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Miesbach W, von Drygalski A, Smith C, Sivamurthy K, Pinachyan K, Bensen-Kennedy D, Drelich D, Kulkarni R. The current challenges faced by people with hemophilia B. Eur J Haematol 2024; 112:339-349. [PMID: 38082533 DOI: 10.1111/ejh.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Hemophilia B (HB) is a rare, hereditary disease caused by a defect in the gene encoding factor IX (FIX) and leads to varying degrees of coagulation deficiency. The prevailing treatment for people with HB (PWHB) is FIX replacement product. The advent of recombinant coagulation products ushered in a new era of safety, efficacy, and improved availability compared with plasma-derived products. For people with severe HB, lifelong prophylaxis with a FIX replacement product is standard of care. Development of extended half-life FIX replacement products has allowed for advancements in the care of these PWHB. Nonetheless, lifelong need for periodic dosing and complex surveillance protocols pose substantive challenges in terms of access, adherence, and healthcare resource utilization. Further, some PWHB on prophylactic regimens continue to experience breakthrough bleeds and joint damage, and subpopulations of PWHB, including women, those with mild-to-moderate HB, and those with inhibitors to FIX, experience additional unique difficulties. This review summarizes the current challenges faced by PWHB, including the unique subpopulations; identifying the need for improved awareness, personalized care strategies, and new therapeutic options for severe HB, which may provide future solutions for some of the remaining unmet needs of PWHB.
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Affiliation(s)
| | | | | | | | | | | | | | - Roshni Kulkarni
- Michigan State University Center for Bleeding and Clotting Disorders, Lansing, Michigan, USA
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Symington E, Rangarajan S, Lester W, Madan B, Pierce GF, Raheja P, Robinson TM, Osmond D, Russell CB, Vettermann C, Agarwal SK, Li M, Wong WY, Laffan M. Long-term safety and efficacy outcomes of valoctocogene roxaparvovec gene transfer up to 6 years post-treatment. Haemophilia 2024; 30:320-330. [PMID: 38317480 DOI: 10.1111/hae.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Valoctocogene roxaparvovec uses an adeno-associated virus serotype 5 (AAV5) vector to transfer a factor VIII (FVIII) coding sequence to individuals with severe haemophilia A, providing bleeding protection. AIM To assess safety and efficacy of valoctocogene roxaparvovec 5-6 years post-treatment. METHODS In a phase 1/2 trial, adult male participants with severe haemophilia A (FVIII ≤1 IU/dL) without FVIII inhibitors or anti-AAV5 antibodies received valoctocogene roxaparvovec and were followed for 6 (6 × 1013 vg/kg; n = 7) and 5 (4 × 1013 vg/kg; n = 6) years. Safety, including investigation of potential associations between a malignancy and gene therapy, and efficacy are reported. RESULTS No new treatment-related safety signals emerged. During year 6, a participant in the 6 × 1013 vg/kg cohort was diagnosed with grade 2 parotid gland acinar cell carcinoma; definitive treatment was uncomplicated parotidectomy with lymph node dissection. Target enrichment sequencing of tumour and adjacent healthy tissue revealed low vector integration (8.25 × 10-5 per diploid cell). Integrations were not elevated in tumour samples, no insertions appeared to drive tumorigenesis, and no clonal expansion of integration-containing cells occurred. During all follow-ups, >90% decreases from baseline in annualised treated bleeds and FVIII infusion rates were maintained. At the end of years 6 and 5, mean FVIII activity (chromogenic assay) was 9.8 IU/dL (median, 5.6 IU/dL) and 7.6 IU/dL (median, 7.1 IU/dL) for the 6 × 1013 and 4 × 1013 vg/kg cohorts, respectively, representing proportionally smaller year-over-year declines than earlier timepoints. CONCLUSIONS Valoctocogene roxaparvovec safety and efficacy profiles remain largely unchanged; genomic investigations showed no association with a parotid tumour.
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Affiliation(s)
- Emily Symington
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Will Lester
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bella Madan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Priyanka Raheja
- Haemophilia Centre Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Dane Osmond
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | | | | | | | - Mingjin Li
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
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Schneider NB, de Araujo CLP, Godoy Dos Santos HW, Lima S, Falavigna M, Pachito DV. Epidemiology, patient journey and unmet needs related to hemophilia in Brazil: a scoping review with evidence map. Hematol Transfus Cell Ther 2024:S2531-1379(24)00014-2. [PMID: 38614934 DOI: 10.1016/j.htct.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Brazil is one of the countries with the largest population of people with hemophilia (PwH) worldwide. In this scoping review, we aim to investigate the Brazilian context for hemophilia regarding three predefined concepts: (i) clinical-epidemiological profile, (ii) burden of disease and (iii) patient journey and unmet needs. METHODS Three questions in each concept guided the screening of references retrieved by systematic searches carried out in MEDLINE, LILACS and the Digital Library of Theses and Dissertations. Quantitative and qualitative studies conducted in Brazil from 2002 onwards were assessed for eligibility. MAIN RESULTS Ninety-two studies were included. A total of 66 studies addressed the concept "Clinical-epidemiological profile", 31 investigated the concept of "Burden of disease" and 26 addressed the concept "Patient journey and unmet needs". Based on these studies, pain and arthropathy affect a substantial proportion of the PwH, with physical functioning, pain and school or work being the domains of quality of life with the greatest impact. About 43 % to 82.6 % of the PwH are unemployed. Rates of inhibitor development are highly variable across studies, especially in hemophilia A. Adherence to prophylactic treatment ranges from 25 % to 72 %. The annualized bleeding rate is estimated at 2.4 ± 4.1. The barriers to treatment identified include distance to reference centers, lack of coordination of specialized and emergency care and restricted access to rehabilitation. CONCLUSIONS Hemophilia poses a considerable burden on the PwH. Despite the available modalities of treatment, there are remaining unmet needs that should be addressed by researchers and policy makers in the future.
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Affiliation(s)
| | - Cintia Laura Pereira de Araujo
- HTA Unit, Inova Medical, Porto Alegre, RS, Brazil; Research Institute, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Zhang L, Zhang P, Chen W. Overview of Patients with Hemophilia in China: Demographics, Diseases, Treatment, and Health Status. Patient Prefer Adherence 2024; 18:101-109. [PMID: 38234633 PMCID: PMC10793115 DOI: 10.2147/ppa.s441873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
Background In China, there were over 65,000 hemophilia patients according to estimations requiring overall description. However, former Chinese studies related to hemophilia were based on data of relatively small sample size from single-center or selected multi-centers in specific areas. Objective This study is aimed to provide an overview of patients with hemophilia in China and basic information for optimized hemophilia care and policy decisions in the future. Methods We cooperated with the biggest patient organization of hemophilia in China, Hemophilia Home, got access to over ten thousand registered patients with hemophilia and conducted a national representative online survey in 2021. Descriptive statistics were conducted to describe the mean and standard deviation for continuous variables and numbers and proportions for categorical variables. Results Nine hundred and fifty patients with hemophilia aged 0-71 years were included in our analysis and divided into 538 children and 412 adults. Compared to international research, consistent results were found regarding the proportions of hemophilia types and hemophilia severity, while Chinese patients had less opportunity to receive the formal education and the lower rate to be employed or married. Although children with hemophilia had higher household income, timely treatment, and more prophylaxis treatment leading to better clinical outcomes and higher HRQoL than adults, there were still more annual bleeds, chronic pains, and lower EQ-VAS scores especially in adults than in other countries. Conclusions and Recommendation Our findings suggest the urgency for promoting hemophilia care and improving the social adaptation of hemophilia patients in China.
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Affiliation(s)
- Luying Zhang
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Peng Zhang
- School of Humanities, Shanghai Institute of Technology, Shanghai, 201418, People’s Republic of China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
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O'Mahony B, Dunn AL, Leavitt AD, Peyvandi F, Ozelo MC, Mahlangu J, Peerlinck K, Wang JD, Lowe GC, Tan CW, Giermasz A, Tran H, Khoo TL, Cockrell E, Pepperell D, Chambost H, López Fernández MF, Kazmi R, Majerus E, Skinner MW, Klamroth R, Quinn J, Yu H, Wong WY, Robinson TM, Pipe SW. Health-related quality of life following valoctocogene roxaparvovec gene therapy for severe hemophilia A in the phase 3 trial GENEr8-1. J Thromb Haemost 2023; 21:3450-3462. [PMID: 37678546 DOI: 10.1016/j.jtha.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Severe hemophilia A (HA) negatively impacts health-related quality of life (HRQOL). OBJECTIVES We aimed to analyze HRQOL in adult men with severe HA without inhibitors after valoctocogene roxaparvovec gene transfer in the phase 3 trial GENEr8-1. METHODS Participant-reported outcomes were the hemophilia-specific quality of life questionnaire for adults (Haemo-QOL-A), the EQ-5D-5L instrument, the Hemophilia Activities List (HAL), and the Work Productivity and Activity Impairment Questionnaire: Hemophilia Specific (WPAI+CIQ:HS). Participants completed the questionnaires at baseline and through 104 weeks postinfusion with 6 × 1013 vg/kg of valoctocogene roxaparvovec. Scores were analyzed per participant characteristics and outcomes. RESULTS For 132 HIV-negative participants, mean change from baseline in Haemo-QOL-A Total Score met the anchor-based clinically important difference (CID: 5.5) by week 12; the mean (SD) increase was 7.0 (12.6) at week 104. At week 104, improvement in Consequences of Bleeding, Treatment Concern, Worry, and Role Functioning domain scores exceeded the CID (6). EQ-5D-5L Utility Index scores improved above the CID at week 52, but not at week 104. EQ-5D-5L visual analog scale and HAL scores increased from baseline to week 104. Participants reported less activity and work impairment at week 104 than baseline. Participants with problem joints had lower mean baseline Haemo-QOL-A Total and domain scores than those without them, but improved over 104 weeks, except for 11 participants with ≥3 problem joints. Participants with 0 bleeds during the baseline prophylaxis period reported Haemo-QOL-A score improvements above the CID, including in the Consequences of Bleeding domain. CONCLUSION Valoctocogene roxaparvovec provided clinically meaningful HRQOL improvement for men with severe HA.
