Contrary to guideline recommendations, only a small portion of patients with high-risk polycythemia vera (PV) may be receiving cytoreductive therapy, according to a study published in Experimental Hematology & Oncology.

Key contributors to the higher risk of death among patients with PV include cardiovascular disease and thrombotic events; current recommendations advise that patients with high-risk PV be managed with cytoreductive medications, phlebotomy, and low-risk aspirin. Real-world adherence to cytoreductive therapies however, has not been investigated.

For this retrospective analysis, researchers accessed claims data from the Truven Health Marketscan database and evaluated the outcomes of 1823 and 1033 patients with high- and low-risk PV, respectively. Pre-index comorbid conditions, such as hypertension, type 2 diabetes, and congestive heart failure, were observed more commonly among high-risk patients compared with low-risk patients.

The most commonly used pre-index cytoreductive therapies for high-risk and low-risk patients, respectively, were hydroxyurea in 94.7% and 87.5% of patients, anagrelide in 7.4% and 11.9% of patients, and interferon in 1.7% and 4.4% of patients.

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The most commonly used postindex cytoreductive therapies for high-risk and low-risk patients, respectively, were hydroxyurea in 97.0% and 91.4% of patients, anagrelide in 4.0% and 2.9% of patients, and interferon in 2.0% and 8.6% of patients.

Results showed that only 42.0% of patients with high-risk PV and 18.9% with low-risk PV received cytoreductive therapy in the pre- or postindex periods overall.

The authors concluded that “given the increased mortality of patients with PV compared with age-matched subjects without PV, the present data suggest that a considerable proportion of patients with high-risk PV would likely benefit from revised treatment plans that align with current clinical guideline recommendations.”

Reference

Paranagama D, Colucci P, Evans KA, Bonafede M, Parasuraman S. Are patients with high-risk polycythemia vera receiving cytoreductive medications? A retrospective analysis of real-world data [published online July 9, 2018]. doi: 10.1186/s40164-018-0107-8