Impact of Obesity on Dosing of Hemophilia Products
Obesity may impact factor dosing in patients with hemophilia
WFH 2016 (Orlando, July 24-28): Obesity & impact on dosing was discussed at a session at the World Federation of Hemophilia congress recently. Obesity among patients with hemophilia seems to be a growing concern in the hemophilia community. This can lead to several hemophilia-related complications including a higher rate of reduced lower limb range of movement that likely would contribute to reduced quality of life. Weight issues may result in a lower chance of self-infusion in the home setting (harder to find veins). In turn, this may lead to negative joint outcomes over a period of decades, including a greater risk of patients requiring hip arthroplasty (hip replacement) and a much greater risk of patients requiring total knee arthroplasty (total knee replacement); surgery and rehabilitation are also more complicated in overweight individuals even without hemophilia.
Since factor products are dosed based on body weight, those who are overweight or obese tend to use more factor product compared to patients with normal body weight. It has been shown that dosing based on ideal body weight (IBW) may provide similar factor levels and effectiveness compared to dosing based on actual body weight, but there is no current data to suggest that clinical outcomes based upon IBW dosing would be equivalent, nor significant data on impact of reductions in weight on clinical outcomes. Research on these subjects is needed.