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Affiliation(s)
- Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland; Trinity College, Dublin, Ireland.
| | - Amy L Dunn
- The Division of Hematology, Oncology, and BMT at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrew D Leavitt
- University of California San Francisco, San Francisco, California, USA
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Margareth C Ozelo
- Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Johnny Mahlangu
- Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg, South Africa
| | - Kathelijne Peerlinck
- Department of Vascular Medicine and Haemostasis and Haemophilia Centre, University Hospitals Leuven, Leuven, Belgium
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gillian C Lowe
- West Midlands Comprehensive Care Haemophilia Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Chee Wee Tan
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Adam Giermasz
- Hemophilia Treatment Center, University of California Davis, Sacramento, California, USA
| | - Huyen Tran
- Haemostasis & Thrombosis Unit, Haemophilia Treatment Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Teh-Liane Khoo
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Erin Cockrell
- Pediatric Hematology Oncology, Saint Joseph's Children's Hospital, Tampa, Florida, USA
| | - Dominic Pepperell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Hervé Chambost
- AP-HM, Department of Pediatric Hematology Oncology, Children Hospital La Timone & Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | | | - Rashid Kazmi
- Department of Haematology, Southampton University Hospital, Southampton, UK
| | - Elaine Majerus
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mark W Skinner
- Institute for Policy Advancement Ltd, Washington, DC, USA; McMaster University, Hamilton, Ontario, Canada
| | - Robert Klamroth
- Comprehensive Care Haemophilia Treatment Center, Vivantes Klinikum im Friedrichshain, Berlin, Germany; Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Germany
| | | | - Hua Yu
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | | | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Malec L, Matino D. Targeting higher factor VIII levels for prophylaxis in haemophilia A: a narrative review. Haemophilia 2023; 29:1419-1429. [PMID: 37758651 DOI: 10.1111/hae.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION The standard of care in severe haemophilia A is prophylaxis, which has historically aimed for a factor VIII (FVIII) trough level of ≥1%. However, despite prophylactic treatment, people with haemophilia remain at risk of bleeds that have physical and quality of life implications, and that impact everyday life. AIM The aim of this review was to evaluate evidence supporting the relationship between targeting higher FVIII activity levels with prophylaxis and improved outcomes in people with haemophilia A. METHODS We conducted a narrative review that defined the unmet needs and treatment goals in people with haemophilia A, evaluated evidence to support targeting higher FVIII activity levels, and highlighted therapies that may support higher and sustained FVIII activity levels and improved outcomes for people with haemophilia A. RESULTS Despite recent advances in treatment, unmet needs remain, and people with haemophilia continue to experience joint and functional impairment, acute and chronic pain, and poor mental health. All these negatively impact their health-related quality of life. Evidence suggests that FVIII activity levels of up to 50% may be needed to achieve a near-zero joint bleed rate. However, achieving high FVIII activity levels with current standard and extended half-life (EHL) FVIII replacement therapies is associated with a high treatment burden. Innovative treatment options may provide high sustained FVIII activity levels and improved patient outcomes. CONCLUSION Evidence suggests that FVIII activity levels in people with haemophilia A should be sustained at higher levels to improve joint and patient outcomes and enable progression towards health equity.
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Affiliation(s)
- Lynn Malec
- Versiti Blood Research Institute, Milwaukee, Wisconsin, USA
- Division of Hematology & Oncology, Departments of Medicine and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Davide Matino
- Division of Hematology & Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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La Mura V, Bitto N, Capelli C, Caputo C, Siboni S, Arcudi S, Ciavarella A, Gualtierotti R, Fracanzani AL, Sangiovanni A, Peyvandi F. Residual burden of liver disease after HCV clearance in hemophilia: a word of caution in the era of gene therapy. Blood Adv 2023; 7:5817-5824. [PMID: 37505111 PMCID: PMC10561041 DOI: 10.1182/bloodadvances.2023010723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
Ruling out advanced fibrosis/cirrhosis is mandatory for persons with hemophilia (PWH) who are candidates for gene therapy. However, clinical evaluation and noninvasive tests (NITs) may be inaccurate after hepatitis C virus (HCV) clearance. We conducted a prospective hepatological screening to detect advanced fibrosis/cirrhosis in PWH after HCV clearance. Any risk factor of chronic liver damage was registered by using biochemical data, liver stiffness measurement (LSM), and ultrasound (US). A pre/post-HCV clearance analysis was conducted prospectively in a subgroup of patients who underwent LSM, US, and NITs for fibrosis. We evaluated 119 patients (median age, 53 years; range, 36-87 years) with a previous HCV infection (hemophilia A, n = 108; hemophilia B, n = 11). Ninety-six (81%) presented at least 1 potential risk factor of chronic liver damage. Metabolic risk factors were the most prevalent, with 51 patients (44%) having US steatosis. In 21 patients (18%), clinical, biochemical, liver morphology, and/or LSM were suggestive of advanced fibrosis/cirrhosis. Furthermore, 10 patients (8%) had esophageal varices and 3 (3%) had hepatocellular carcinoma. In 57 patients included in the prospective analysis, LSM and NITs were reduced after HCV clearance (P < .05), but US signs specific of cirrhosis remained unchanged. Overall, 23 of 80 patients (29%) with LSM <10 KPa had at least 1 US sign suggestive of advanced fibrosis/cirrhosis. A similar proportion (18%) was observed for LSM <8 KPa. Overall, risk factors of chronic liver damage are frequent after HCV clearance, but changes in LSM and NITs after clearance may be inaccurate to rule out advanced fibrosis/cirrhosis. A specific diagnostic workup is warranted to evaluate liver health in PWH in the era of gene therapy.
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Affiliation(s)
- Vincenzo La Mura
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Niccolò Bitto
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
| | - Cecilia Capelli
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
| | - Camilla Caputo
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
| | - Simona Siboni
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
| | - Sara Arcudi
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
| | - Alessandro Ciavarella
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
| | - Roberta Gualtierotti
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Unit of Internal Medicine and Metabolic Diseases, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Sangiovanni
- Gastroenterology and Hepatology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Ospedale Maggiore Policlinico-Angelo Bianchi Bonomi and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Goetsch Weisman A, Haws T, Lee J, Lewis AM, Srdanovic N, Radtke HB. Transition Readiness Assessment in Adolescents and Young Adults with Neurofibromatosis Type 1 (NF1). Compr Child Adolesc Nurs 2023; 46:223-239. [PMID: 32969737 DOI: 10.1080/24694193.2020.1806402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
Neurofibromatosis type 1 (NF1) conveys significant disease morbidity and lower quality of life compared to the general population. Research has shown that decreased positive health outcomes are directly correlated with inadequate development of health-related self-management skills among similar patient populations, and among these populations a healthcare transition (HCT) intervention improves provision of care and health outcomes. Thus, HCT intervention may improve care and outcomes in NF1. To design a future informed NF1 HCT intervention, baseline transition readiness must be assessed. A survey distributed by Children's Tumor Foundation (CTF) was developed to assess transition readiness and the impact of NF1 on factors of young adult life. A total of 101 participants aged 14-26 years living in the United States completed the survey with a median [IQR] age of 18 [16, 21]. The majority of participants reported that NF1 had significant or some impact on all factors of young adult life including education, career, relationships, and family planning. The median Transition Readiness Assessment Questionnaire (TRAQ) score in this study (3.50/5.00) was significantly lower than the previously published score of healthy peers (3.93/5.00) (p< .001). Higher TRAQ scores correlated with higher NF1-specific transition knowledge and skills (NF1-TRAQ) (r = 0.632). Participants self-report adequate knowledge of NF1 and comfort in talking to medical providers. They report discomfort with appointment keeping, insurance related tasks, addressing NF1 emergencies, and discussing NF1 with non-medical providers and peers. Further, TRAQ and NF1-TRAQ scores were lower in individuals who reported that their diagnosis of NF1 had some or significant impact on education, career, and relationships. Findings demonstrate that among individuals with NF1 in this study, decreased transition readiness is associated with a negative impact on young adult life. Data from this study supports the need to develop NF1-specific HCT intervention tools, with an effort to improve quality of life and standardize NF1 care.
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Affiliation(s)
- Allison Goetsch Weisman
- Division of Genetics, Birth Defects & Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tina Haws
- Neuroscience Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Joanna Lee
- Division of Genetics, Birth Defects & Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- eviCore Healthcare, Bluffton, South Carolina, USA
| | - Andrea M Lewis
- Department of Genetics, Texas Children's Hospital, Houston, Texas, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Nina Srdanovic
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Heather B Radtke
- Division of Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children's Tumor Foundation, New York, New York, USA
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Solomons L, Farrar C, Carpenter L. Psychological support for chronic conditions. Curr Opin Support Palliat Care 2023; 17:240-246. [PMID: 37432092 DOI: 10.1097/spc.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
PURPOSE OF REVIEW Haematological conditions are varied, and every condition presents unique psychosocial challenges to patients and their families. There is a growing body of evidence about high levels of psychological distress, negative impact on outcomes and evidence-based treatments, yet service provision is patchy and demand far exceeds supply. RECENT FINDINGS This article focuses on the major subspecialty areas and associated neuropsychiatric comorbidities - haematological malignancies, issues related to stem cell transplants, haemoglobinopathies and haemophilia. The subsequent sections focus on common psychiatric comorbidities, considerations across the life span and models of care. SUMMARY Anxiety disorders and depression have higher prevalence in people with haematological conditions. The stressors faced by the individual can vary based on their condition and their stage of life. Early diagnosis and integrated management of comorbid psychiatric illness can improve quality of life and clinical outcomes. A stepped care model is recommended to ensure that psychological distress is identified and managed appropriately, and evidence for a collaborative care model is provided.
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Affiliation(s)
| | - Catherine Farrar
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Tang GH, Thachil J, Bowman M, Bekdache C, James PD, Sholzberg M. Patient-centered care in von Willebrand disease: are we there yet? Expert Rev Hematol 2023; 16:641-649. [PMID: 37581602 DOI: 10.1080/17474086.2023.2243386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Von Willebrand Disease is the most common inherited bleeding disorder. Paradoxically, affected individuals are often misdiagnosed and experience substantial diagnostic delay. There are sex-specific health disparities in VWD rooted in the stigmatization of vaginal bleeding, which leads to symptom dismissal, lack of timely access to care and lower health-related quality of life. AREAS COVERED Following the core elements of patient-centered care - respect for patient preferences, values, and needs, we describe the current state of VWD care. Challenges of diagnostic delay, serial misrecognition of abnormal bleeding, and symptom dismissal are barriers that disproportionately affect women with VWD. These negative effects are further amplified in individuals living in low- and middle-income countries. We describe the importance of coordinated multidisciplinary care, as well as the need for patient education and empowered self-advocacy. EXPERT OPINION While tremendous work has been done to improve the diagnosis and management of VWD, timely and high-quality research is urgently needed to address care gaps. Systemic changes such as resource investment, dedicated research funding for novel treatment modalities, and effective knowledge translation strategies to address structural barriers are needed to facilitate effective patient-centered care for VWD.
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Affiliation(s)
- Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jecko Thachil
- Department of Hematology, Manchester University Hospitals, Manchester, UK
| | - Mackenzie Bowman
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Carine Bekdache
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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11
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Byams VR, Baker JR, Bailey C, Connell NT, Creary MS, Curtis RG, Dinno A, Guelcher CJ, Kim M, Kulkarni R, Lattimore S, Norris KL, Ramirez L, Skinner MW, Symington S, Tobase P, Vázquez E, Warren BB, Wheat E, Buckner TW. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities in health services; diversity, equity, and inclusion; and implementation science. Expert Rev Hematol 2023; 16:87-106. [PMID: 36920863 PMCID: PMC11075128 DOI: 10.1080/17474086.2023.2183836] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The National Hemophilia Foundation (NHF) conducted extensive all-stakeholder inherited bleeding disorder (BD) community consultations to inform a blueprint for future research. Sustaining and expanding the specialized and comprehensive Hemophilia Treatment Center care model, to better serve all people with inherited BDs (PWIBD), and increasing equitable access to optimal health emerged as top priorities. RESEARCH DESIGN AND METHODS NHF, with the American Thrombosis and Hemostasis Network (ATHN), convened multidisciplinary expert working groups (WG) to distill priority research initiatives from consultation findings. WG5 was charged with prioritizing health services research (HSR); diversity, equity, and inclusion (DEI); and implementation science (IS) research initiatives to advance community-identified priorities. RESULTS WG5 identified multiple priority research themes and initiatives essential to capitalizing on this potential. Formative studies using qualitative and mixed methods approaches should be conducted to characterize issues and meaningfully investigate interventions. Investment in HSR, DEI and IS education, training, and workforce development are vital. CONCLUSIONS An enormous amount of work is required in the areas of HSR, DEI, and IS, which have received inadequate attention in inherited BDs. This research has great potential to evolve the experiences of PWIBD, deliver transformational community-based care, and advance health equity.
