary angioedema attacks on health-related quality of life and work productivity,” was published in the World Allergy Organization Journal.
HAE characterized by recurrent swelling attacks
HAE is characterized by recurrent swelling attacks affecting different parts of the body. It is caused by genetic mutations that ultimately result in the overproduction of bradykinin, a signaling molecule that causes blood vessels to widen and leak fluid into nearby tissues.
Although the disease is known to impact health-related quality of life negatively, few studies have characterized these effects and the disease’s repercussions on work productivity and well-being, the researchers wrote.
To learn more, researchers conducted an online survey of 114 patients with HAE type 1 or 2 who had at least one attack in the previous three months. The US HAE Association recruited patients to participate in the survey.
Participants were divided into treatment and non-treatment groups based on whether or not they had received on-demand treatment during their last swelling attack. The first group included 94 participants, ages 12 and older, while the second group comprised 20 non-treated patients who were at least 18 years old.
Most patients in both groups experienced their most recent attack in the previous month.
The majority of patients in the treated group were adults (85%). More than half (55%) classified their most recent attack as moderate in severity, while 29% rated it as mild, and 16% as severe or very severe. Most untreated patients considered their last attack mild (70%), with a quarter rating it as moderate, and 5% deeming it severe.
More than half of the participants in both groups had been prescribed long-term preventive treatment and on-demand treatment at the time of their last attack. On-demand treatment most commonly consisted of a therapy given by under-the-skin, or subcutaneous, injections, usually administered within a mean time of 2.9 hours after attack onset.
Questionnaire assesses participants’ quality of life
The EuroQol-Five Dimensions-Five Levels (EQ-5D-5L) questionnaire assessed participants’ physical and mental health-related quality of life. Its scores range from -0.57 to 1, where 1 indicates the best health state possible.
Overall, participants had lower EQ-5D-5L scores during their last attack than when they answered the survey: 0.57 vs. 0.85 for the treated group, and 0.66 vs. 0.86 for the untreated group.
Treated patients had higher EQ-5D-5L scores if they received treatment within less than one hour after attack onset, compared with receiving treatment between one and eight hours after (0.67 vs. 0.50). The scores also decreased with increasing attack severity.
In this group of participants, the mean EQ VAS score, which assessed overall health status, was lower during the last attack than at the time of the survey (56.4 vs. 75.9), indicating a worse health status during the HAE attack. The score decreased as the time to treatment increased, from 60.1 in those treated within less than one hour to 53.3 in those treated after eight hours or longer.
Together, these data suggest that early treatment (i.e., upon attack recognition) may mitigate the negative impact of attacks on patient well-being and functioning by reducing attack severity.
In the week following attack onset, 39% of the patients experienced overall work impairment, while 35% were working but with a significant reduction in productivity, or presenteeism. Also, 15% missed work due to HAE, a proportion that was lower in patients treated within one hour of attack onset compared with those treated between five and eight hours later (2% vs. 20%).
Despite attacks being generally milder in the untreated group, there was a decrease in the overall EQ VAS score during the last attack (73 vs. 84.1), with similar effects in work productivity (12% absenteeism, 32% presenteeism, and 36% work impairment).
This study demonstrated that acute HAE attacks affect patients’ overall health, quality of life, and work productivity. These effects were associated with the time to treatment administration, with longer times being tied to worse outcomes.
“Together, these data suggest that early treatment (i.e., upon attack recognition) may mitigate the negative impact of attacks on patient well-being and functioning by reducing attack severity,” the researchers wrote.
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