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Affiliation(s)
- Vanessa R. Byams
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Judith R. Baker
- Center for Inherited Blood Disorders, Western States Regional Hemophilia Network, Orange, California, USA
| | - Cindy Bailey
- Los Angeles Orthopaedic Hemophilia Treatment Center, Los Angeles, California, USA
| | - Nathan T. Connell
- Boston Hemophilia Center, Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa S. Creary
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Randall G. Curtis
- Hematology Utilization Group Study (HUGS), University of Southern California, Los Angeles, California, USA
- Hemophilia Foundation of Southern California, Pasadena, California, USA
| | - Alexis Dinno
- The Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Christine J. Guelcher
- Hemostasis and Thrombosis Program, Children’s National Hospital, Washington, DC, USA
| | - Michelle Kim
- The Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Roshni Kulkarni
- MSU Center of Bleeding and Clotting Disorders, Department Pediatrics and Human Development, Michigan State University, East Lansing, Michigan, USA
| | - Susan Lattimore
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
- Mountain States Regional Hemophilia Network, Portland, Oregon, USA
| | | | - Lucy Ramirez
- Rush Hemophilia and Thrombophilia Treatment Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark W. Skinner
- Institute for Policy Advancement, Washington, DC, USA
- Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Patricia Tobase
- University of California San Francisco Hemophilia Treatment Center, University of California San Francisco, San Francisco, California, USA
| | | | - Beth B. Warren
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Hemophilia and Thrombosis Center, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Emily Wheat
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Hemophilia and Thrombosis Center, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tyler W. Buckner
- Hemophilia and Thrombosis Center, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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Mahlangu J, Kaczmarek R, von Drygalski A, Shapiro S, Chou SC, Ozelo MC, Kenet G, Peyvandi F, Wang M, Madan B, Key NS, Laffan M, Dunn AL, Mason J, Quon DV, Symington E, Leavitt AD, Oldenburg J, Chambost H, Reding MT, Jayaram K, Yu H, Mahajan R, Chavele KM, Reddy DB, Henshaw J, Robinson TM, Wong WY, Pipe SW. Two-Year Outcomes of Valoctocogene Roxaparvovec Therapy for Hemophilia A. N Engl J Med 2023; 388:694-705. [PMID: 36812433 DOI: 10.1056/nejmoa2211075] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Valoctocogene roxaparvovec delivers a B-domain-deleted factor VIII coding sequence with an adeno-associated virus vector to prevent bleeding in persons with severe hemophilia A. The findings of a phase 3 study of the efficacy and safety of valoctocogene roxaparvovec therapy evaluated after 52 weeks in men with severe hemophilia A have been published previously. METHODS We conducted an open-label, single-group, multicenter, phase 3 trial in which 134 men with severe hemophilia A who were receiving factor VIII prophylaxis received a single infusion of 6×1013 vector genomes of valoctocogene roxaparvovec per kilogram of body weight. The primary end point was the change from baseline in the annualized rate of treated bleeding events at week 104 after receipt of the infusion. The pharmacokinetics of valoctocogene roxaparvovec were modeled to estimate the bleeding risk relative to the activity of transgene-derived factor VIII. RESULTS At week 104, a total of 132 participants, including 112 with data that were prospectively collected at baseline, remained in the study. The mean annualized treated bleeding rate decreased by 84.5% from baseline (P<0.001) among the participants. From week 76 onward, the trajectory of the transgene-derived factor VIII activity showed first-order elimination kinetics; the model-estimated typical half-life of the transgene-derived factor VIII production system was 123 weeks (95% confidence interval, 84 to 232). The risk of joint bleeding was estimated among the trial participants; at a transgene-derived factor VIII level of 5 IU per deciliter measured with chromogenic assay, we expected that participants would have 1.0 episode of joint bleeding per year. At 2 years postinfusion, no new safety signals had emerged and no new serious adverse events related to treatment had occurred. CONCLUSIONS The study data show the durability of factor VIII activity and bleeding reduction and the safety profile of valoctocogene roxaparvovec at least 2 years after the gene transfer. Models of the risk of joint bleeding suggest that the relationship between transgene-derived factor VIII activity and bleeding episodes is similar to that reported with the use of epidemiologic data for persons with mild-to-moderate hemophilia A. (Funded by BioMarin Pharmaceutical; GENEr8-1 ClinicalTrials.gov number, NCT03370913.).
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Affiliation(s)
- Johnny Mahlangu
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Radoslaw Kaczmarek
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Annette von Drygalski
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Susan Shapiro
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Sheng-Chieh Chou
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Margareth C Ozelo
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Gili Kenet
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Flora Peyvandi
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Michael Wang
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Bella Madan
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Nigel S Key
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Michael Laffan
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Amy L Dunn
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Jane Mason
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Doris V Quon
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Emily Symington
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Andrew D Leavitt
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Johannes Oldenburg
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Hervé Chambost
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Mark T Reding
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Kala Jayaram
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Hua Yu
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Reena Mahajan
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Konstantia-Maria Chavele
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Divya B Reddy
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Joshua Henshaw
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Tara M Robinson
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Wing Yen Wong
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
| | - Steven W Pipe
- From the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg (J. Mahlangu); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.); the Department of Medicine, University of California, San Diego, La Jolla (A.D.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), the University of California, San Francisco, San Francisco (A.D.L.), and BioMarin Pharmaceutical, Novato (K.J., H.Y., R.M., K.-M.C., D.B.R., J.H., T.M.R., W.Y.W.) - all in California; Oxford University Hospitals NHS Foundation Trust, the Radcliffe Department of Medicine, University of Oxford, and the Oxford National Institute for Health Research Biomedical Research Centre, Oxford (S.S.), Guy's and St. Thomas' NHS Foundation Trust (B.M.) and the Centre for Haematology, Imperial College London (M.L.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (S.-C.C.); Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and the Amalia Biron Research Institute of Thrombosis and Hemostasis, Tel Aviv University, Tel Aviv (G.K.) - both in Israel; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, and Università degli Studi di Milano, Department of Pathophysiology and Transplantation - both in Milan (F.P.); the Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora (M.W.); the UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill (N.S.K.); Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (A.L.D.); the Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, and the University of Queensland - both in Brisbane, Australia (J. Mason); the Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany (J.O.); Assistance Publique-Hôpitaux de Marseille, Department of Pediatric Hematology Oncology, Children's Hospital La Timone and Aix Marseille University, INSERM, Institut National de la Recherche Agronomique, Center for Cardiovascular and Nutrition Research, Marseille, France (H.C.); the Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis (M.T.R.); and the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.)
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13
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Ransmann P, Krüger S, Hilberg T, Hagedorn T, Roussel N. Prevalence of pain in adult patients with moderate to severe haemophilia: a systematic review. Scand J Pain 2022; 22:436-444. [PMID: 35297228 DOI: 10.1515/sjpain-2021-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with haemophilia (PwH) often suffer from joint pain due to repetitive haemarthroses and resulting arthropathy. Literature focuses so far on pain causes, diagnosis or treatment. A summary of prevalence rates, providing facts on the absolute occurrence of pain, is not sufficiently described so far. This review aimed to explore and systematically review different pain conditions, focussing on prevalence rates of pain in adult PwH. METHODS A review of English articles using PubMed and Web of Science was conducted in February 2020. The search strategy included patients with haemophilia A or B suffering from pain. The articles were selected based on defined PICOS-selection criteria. RESULTS Out of 606 identified articles, 13 studies matched the given eligibility criteria and indicated pain prevalence rates. The weighted mean (WM) for the prevalence rate (varying timeframes) for chronic pain was 40% whereas for point prevalence the rate was WM=75%. Regarding pain intensity, findings of the EQ-5D-3L revealed moderate pain to be more present (61.0%) compared to extreme (11.6%). The main problem was the inconsistency of the definition of both acute and chronic pain as well as for prevalence types. CONCLUSIONS Pain is a major problem in patients with haemophilia. Pain therapy should be carried out taking into account the difference between bleeding-related or arthropathy-related causes of pain. In addition, the intensity and duration of pain should be recorded consistently to better monitor therapy and allow comparison with existing data.
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Affiliation(s)
- Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thorsten Hagedorn
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Nathalie Roussel
- Department of Rehabilitation Science and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, Belgium
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14
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Nguyen NAT, Auquier P, Beltran Anzola A, d'Oiron R, Biron-Andréani C, Lienhart A, Rauch A, Baumstarck K, Boucekine M, Milien V, Rosso-Delsemme N, Tabele C, Giraud N, Sannié T, Chambost H, Resseguier N. Occupational integration of adults with severe haemophilia (INTHEMO): A study based on the FranceCoag registry. Haemophilia 2022; 28:962-976. [PMID: 35858674 DOI: 10.1111/hae.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Health of people with severe haemophilia (PwSH) improves thanks to the advancements in haemophilia care, giving them more opportunities in occupational integration. However, there is little literature on the occupational integration of PwSH. OBJECTIVES The main objective of our study was to assess the occupational integration of PwSH and to compare it with that of the general population. The secondary objective was to study the association between individual characteristics (sociodemographic, clinical and psycho-behavioural) and occupational integration of PwSH. METHODS A multicentre, non-interventional, cross-sectional study was conducted in 2018-2020 on PwSH, aged over 18 and under 65 years and included in the FranceCoag registry. Measurements included indicators of occupational integration, sociodemographic, clinical and psycho-behavioural characteristics. The indicators of occupational integration were compared with those of the general population, using indirect standardization. The data of the general population were available from the National Institute of Statistics and Economic Studies (INSEE). Determinants of occupational integration were explored using structural equation modelling. RESULTS Of 1262 eligible people, 588 were included. PwSH had a lower employment rate than the general population (standardized ratio, .85; 95% CI, .77-.94). There were more PwSH at tertiary education level than expected (standardized ratio, 1.38; 95% CI, 1.17-1.61). HIV infection, poor physical health and mental health concerns were associated with a higher risk of unemployment in PwSH. CONCLUSION Employment rate of PwSH is lower than that of the general population despite their higher education level. Target interventions focusing on determinants of difficult occupational integration could be helpful for PwSH.
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Affiliation(s)
- Ngoc Anh Thu Nguyen
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Pascal Auquier
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Any Beltran Anzola
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Roseline d'Oiron
- Haemophilia Treatment Centre, Bicêtre Hospital, University Hospital of Paris (APHP), Kremlin-Bicêtre, France
| | | | - Anne Lienhart
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Bron, France
| | - Antoine Rauch
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Karine Baumstarck
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Mohamed Boucekine
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Vanessa Milien
- FranceCoag Network, Marseille, France.,Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Natacha Rosso-Delsemme
- Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Clemence Tabele
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,FranceCoag Network, Marseille, France
| | - Nicolas Giraud
- Association française des hémophiles (AFH), Paris, France
| | - Thomas Sannié
- Association française des hémophiles (AFH), Paris, France
| | - Hervé Chambost
- FranceCoag Network, Marseille, France.,Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Noémie Resseguier
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
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15
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Valérie C, Laurie F, Julie F, Clément C, Claude N, Carlos EK. PHAREO study: Perceived and observed accessibility to therapeutic drugs used for treating patients with inherited bleeding disorders. J Clin Pharm Ther 2022; 47:1667-1675. [PMID: 35726381 DOI: 10.1111/jcpt.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The dispensing of clotting factor concentrates in hospital pharmacies imposes accessibility constraints on patients and their caregivers, thereby increasing the disease burden. Very few studies have addressed these issues so far in terms of individual perceptions and actual difficulties. The PHAREO study aims to report patient's perception of treatment accessibility and evaluate spatial accessibility. METHODS The PHAREO study is an observational survey based on a questionnaire specifically designed for the study purpose in collaboration with patients' representatives in the second demographic and economic French region. RESULTS AND DISCUSSION We collected 293 responses (participation rate of 64.1%) which show that 89.8% of respondents were either very or rather satisfied with regard to access to treatment. However, respondents reported difficulties in accessing the hospital pharmacy. The data also showed that 79.2% of respondents tended to over-estimate travel time which was reported above their acceptable threshold for 39.2% of them. The main determinants of dissatisfaction were parental burden (OR 2.5 [1.3; 4.8], p = 0.008) and waiting time at the hospital pharmacy (OR 1.5 [1.1;2.0], p = 0.016, per 10 min increase). WHAT IS NEW AND CONCLUSION The PHAREO study provides subjective and objective data regarding satisfaction levels of persons with haemophilia and other coagulation deficiencies, with a high representativeness rate for patients on prophylaxis (87.5%). Both respondents and hospital pharmacists pled for an evolution of the current dispensing circuit to improve access to treatment and reduce the burden for patients. Currently, the community pharmacists are apart from the dispensing circuit. The authors propose improvements in the pathway of care for patients and their caregivers by including the community pharmacists alongside the hospital pharmacists in a centralized coordination scheme.
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Affiliation(s)
- Chamouard Valérie
- Centre de Référence de l'Hémophilie et autres déficits constitutionnels en protéines de la coagulation, Hôpital Louis Pradel, Groupement Hospitalier Est, Bron, France.,Service pharmaceutique, Hôpital Louis Pradel, Groupement Hospitalier Est, Bron, France
| | - Fraticelli Laurie
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France.,Laboratoire Parcours Santé Systémique (P2S) UR 4129, Université de Lyon 1, Lyon, France
| | - Freyssenge Julie
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France.,Research On Healthcare Performance (RESHAPE), INSERM, Lyon, France
| | - Claustre Clément
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France
| | - Négrier Claude
- Centre de Référence de l'Hémophilie et autres déficits constitutionnels en protéines de la coagulation, Hôpital Louis Pradel, Groupement Hospitalier Est, Bron, France
| | - El Khoury Carlos
- RESCUe-RESUVal, Centre Hospitalier Lucien Hussel, Montée Docteur Maurice Chapuis, Vienne, France.,Clinical Research Unit, Médipôle Hôpital Mutualiste, Villeurbanne, France
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16
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Cheung YT, Lam PH, Lam HHW, Ma CT, Leung AWK, Wong RSM, Li CK. Treatment Adherence and Health-Related Quality of Life in Patients with Hemophilia in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116496. [PMID: 35682087 PMCID: PMC9180237 DOI: 10.3390/ijerph19116496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Background: This study aims to identify factors affecting health-related quality of life (HRQoL) in Chinese patients with hemophilia in Hong Kong, and to examine the association between treatment adherence and HRQoL outcomes. Methods: Patients with hemophilia A or B from a non-governmental organization reported their HRQoL and treatment adherence to prophylactic therapy using validated tools. Univariate tests and multivariable regression analysis were used to compare differences in outcomes across clinically relevant subgroups. Results: Fifty-six patients were recruited (mean age 30.4 [17.4] years; majority hemophilia A: 75%; moderate-to-severe severity: 88%). Patients who received prophylactic treatment reported fewer work/school problems (25.8 [18.9] versus 51.5 [26.3]; p = 0.001) than those who received on-demand therapy. The multivariable model showed that older age (B = 0.42, 95% CI = 0.093−0.75) and living in public housing (B = 10.24, 95% CI = 0.70−19.77) were associated with worse HRQoL. Older age was associated with treatment non-adherence (r = 0.66, p < 0.0001). Patients with poor adherence tended to report worse functioning in sports/leisure (r = 0.31, p = 0.033). Conclusions: Our results suggest that patients who were older, had lower education attainment and received on-demand treatment had poorer perception of their health. Improving adherence may lead to better HRQoL. Future work includes evaluating the occupational needs prospectively in this population.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
- Correspondence: ; Tel.: +852-3943-6833; Fax: +852-2603-5295
| | - Pok Hong Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (P.H.L.); (A.W.K.L.); (C.K.L.)
| | | | - Chung-Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Alex Wing Kwan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (P.H.L.); (A.W.K.L.); (C.K.L.)
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Siu Ming Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (P.H.L.); (A.W.K.L.); (C.K.L.)
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
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17
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Hmida J, Hilberg T, Ransmann P, Tomschi F, Klein C, Koob S, Franz A, Richter H, Oldenburg J, Strauss AC. Most subjectively affected joints in patients with haemophilia - what has changed after 20 years in Germany? Haemophilia 2022; 28:663-670. [PMID: 35420240 DOI: 10.1111/hae.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with haemophilia (PwH), most frequently affected joints are the ankle, knee and elbow. Due to improved factor therapy in the last decades, these previous findings have to be verified in Germany. AIM The aim of this study is to detect the most affected joint, evaluate the significance of the source of pain and determine the point prevalence of back pain in Germany today. PATIENTS AND METHODS In a retrospective study, data of n = 300 patients with severe moderate and mild haemophilia were evaluated regarding the most affected joint, the most common source of pain, and the point prevalence of back pain. An anamnesis questionnaire and the German Pain Questionnaire were used for this assessment. RESULTS The most affected joint in German PwH is still the ankle (41%), followed by the knee (27%) and the elbow (11%). The most common source of pain is also the ankle joint (32%). Back pain was also identified as one of the most common sources of pain, which is comparable to the elbow (elbow:15%; back:13%). The point prevalence in PwH for back pain was significantly higher compared to the general German population (P = .031). CONCLUSION Our data showed that the ankle is still the most affected joint and the most common source of pain in Germany. These results also showed the relevance of back pain as a pain source. The evaluations also demonstrated the high point prevalence of back pain in PwH. Future therapies should also focus on the spine because joint changes affect posture.
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Affiliation(s)
- Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Fabian Tomschi
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Claudia Klein
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Alexander Franz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | | | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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18
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Ozelo MC, Mahlangu J, Pasi KJ, Giermasz A, Leavitt AD, Laffan M, Symington E, Quon DV, Wang JD, Peerlinck K, Pipe SW, Madan B, Key NS, Pierce GF, O'Mahony B, Kaczmarek R, Henshaw J, Lawal A, Jayaram K, Huang M, Yang X, Wong WY, Kim B. Valoctocogene Roxaparvovec Gene Therapy for Hemophilia A. N Engl J Med 2022; 386:1013-1025. [PMID: 35294811 DOI: 10.1056/nejmoa2113708] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Valoctocogene roxaparvovec (AAV5-hFVIII-SQ) is an adeno-associated virus 5 (AAV5)-based gene-therapy vector containing a coagulation factor VIII complementary DNA driven by a liver-selective promoter. The efficacy and safety of the therapy were previously evaluated in men with severe hemophilia A in a phase 1-2 dose-escalation study. METHODS We conducted an open-label, single-group, multicenter, phase 3 study to evaluate the efficacy and safety of valoctocogene roxaparvovec in men with severe hemophilia A, defined as a factor VIII level of 1 IU per deciliter or lower. Participants who were at least 18 years of age and did not have preexisting anti-AAV5 antibodies or a history of development of factor VIII inhibitors and who had been receiving prophylaxis with factor VIII concentrate received a single infusion of 6×1013 vector genomes of valoctocogene roxaparvovec per kilogram of body weight. The primary end point was the change from baseline in factor VIII activity (measured with a chromogenic substrate assay) during weeks 49 through 52 after infusion. Secondary end points included the change in annualized factor VIII concentrate use and bleeding rates. Safety was assessed as adverse events and laboratory test results. RESULTS Overall, 134 participants received an infusion and completed more than 51 weeks of follow-up. Among the 132 human immunodeficiency virus-negative participants, the mean factor VIII activity level at weeks 49 through 52 had increased by 41.9 IU per deciliter (95% confidence interval [CI], 34.1 to 49.7; P<0.001; median change, 22.9 IU per deciliter; interquartile range, 10.9 to 61.3). Among the 112 participants enrolled from a prospective noninterventional study, the mean annualized rates of factor VIII concentrate use and treated bleeding after week 4 had decreased after infusion by 98.6% and 83.8%, respectively (P<0.001 for both comparisons). All the participants had at least one adverse event; 22 of 134 (16.4%) reported serious adverse events. Elevations in alanine aminotransferase levels occurred in 115 of 134 participants (85.8%) and were managed with immune suppressants. The other most common adverse events were headache (38.1%), nausea (37.3%), and elevations in aspartate aminotransferase levels (35.1%). No development of factor VIII inhibitors or thrombosis occurred in any of the participants. CONCLUSIONS In patients with severe hemophilia A, valoctocogene roxaparvovec treatment provided endogenous factor VIII production and significantly reduced bleeding and factor VIII concentrate use relative to factor VIII prophylaxis. (Funded by BioMarin Pharmaceutical; GENEr8-1 ClinicalTrials.gov number, NCT03370913.).
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Affiliation(s)
- Margareth C Ozelo
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Johnny Mahlangu
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - K John Pasi
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Adam Giermasz
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Andrew D Leavitt
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Michael Laffan
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Emily Symington
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Doris V Quon
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Jiaan-Der Wang
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Kathelijne Peerlinck
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Steven W Pipe
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Bella Madan
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Nigel S Key
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Glenn F Pierce
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Brian O'Mahony
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Radoslaw Kaczmarek
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Joshua Henshaw
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Adebayo Lawal
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Kala Jayaram
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Mei Huang
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Xinqun Yang
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Wing Y Wong
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
| | - Benjamin Kim
- From Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil (M.C.O.); the Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg (J.M.); Barts and the London School of Medicine and Dentistry (K.J.P.), the Centre for Haematology, Imperial College London (M.L.), and Guy's and St. Thomas' NHS Foundation Trust (B.M.), London, and Cambridge University Hospitals NHS Foundation Trust, Cambridge (E.S.) - all in the United Kingdom; the Hemophilia Treatment Center, University of California, Davis, Sacramento (A.G.), the University of California, San Francisco, San Francisco (A.D.L.), the Orthopedic Hemophilia Treatment Center, Los Angeles (D.V.Q.), independent consultant, La Jolla (G.F.P.), and BioMarin Pharmaceutical, Novato (J.H., A.L., K.J., M.H., X.Y., W.Y.W., B.K.) - all in California; the Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan (J.-D.W.); the Department of Vascular Medicine and Hemostasis and Hemophilia Center, University Hospitals Leuven, Leuven, Belgium (K.P.); the Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor (S.W.P.); the UNC Blood Research Center, University of North Carolina, Chapel Hill (N.S.K.); the Irish Haemophilia Society and Trinity College, Dublin (B.O.); the Department of Pediatrics, Indiana University School of Medicine, IUPUI-Wells Center for Pediatric Research, Indianapolis (R.K.); and the Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland (R.K.)
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19
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O’Donovan M, Quinn E, Johnston K, Singleton E, Benson J, O'Mahony B, Noone D, Duggan C, Gilmore R, Ryan K, O'Donnell JS, O’Connell NM. Recombinant factor IX-Fc fusion protein in severe hemophilia B: Patient-reported outcomes and health-related quality of life. Res Pract Thromb Haemost 2021; 5:e12602. [PMID: 34667923 PMCID: PMC8505226 DOI: 10.1002/rth2.12602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In 2017, all people with severe hemophilia B in Ireland switched to recombinant factor IX Fc fusion protein concentrate (rFIXFc) prophylaxis. Patient-reported outcomes (PROs) and health-related quality of life (HRQoL) are important to evaluate with new treatments. AIMS To assess HRQoL in people with severe hemophilia B and their experience after switching to rFIXFc prophylaxis. METHODS Participants completed a Patient Reported Outcomes Burden and Experience (PROBE) questionnaire on initiation and following two years of rFIXFc prophylaxis. The PROBE questionnaire has four domains: demographics, general health, haemophilia-specific, and European Quality of Life 5-Dimensions (EQ-5D-5L) questionnaire. RESULTS Twenty-three participants completed the questionnaire at both time points. The number of activities where chronic pain occurred and interfered with the activity was reduced by 25% and 33%, respectively (P < .001), following two years of rFIXFc prophylaxis. There was a 9% decrease in chronic pain during the second year of rFIXFc prophylaxis compared to baseline, but the rate remained high, at 74%. A 25% reduction in the number of affected activities of daily living (ADLs) was reported following 2 years of rFIXFc prophylaxis (P = .007). The most common health problems were arthritis, hypertension, anxiety/depression, and gingivitis. The median EQ-5D-5L score was similar following two years of rFIXFc prophylaxis, 0.76 (range, -0.01 to 0.95), compared to 0.77 (range, 0.36-1) at baseline. CONCLUSION This study of real-world patient experience using PROs demonstrates a reduction in chronic pain and improvement in ADLs in participants after switching to rFIXFc prophylaxis. It provides important insights into patient-identified health care needs and living with severe hemophilia B.
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Affiliation(s)
- Mairead O’Donovan
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
| | - Eimear Quinn
- National Coagulation CentreSt James’s HospitalDublinIreland
| | - Kate Johnston
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
| | | | - Julie Benson
- National Coagulation CentreSt James’s HospitalDublinIreland
| | - Brian O'Mahony
- School of MedicineTrinity College DublinDublinIreland
- Irish Haemophilia SocietyDublinIreland
| | | | | | | | - Kevin Ryan
- National Coagulation CentreSt James’s HospitalDublinIreland
| | | | - Niamh M. O’Connell
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
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20
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Vasquez-Loarte TC, Lucas TL, Harris-Wai J, Bowen DJ. Beliefs and Values About Gene Therapy and In-Utero Gene Editing in Patients with Hemophilia and Their Relatives. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:633-642. [PMID: 32794073 DOI: 10.1007/s40271-020-00442-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Hemophilia is an inherited disease for which current treatment is noncurative. While gene therapy and gene editing are being researched, we do not know how the hemophilia community perceives them. Herein, we explore the beliefs and values regarding these new therapies in patients with hemophilia and their relatives. METHODS This qualitative study used phone-based semi-structured interviews on 21 adult English-speaking patients with hemophilia A or B and their parents across the United States during March to July 2019. The study was advertised through different chapters of the Hemophilia Foundation. The interview guide included questions about participants' prior experience with hemophilia, and included two case scenarios about the use of gene therapy and in utero gene editing, after which participants were asked about their opinions, beliefs, and values on each scenario. We used a grounded theory approach and identified the main themes using an inductive process. RESULTS We interviewed 21 participants-12 patients and 9 mothers. Most of them had or were related to a patient with severe disease. The main themes discussed were related to efficacy, safety and financial concerns and insurance coverage for both gene therapy and in utero gene editing. Patients and their parents had expected outcomes in terms of durability of therapy and impact on emotional health and lifestyle changes in the long term. Gene therapy was more accepted among patients with severe and uncontrolled disease. In-utero gene editing was not completely accepted because of safety and ethical issues. CONCLUSION Patients with severe hemophilia perceive gene therapy as a potential cure, while gene editing was more controversial. Patients still have questions that remain to be answered regarding safety and efficacy that should be assessed with long-term follow up studies.
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Affiliation(s)
| | - Tiffany Lin Lucas
- Division of Hematology/Oncology, Department of Pediatrics, University of California San Francisco, 550 16th Street Box 0434, San Francisco, CA, USA.
| | - Julie Harris-Wai
- Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | - Deborah J Bowen
- Public Health Genetics, University of Washington, Seattle, WA, USA
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21
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O'Hara J, Noone D, Jain M, Pedra G, Landis S, Hawes C, Burke T, Camp C. Clinical attributes and treatment characteristics are associated with work productivity and activity impairment in people with severe haemophilia A. Haemophilia 2021; 27:938-946. [PMID: 34273215 DOI: 10.1111/hae.14302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/21/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Few studies have examined the real-world impact of haemophilia on daily activities and work productivity in people with severe haemophilia A (PWSHA). AIM To determine clinical attributes and treatment characteristics associated with impairment in daily activities and work among PWSHA using the patient-reported Work Productivity and Activity Impairment-General Health Questionnaire (WPAI-GH). METHODS PWSHA were asked to complete the WPAI-GH as part of the Cost of Haemophilia in Europe: A Socioeconomic Survey (CHESS) study. Outcomes were determined for activity impairment (AI), absenteeism, presenteeism and overall work productivity loss (WPL). Descriptive statistics and regression analyses were used to evaluate the association between these outcomes and clinical and treatment attributes. RESULTS Overall, 376 participants completed the AI element of WPAI-GH; 175 were employed and thus also reported on work impact. Mean ± standard deviation scores were as follows: AI = 34.2% ± 25.8%; absenteeism = 0.06% ±0.2%; presenteeism = 26.8% ± 22.4%; WPL = 28.6% ± 24.0%. Increased AI and WPL were associated with high haemophilia-related morbidity, measured both as chronic pain (p < .001 for both) and joint synovitis (AI: p <0.001; WPL: p = .017). In descriptive and multivariate analyses, lifelong prophylaxis was associated with reduced AI (p < .001 and p = .031, respectively); high therapy adherence was associated with reduced AI (p = .001 and p = .012, respectively) and with reduced WPL (p < .001 and p = .012, respectively). CONCLUSION The WPAI-GH identified haemophilia-related morbidity and treatment characteristics, including therapy regimen and adherence, as key attributes impacting functional impairment and work contributions of PWSHA. Early prophylactic intervention and greater adherence to therapy may lead to lower AI and WPL in PWSHA.
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Affiliation(s)
- Jamie O'Hara
- HCD Economics, The Innovation Centre, Daresbury, UK
| | - Declan Noone
- European Haemophilia Consortium, Brussels, Belgium
| | | | | | | | | | - Tom Burke
- HCD Economics, The Innovation Centre, Daresbury, UK.,BioMarin Europe, London, UK
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22
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Skinner MW, Négrier C, Paz-Priel I, Chebon S, Jiménez-Yuste V, Callaghan MU, Lehle M, Niggli M, Mahlangu J, Shapiro A, Shima M, Campinha-Bacote A, Levy GG, Oldenburg J, von Mackensen S, Pipe SW. The effect of emicizumab prophylaxis on long-term, self-reported physical health in persons with haemophilia A without factor VIII inhibitors in the HAVEN 3 and HAVEN 4 studies. Haemophilia 2021; 27:854-865. [PMID: 34171159 PMCID: PMC8518882 DOI: 10.1111/hae.14363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/22/2021] [Accepted: 06/05/2021] [Indexed: 12/11/2022]
Abstract
Introduction Severe haemophilia A (HA) has a major impact on health‐related quality of life (HRQoL). Aim Assess the impact of emicizumab on HRQoL in persons with severe HA (PwHA) without factor VIII (FVIII) inhibitors in the phase 3 HAVEN 3 and 4 studies. Methods This pooled analysis examines the HRQoL of PwHA aged ≥ 18 years treated with emicizumab prophylaxis via Haemophilia‐Specific Quality of Life Questionnaire for Adults (Haem‐A‐QoL) and EuroQoL 5‐Dimensions 5‐levels (EQ‐5D‐5L). In particular, changes from baseline in Haem‐A‐QoL ‘Physical Health’ (PH) domain and ‘Total Score’ (TS) are evaluated. Results Among 176 evaluable participants, 96 (55%) had received prior episodic treatment and 80 (45%) prophylaxis; 70% had ≥ 1 target joint and 51% had experienced ≥ 9 bleeds in the previous 24 weeks. Mean Haem‐A‐QoL PH and TS improved after emicizumab initiation. Mean (standard deviation) –12.0 (21.26)‐ and –8.6 (12.57)‐point improvements were observed in PH and TS from baseline to Week 73; Week 73 scores were 27.9 (24.54) and 22.0 (14.38), respectively. Fifty‐four percent of participants reported a clinically meaningful improvement in PH scores (≥ 10 points) by Week 73. Subgroups with poorer HRQoL prior to starting emicizumab (i.e. receiving episodic treatment, ≥ 9 bleeds, target joints) had the greatest improvements in PH scores, and corresponding reductions in missed workdays; change was not detected among those previously taking prophylaxis. No change over time was detected by the EQ‐5D‐5L questionnaire. Conclusions Emicizumab prophylaxis in PwHA without FVIII inhibitors resulted in persistent and meaningful improvements in Haem‐A‐QoL PH and less work disruption than previous treatment.
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Affiliation(s)
- Mark W Skinner
- Institute for Policy Advancement Ltd, Washington, District of Columbia, USA.,McMaster University, Hamilton, Canada
| | - Claude Négrier
- Louis Pradel University Hospital, Claude Bernard University Lyon 1, Lyon, France
| | - Ido Paz-Priel
- Genentech Inc., South San Francisco, California, USA
| | | | | | | | | | | | - Johnny Mahlangu
- University of the Witwatersrand and NHLS, Johannesburg, South Africa
| | - Amy Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Midori Shima
- Nara Medical University Hospital, Kashihara, Japan
| | | | - Gallia G Levy
- Genentech Inc., South San Francisco, California, USA.,Spark Therapeutics, Inc., Philadelphia, Pennsylvania, USA
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
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23
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Ucero-Lozano R, López-Pina JA, Ortiz-Pérez A, Cuesta-Barriuso R. Quality of life and its predictors among adult patients with haemophilic arthropathy. An observational study. BMC Musculoskelet Disord 2021; 22:448. [PMID: 33992116 PMCID: PMC8126122 DOI: 10.1186/s12891-021-04319-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recurrent hemarthrosis that begin in childhood lead to progressive joint deterioration. Patients with haemophilia have chronic pain, functional disability and a reduced perception of health-related quality of life. PURPOSE To analyse the perceived quality of life of adult patients with haemophilic arthropathy and its relationship with pain, joint condition, kinesiophobia and catastrophism. METHODS Eighty-three adult patients with haemophilia were included in this multicentre, cross-sectional, descriptive study. Perceived quality of life (36-Item Short Form Health Survey), perceived usual and maximum pain (visual analogue scale), joint condition (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia) and catastrophism (Pain Catastrophizing Scale) were assessed. Sociodemographic, clinical and therapeutic variables and drug consumption for pain control were collected. Descriptive statistics used means and standard deviations. The correlation of quality of life with the dependent variables was calculated with the Pearson correlation test. The differences in quality of life as a function of the binomial variables were calculated with Student's t-test for independent samples. RESULTS Physical component of quality of life perceived by patients with hemophilia is lower than Spanish population (30.51 VS 48.85). Regarding the mental component, patients with hemophilia showed higher values (56.07 VS 49.97). Catastrophism correlated (p < .05) with all items of quality of life questionnaire. Kinesiophobia correlated (p < .05) with all items of quality of life except to role-emotional (r = -.18; p > .05). Habitual and maximal joint pain correlated with all items except to role-emotional (r = - .19 and r = - .09, respectively) and mental component score (r = - .16 and r = - .07, respectively). Catastrophism and weekly drug intake were inversely correlated with quality of life. Age was positively correlated with perceived quality of life. There were differences in quality of life as a function of the severity of haemophilia and the intake of drugs for pain control. CONCLUSIONS The perceived quality of life of adult patients with haemophilia is worse than that of the Spanish population. Pain, kinesiophobia, catastrophism, haemophilia severity and the intake of pain-control medication influence the quality of life of these patients.
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Affiliation(s)
| | | | - Alba Ortiz-Pérez
- Health Psychologist, Free Exercise of the Profession, Madrid, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, University of Murcia, Murcia, Spain.
- Royal Victoria Eugenia Foundation, Madrid, Spain.
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24
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Cuesta-Barriuso R, Pérez-Llanes R, López-Pina JA, Donoso-Úbeda E, Meroño-Gallut J. Manual therapy reduces the frequency of clinical hemarthrosis and improves range of motion and perceived disability in patients with hemophilic elbow arthropathy. A randomized, single-blind, clinical trial. Disabil Rehabil 2021; 44:3938-3945. [PMID: 33684015 DOI: 10.1080/09638288.2021.1894607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy. MATERIALS AND METHODS Sixty-nine patients were randomized into experimental (N = 35) and control group (N = 34). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol. RESULTS There were differences (p < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis (F = 20.64) and range of motion in flexion (F = 17.37) and extension (F = 21.71). No differences were found in the overall perceived disability (F = 0.91; p = .37). We found group interaction with the (p < 0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability. CONCLUSIONS Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs. Trial registration number: id NCT03009591IMPLICATIONS FOR REHABILITATIONImpairments in the range of motion, pain and disability may occur in patients with hemophilic elbow arthropathy since early age.There is a need to validate safe and effectiveness protocols of rehabilitation to treat these patients.Prophylactic replacement is the most effective treatment for the prevention of hemarthrosis.Physiotherapists need to be trained in the specific management of patients with hemophilia.Manual therapy can be a safe and effective tool in the treatment of hemophilic arthropathy.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, Madrid, Spain.,Royal Victoria Eugenia Foundation, Madrid, Spain.,Fishemo CEE, Spanish Federation of Hemophilia, Madrid, Spain
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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25
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Brown LJ, La HA, Li J, Brunner M, Snoke M, Kerr AM. The societal burden of haemophilia A. I - A snapshot of haemophilia A in Australia and beyond. Haemophilia 2020; 26 Suppl 5:3-10. [PMID: 32935397 DOI: 10.1111/hae.14102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Few studies, both in Australia and overseas, have examined the social impacts of living with haemophilia A (HA) or the economic costs associated with the disorder. The purpose of this paper is to examine the epidemiology and societal burden of people with HA (PwHA) in Australia, with a particular focus on men with this disorder. METHODS The epidemiology and societal burden of HA in Australia, with a particular focus on men with this disorder, were assessed, using data available in the Australian and international literature and publicly available data. RESULTS The mean annual prevalence of HA is approximately 1-2 per 10 000 males. Prophylactic treatment is used in one-quarter (25.1%) of people with moderate HA, and 82.2% of people with severe HA. Within the latter group, 16.1% have inhibitors for Factor VIII, predisposing them to worse morbidity, mortality and quality of life when compared to the non-inhibitor population. Joint pain and joint disease occur commonly in PwHA, with up to 70% of adults with HA experiencing joint problems. HA is associated with poor physical health, and PwHA miss school and work due to bleeding-related events. CONCLUSION HA is associated with substantial economic burden; with large differences in costs reported between countries. Overall, HA imposes a significant burden of disease on PwHA, their families and the community at large.
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Affiliation(s)
- Laurie J Brown
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Hai A La
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Jinjing Li
- NATSEM, Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | | | - Martin Snoke
- Roche Products Pty Limited, Sydney, NSW, Australia
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Wang M, Recht M, Iyer NN, Cooper DL, Soucie JM. Hemophilia without prophylaxis: Assessment of joint range of motion and factor activity. Res Pract Thromb Haemost 2020; 4:1035-1045. [PMID: 32864554 PMCID: PMC7443428 DOI: 10.1002/rth2.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recurrent joint bleeding in hemophilia results in arthropathy and functional impairment. The relationship of arthropathy development and factor activity (FA) has not been reported in patients with FA levels <15%-20%. METHODS During the Centers for Disease Control and Prevention Universal Data Collection, joint range-of-motion (ROM) measurements were taken at each comprehensive visit. Data were extracted from male patients with hemophilia (PWH) age ≥2 years with baseline factor activity levels ≤40%, excluding those prescribed prophylaxis, and used to calculate a proportion of normal ROM (PN-ROM) measure. Data were analyzed using regression models. RESULTS There were 6703 eligible PWH with 30 102 visits. PN-ROM declined with increasing age, and was associated with hemophilia severity, race/ethnicity, obesity, and viral illnesses. PWH ≥30 years old with fFA ≤2% and those ≥50 years old with FA ≤5% had mean PN-ROM values >10% less than controls; those ≥40 years old with FA <1% had values >20% less than controls. In the multivariable analysis, subjects with <1% FA had a 0.43% greater decrease (-0.49 to -0.37, 95% confidence interval) in PN-ROM each year relative to those with 16%-40% factor activity. A less pronounced effect was seen with 1%-5% or 6%-9% FA. CONCLUSION The effect of FA on ROM loss is far greater than that of any of the other characteristics, especially with FA <10%. This emphasizes the need to maintain a high index of suspicion for arthropathy in individuals with moderate and low-mild hemophilia.
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Affiliation(s)
- Michael Wang
- Hemophilia and Thrombosis CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Michael Recht
- The Hemophilia Center at Oregon Health & Science UniversityPortlandOregonUSA
| | - Neeraj N. Iyer
- Novo Nordisk Inc.Clinical, Medical, and Regulatory AffairsPlainsboroNew JerseyUSA
| | - David L. Cooper
- Novo Nordisk Inc.Clinical, Medical, and Regulatory AffairsPlainsboroNew JerseyUSA
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Shelley AR, McCarthy Veach P, LeRoy B, Redlinger-Grosse K. A Systematized review of experiences of individuals in Arnett's emerging adulthood stage who live with or are at-risk for genetic conditions. J Genet Couns 2020; 29:1059-1080. [PMID: 32146730 DOI: 10.1002/jgc4.1238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 02/09/2020] [Indexed: 11/10/2022]
Abstract
Emerging adulthood, a distinct developmental period between ages 18 and 29 years, comprises five features: identity exploration, experimentation/possibilities, negativity/instability regarding one's outlook, self-focus, and feeling in-between adolescence and adulthood. A growing literature examines the impact of genetic conditions on individuals who chronologically fit the emerging adulthood period. This systematized literature review uses the emerging adulthood theory to determine whether individuals living with or at-risk for a genetic condition experience the features of this period as well as similarities and differences between these two groups. A literature search yielded 1,303 peer-reviewed papers from the 17 years since emerging adulthood theory was published. Ten papers met inclusion criteria-five for those Living With a genetic condition (e.g., cystic fibrosis) and five for those At-Risk for a genetic condition (e.g., hereditary breast and ovarian cancer). Content analysis yielded themes consistent with the five emerging adulthood features for both individuals Living With and At-Risk for genetic conditions. Negativity/instability was most prevalent, and feeling in-between was least prevalent in both groups. Results further suggest unique challenges related to one's genetic conditions/risk with respect to independence (from family, healthcare providers), career/education, relationships/social life, family planning, and life perspective experiences. Salient differences were apparent between the groups in their experiences of the emerging adulthood features. For instance, Living With individuals reported challenges concerning their ongoing physical symptoms, whereas At-Risk individuals reported challenges regarding genetic testing decisions and anticipation of physical symptoms. Thus, emerging adults Living With and At-Risk for genetic conditions appear to experience the main emerging adulthood features, but they face unique challenges related to their genetic conditions/risk. Understanding emerging adults' experiences can aid genetic counselors in addressing their specific concerns.
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Affiliation(s)
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Bonnie LeRoy
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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Arya S, Wilton P, Page D, Boma-Fischer L, Floros G, Dainty KN, Winikoff R, Sholzberg M. Healthcare provider perspectives on inequities in access to care for patients with inherited bleeding disorders. PLoS One 2020; 15:e0229099. [PMID: 32078655 PMCID: PMC7032703 DOI: 10.1371/journal.pone.0229099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The ways in which social determinants of health affect patients with inherited bleeding disorders remains unclear. The objective of this study was to understand healthcare provider perspectives regarding access to care and diagnostic delay amongst this patient population. METHODS A healthcare provider survey comprising 24 questions was developed, tested, and subsequently disseminated online with recruitment to all members of The Association of Hemophilia Clinic Directors of Canada (N = 73), members of the Canadian Association of Nurses in Hemophilia Care (N = 40) and members of the Canadian Physiotherapists in Hemophilia Care (N = 44). RESULTS There were 70 respondents in total, for a total response rate of 45%. HCPs felt that there were diagnostic delays for patients with mild symptomatology (71%, N = 50), women presenting with abnormal uterine bleeding as their only or primary symptom (59%, N = 41), and patients living in rural Canada (50%, N = 35). Fewer respondents felt that factors such as socioeconomic status (46%, N = 32) or race (21%, N = 15) influenced access to care, particularly as compared to the influence of rural location (77%, N = 54). DISCUSSION We found that healthcare providers identified patients with mild symptomatology, isolated abnormal uterine bleeding, and residence in rural locations as populations at risk for inequitable access to care. These factors warrant further study, and will be investigated further by our group using our nation-wide patient survey and ongoing in-depth qualitative patient interviews.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Pamela Wilton
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Laurence Boma-Fischer
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Hematology, St. Michael's Hospital, Toronto, Canada
| | - Georgina Floros
- Department of Hematology, St. Michael's Hospital, Toronto, Canada
- Department of Nursing, St. Michael’s Hospital, Toronto, Canada
| | - Katie N. Dainty
- North York General Hospital, Toronto, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Michelle Sholzberg
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Canada
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Lorenzato CS, Santos RB, Fagundes GZZ, Ozelo MC. Haemophilia Experiences, Results and Opportunities (HERO study) in Brazil: Assessment of the psychosocial effects of haemophilia in patients and caregivers. Haemophilia 2019; 25:640-650. [DOI: 10.1111/hae.13774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | - Margareth C. Ozelo
- IHTC “Cláudio L P Correa”, INCT do Sangue Hemocentro UNICAMP University of Campinas Campinas Brazil
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30
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Limperg PF, Maurice-Stam H, Haverman L, Coppens M, Kruip MJHA, Eikenboom J, Grootenhuis MA, Peters M. Professional functioning of young adults with congenital coagulation disorders in the Netherlands. Haemophilia 2019; 25:e138-e145. [PMID: 30859671 PMCID: PMC6850762 DOI: 10.1111/hae.13698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 01/17/2023]
Abstract
Introduction and Aim Suboptimal health‐related quality of life and lowered employment rates found in a previous study in young adults (YA) with congenital coagulation disorders (CCD) in the Netherlands underline the need for more insight into professional functioning of YA with CCD and into determinants of professional functioning. Methods Young adults (18‐30 years) with CCD participated in a cross‐sectional study. Professional functioning was assessed with the Work Productivity and Activity Impairment questionnaire (WPAI). Potential determinants were assessed with the Course of Life Questionnaire (CoLQ), Pediatric Quality of Life Inventory Young Adult version (PedsQL_YA), Illness Cognition Questionnaire (ICQ) and Haemophilia Activities List (HAL). Logistic regression analyses were performed in the complete sample of YA with CCD, and in YA men with haemophilia separately, to examine determinants of WPAI outcomes. Results Ninety‐four YA (77 men; mean age 24.1 years, SD 3.5 and 17 women; mean age 24.5 years, SD 3.8) with CCD (74% haemophilia A/B) participated. 74.5% of YA were paid employed for on average 30 hours per week. Of these, more than a quarter reported work impairment. Older age and a non‐severe type of haemophilia (in the sample of YA men with haemophilia) were associated with successful (paid) employment. No variables were associated with professional functioning (expressed as Presenteeism and Overall work impairment) in patients with CCD or haemophilia. Conclusion Three‐quarters of YA with CCD were successful in finding paid employment. Though absenteeism was low, YA with paid employment needs attention as a considerable part experienced work impairment.
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Affiliation(s)
- Perrine F Limperg
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Hemophilia Comprehensive Care Treatment Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Peters
- Department of Pediatric-Hematology and Hemophilia Comprehensive Care Treatment Center, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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31
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Lee Mortensen G, Strand AM, Almén L. Adherence to prophylactic haemophilic treatment in young patients transitioning to adult care: A qualitative review. Haemophilia 2019; 24:862-872. [PMID: 30485633 DOI: 10.1111/hae.13621] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Abstract
Recombinant prophylactic treatment (PTX) has greatly improved morbidity, mortality and health-related quality of life (HRQoL) in patients with severe haemophilia. Yet, treatment adherence appears suboptimal in adolescents and young adults with haemophilia (YWH). Young patients experience major biopsychosocial changes challenging their adherence through the transition from parental to self-care, from paediatric to adult care. In clinical practice, a systematic approach to transition is rarely used and there is little evidence on best practices. This qualitative review was based on a systematic literature search including quantitative as well as qualitative research reports to examine all relevant factors influencing adherence to PTX in YWH. We aimed to gain comprehensive insight into main drivers and barriers to adherence by exploring them in the context of YWH's disease perceptions, characteristics, HRQoL and needs. The outcome is an overview of the latest published recommendations to support treatment adherence in YWH during the transition from family-oriented care to self-care and from paediatric to adult care. The literature suggests that adherence to PTX is best supported when individual patient needs and preferences are taken into consideration when planning treatment. Preserving normality is a main priority in young patients making it crucial to support patients from early childhood in considering PTX as enabling rather than hindering a normal social and physically active life. Education in self-management should include psychosocial support of patients as well as caregivers. This requires systematic transition planning including milestone assessments and ongoing multidisciplinary support until full self-management is secured.
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Kearney S, Raffini LJ, Pham TP, Lee XY, von Mackensen S, Landorph A, Takedani H, Oldenburg J. Health-related quality-of-life and treatment satisfaction of individuals with hemophilia A treated with turoctocog alfa pegol (N8-GP): a new recombinant extended half-life FVIII. Patient Prefer Adherence 2019; 13:497-513. [PMID: 31040652 PMCID: PMC6460998 DOI: 10.2147/ppa.s196103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prophylactic treatment regimens lead to improvements in health-related quality-of-life (HRQoL) among individuals with hemophilia. Turoctocog alfa pegol (N8-GP) provides the benefit of extending the duration of protection from bleeding and reducing the number of injections, which is expected to impact HRQoL and treatment satisfaction (TS). AIM To investigate the HRQoL and TS of patients with severe hemophilia A from two phase III trials evaluating the safety and efficacy of N8-GP. METHODS HRQoL was assessed using the Haemo-QoL (reported by children and their parents) and Haem-A-QoL (reported by adults). TS was assessed using Hemo-Sat. Domain and total scores for all questionnaires ranged from 0 to 100, with lower scores indicating a better HRQoL or TS. A negative change in score indicates an improvement in HRQoL/TS. RESULTS Mean changes in HRQoL scores were reported for 14 children aged 4-7 years, 21 children aged 8-11 years, 10 adolescents aged 13-16 years, and 163 adults (17 years and above). Mean changes in children/adolescents-reported Haemo-QoL total score were -14.0 for ages 4-7 years, -3.6 for ages 8-11 years, and -0.1 for ages 13-16 years. Mean changes in parent-reported Haemo-QoL total scores were -11.5 for 4-7 years, -8.6 for ages 8-11 years, and -4.0 for 13-16 years. Adults' mean change in Haem-A-QoL total score was -3.1 for those receiving on-demand treatment and -2.3 for those receiving prophylaxis treatment. High levels of TS with N8-GP were reported by parents of children/adolescents and the adults at the end of the trial. CONCLUSION While most patients reported a relatively good baseline HRQoL when entering the respective trials, the HRQoL of patients was either maintained or further improved when treated with N8-GP. Adults and parents of children and adolescents reported a high level of treatment satisfaction with N8-GP.
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Affiliation(s)
- Susan Kearney
- Center for Bleeding and Clotting Disorders, Children's Hospital Minnesota, Minneapolis, MN, USA
| | - Leslie J Raffini
- Division of Hematology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tan P Pham
- Mapi (an Icon plc company), Boston, MA, USA
| | - Xin Ying Lee
- Global Biopharm Patient Access, Biopharm Operations, Novo Nordisk A/S, Copenhagen, Denmark
| | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany,
| | - Andrea Landorph
- Medical & Science, Biopharm Operations, Novo Nordisk A/S, Copenhagen, Denmark
| | - Hideyuki Takedani
- Department of Joint Surgery, Research Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
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Wilding J, Zourikian N, Di Minno M, Khair K, Marquardt N, Benson G, Ozelo M, Hermans C. Obesity in the global haemophilia population: prevalence, implications and expert opinions for weight management. Obes Rev 2018; 19:1569-1584. [PMID: 30188610 DOI: 10.1111/obr.12746] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/24/2018] [Indexed: 12/18/2022]
Abstract
Overweight and obesity may carry a significant disease burden for patients with haemophilia (PWH), who experience reduced mobility due to joint inflammation, muscle dysfunction and haemophilic arthropathy. This review aimed to define the prevalence and clinical impact of overweight/obesity in the global population of PWH. A detailed literature search pertaining to overweight/obesity in haemophilia in the last 15 years (2003-2018) was conducted, followed by a meta-analysis of epidemiological data. The estimated pooled prevalence of overweight/obesity in European and North American PWH was 31%. Excess weight in PWH is associated with a decreased range in motion of joints, accelerated loss of joint mobility and increase in chronic pain. Additionally, the cumulative disease burden of obesity and haemophilia may impact the requirement for joint surgery, occurrence of perioperative complications and the prevalence of anxiety and depression that associates with chronic illness. Best practice guidelines for obesity prevention and weight management, based on multidisciplinary expert perspectives, are considered for adult and paediatric PWH. Recommendations in the haemophilia context emphasize the importance of patient education and tailoring engagement in physical activity to avoid the risk of traumatic bleeding.
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Affiliation(s)
- J Wilding
- Obesity and Endocrinology Research Group, Institute of Ageing and Chronic Disease, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - N Zourikian
- Pediatric/Adult Comprehensive Hemostasis Center, CHU Sainte-Justine/Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - M Di Minno
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - K Khair
- Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children, London, UK
| | - N Marquardt
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - G Benson
- Northern Ireland Haemophilia Comprehensive Care Centre and Thrombosis Unit, Belfast City Hospital, Belfast, UK
| | - M Ozelo
- International Haemophilia Training Centre (IHTC) 'Claudio L.P. Correa', INCT do Sangue Hemocentro UNICAMP, University of Campinas, Campinas, Brazil
| | - C Hermans
- Division of Haematology, Haemostasis and Thrombosis Unit, Haemophilia Clinic, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Resseguier N, Rosso-Delsemme N, Beltran Anzola A, Baumstarck K, Milien V, Ardillon L, Bayart S, Berger C, Bertrand MA, Biron-Andreani C, Borel-Derlon A, Castet S, Chamouni P, Claeyssens Donadel S, De Raucourt E, Desprez D, Falaise C, Frotscher B, Gay V, Goudemand J, Gruel Y, Guillet B, Harroche A, Hassoun A, Huguenin Y, Lambert T, Lebreton A, Lienhart A, Martin M, Meunier S, Monpoux F, Mourey G, Negrier C, Nguyen P, Nyombe P, Oudot C, Pan-Petesch B, Polack B, Rafowicz A, Rauch A, Rivaud D, Schneider P, Spiegel A, Stoven C, Tardy B, Trossaërt M, Valentin JB, Vanderbecken S, Volot F, Voyer-Ebrard A, Wibaut B, Leroy T, Sannie T, Chambost H, Auquier P. Determinants of adherence and consequences of the transition from adolescence to adulthood among young people with severe haemophilia (TRANSHEMO): study protocol for a multicentric French national observational cross-sectional study. BMJ Open 2018; 8:e022409. [PMID: 30049701 PMCID: PMC6067371 DOI: 10.1136/bmjopen-2018-022409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Severe haemophilia is a rare disease characterised by spontaneous bleeding from early childhood, which may lead to various complications, especially in joints. It is nowadays possible to avoid these complications thanks to substitutive therapies for which the issue of adherence is major. The transition from adolescence to adulthood in young people with severe haemophilia is a critical period as it is associated with a high risk of lack of adherence to healthcare, which might have serious consequences on daily activities and on quality of life. METHODS AND ANALYSIS We present the protocol for a cross-sectional, observational, multicentric study to assess the differences between adolescents and young adults with severe haemophilia in France through the transition process, especially on adherence to healthcare. This study is based on a mixed methods design, with two complementary and consecutive phases, comparing data from a group of adolescents (aged 14-17 years) with those from a group of young adults (aged 20-29 years). The quantitative phase focuses on the determinants (medical, organisational, sociodemographic and social and psychosocial and behavioural factors) of adherence to healthcare (considered as a marker of the success of transition). The qualitative phase explores participants' views in more depth to explain and refine the results from the quantitative phase. Eligible patients are contacted by the various Haemophilia Treatment Centres participating in the French national registry FranceCoag. ETHICS AND DISSEMINATION The study was approved by the French Ethics Committee and by the French National Agency for Medicines and Health Products Safety (number: 2016-A01034-47). Study findings will be disseminated to the scientific and medical community in peer-reviewed journals and presented at scientific meetings. Results will be popularised to be communicated via the French association for people with haemophilia to participants and to the general public. TRIAL REGISTRATION NUMBER NCT02866526; Pre-results.
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Affiliation(s)
| | - Natacha Rosso-Delsemme
- LPCPP, Aix Marseille Unviersity, Aix-en-Provence, France
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
| | | | - Karine Baumstarck
- CERESS, Aix Marseille University, Marseille, France
- FranceCoag Network, Marseille, France
| | - Vanessa Milien
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
- FranceCoag Network, Marseille, France
| | - Laurent Ardillon
- Haemophilia Treatment Centre, University Hospital of Tours, Tours, France
| | - Sophie Bayart
- Haemophilia Treatment Centre, University Hospital of Rennes, Rennes, France
| | - Claire Berger
- Haemophilia Treatment Centre, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marie-Anne Bertrand
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | | | | | - Sabine Castet
- Haemophilia Treatment Centre, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre Chamouni
- Haemophilia Treatment Centre, University Hospital of Rouen, Rouen, France
| | | | | | - Dominique Desprez
- Haemophilia Treatment Centre, University Regional Hospital of Strasbourg, Strasbourg, France
| | - Céline Falaise
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
| | - Birgit Frotscher
- Haemophilia Treatment Centre, University Hospital of Nancy, Nancy, France
| | - Valérie Gay
- Haemophilia Treatment Centre, Hospital of Chambery, Chambery, France
| | - Jenny Goudemand
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Yves Gruel
- Haemophilia Treatment Centre, University Hospital of Tours, Tours, France
| | - Benoît Guillet
- Haemophilia Treatment Centre, University Hospital of Rennes, Rennes, France
| | - Annie Harroche
- Haemophilia Treatment Centre, Hospital Necker, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Abel Hassoun
- Haemophilia Treatment Centre, Hospital of Simone Veil d’Eaubonne, Montmorency, France
| | - Yoann Huguenin
- Haemophilia Treatment Centre, University Hospital of Bordeaux, Bordeaux, France
| | - Thierry Lambert
- Haemophilia Treatment Centre, Hospital Bicêtre, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Aurélien Lebreton
- Haemophilia Treatment Centre, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Lienhart
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Michèle Martin
- Haemophilia Treatment Centre, University Hospital of Nancy, Nancy, France
| | - Sandrine Meunier
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Fabrice Monpoux
- Haemophilia Treatment Centre, University Hospital of Nice, Nice, France
| | - Guillaume Mourey
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | - Claude Negrier
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Philippe Nguyen
- Haemophilia Treatment Centre, University Hospital of Reims, Reims, France
| | - Placide Nyombe
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Caroline Oudot
- Haemophilia Treatment Centre, University Hospital of Limoges, Limoges, France
| | | | - Benoît Polack
- Haemophilia Treatment Centre, University Hospital of Grenoble, Grenoble, France
| | - Anne Rafowicz
- Haemophilia Treatment Centre, Hospital of Versailles, Versailles, France
- Haemophilia Treatment Centre, Hospital Bicêtre, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Antoine Rauch
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Delphine Rivaud
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Pascale Schneider
- Haemophilia Treatment Centre, University Hospital of Rouen, Rouen, France
| | - Alexandra Spiegel
- Haemophilia Treatment Centre, University Regional Hospital of Strasbourg, Strasbourg, France
| | - Cecile Stoven
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Brigitte Tardy
- Haemophilia Treatment Centre, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marc Trossaërt
- Haemophilia Treatment Centre, University Hospital of Nantes, Nantes, France
| | | | - Stéphane Vanderbecken
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Fabienne Volot
- Haemophilia Treatment Centre, University Hospital of Dijon, Dijon, France
| | | | - Bénédicte Wibaut
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Tanguy Leroy
- CERESS, Aix Marseille University, Marseille, France
- Social Psychology Research Group (GRePS EA 4163), Lumière Lyon 2 University, Lyon, France
| | - Thomas Sannie
- French Patients' Association for People with Haemophilia (AFH), Paris, France
| | - Hervé Chambost
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
- FranceCoag Network, Marseille, France
| | - Pascal Auquier
- CERESS, Aix Marseille University, Marseille, France
- FranceCoag Network, Marseille, France
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35
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Feldman BM, Rivard GE, Babyn P, Wu JKM, Steele M, Poon MC, Card RT, Israels SJ, Laferriere N, Gill K, Chan AK, Carcao M, Klaassen RJ, Cloutier S, Price VE, Dover S, Blanchette VS. Tailored frequency-escalated primary prophylaxis for severe haemophilia A: results of the 16-year Canadian Hemophilia Prophylaxis Study longitudinal cohort. LANCET HAEMATOLOGY 2018; 5:e252-e260. [PMID: 29731369 DOI: 10.1016/s2352-3026(18)30048-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe haemophilia A has high morbidity, and treatment, while effective, is very expensive. We report the 16-year follow-up of the Canadian Hemophilia Prophylaxis Study, which examined the effectiveness of tailored frequency-escalated primary prophylaxis with a focus on health outcomes within the domains of body structures and functions, and activities and participation (according to the WHO International Classification of Functioning, Disability and Health [WHO-ICF] framework) and a view to reducing consumption of costly clotting factor, which accounts for more than 90% of the cost of care of severe haemophilia. METHODS In this longitudinal study, boys with severe haemophilia A from 12 Canadian centres were enrolled at age 1·0-2·5 years. They were treated with standard half-life recombinant factor VIII (SHL-rFVIII), beginning as once-weekly prophylaxis with 50 IU/kg and escalating in frequency (with accompanying dose adjustments) in response to breakthrough bleeding as determined by the protocol. The primary endpoint for this analysis was joint health, as measured by the modified Colorado Child Physical Examination Scores (CCPES) at study end. All analyses were done by intention to treat. The trial is complete, and is registered with ClinicalTrials.gov, number NCT01085344. FINDINGS Between June 26, 1997, and Jan 30, 2007, 56 boys were enrolled. They were followed for a median of 10·2 years (to a maximum of 16·1 years). Median rFVIII usage was about 3600 IU/kg per year. The median end-of-study CCPES physical examination score was 1 (IQR 1-3; range 0-12) for the left ankle and 1 (1-2; 0-12) for the right ankle, with all other joints having a median score of 0. No treatment-related safety events occurred over the duration of the study, including central venous catheter infections. The median annualised index joint bleeding rate was 0·95 per year (IQR 0·44-1·35; range 0·00-13·43), but 17 (30%) patients had protocol-defined unacceptable breakthrough bleeding at some point during the study. INTERPRETATION Tailored frequency-escalated prophylaxis leads to very little arthropathy and very good health outcomes within the WHO-ICF domains, and only uses a moderate amount of expensive clotting factor as compared with standard prophylaxis protocols. Some sequelae of bleeding were observed in our cohort, and future studies should consider a more stringent protocol of escalation. FUNDING This study was initially funded by grants from the Medical Research Council of Canada/Pharmaceutical Manufacturers Association of Canada Partnership Fund and the Bayer/Canadian Blood Services/Hema-Quebec Partnership Fund. Subsequent renewals were funded by Bayer.
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Affiliation(s)
- Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - John K M Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Man-Chiu Poon
- Department of Medicine, Division of Hematology and Hematologic Malignancies, Foothills Hospital, Calgary, AB, Canada
| | - Robert T Card
- Department of Hematology, Division of Oncology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | - Kulwant Gill
- Hemophilia Program, Laurentian Hospital, Sudbury, ON, Canada
| | - Anthony K Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Manuel Carcao
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Klaassen
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stephanie Cloutier
- Centre de l'hémophilie de l'est du Québec de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, QC, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Rambod M, Sharif F, Molazem Z, Khair K, von Mackensen S. Health-Related Quality of Life and Psychological Aspects of Adults With Hemophilia in Iran. Clin Appl Thromb Hemost 2018; 24:1073-1081. [PMID: 29575928 PMCID: PMC6714756 DOI: 10.1177/1076029618758954] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hemophilia causes bleeding that may affect patients’ psychological aspects and quality of life. This study aims to evaluate the impact of psychological aspects and pain on health-related quality of life (HRQoL) in adult patients with hemophilia. This cross-sectional study was conducted on 103 patients with hemophilia. Data were collected using hemophilia-specific quality of life, Depression Anxiety Stress Scales, and pain visual analogue scales. Data were analyzed using correlation coefficients, analysis of covariance, and regression analysis. The results showed that 71.7% of patients with hemophilia experienced pain on the study day. The mean score of HRQoL of patients with hemophilia was 51.09 (standard deviation = 19.37). Moreover, 57.4%, 64.6%, and 44.6% of the patients had mild to severe depression, anxiety, and stress, respectively. In addition, a significant association was observed between HRQoL and depression, anxiety, and severity of pain. In the regression model, 48% of changes in HRQOL were explained by the study variables, with the severity of pain and depression being significant predictors. Therefore, attention should be paid to these aspects to improve patients’ quality of life and psychosocial health.
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Affiliation(s)
- Masoume Rambod
- 1 Department of Medical Surgical Nursing, Community-Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farkhondeh Sharif
- 2 Department of Mental Health and Psychiatric Nursing, Community-Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Molazem
- 1 Department of Medical Surgical Nursing, Community-Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kate Khair
- 3 Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,4 London South Bank University, London, UK
| | - Sylvia von Mackensen
- 5 Institute of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Limperg PF, Haverman L, Maurice-Stam H, Coppens M, Valk C, Kruip MJHA, Eikenboom J, Peters M, Grootenhuis MA. Health-related quality of life, developmental milestones, and self-esteem in young adults with bleeding disorders. Qual Life Res 2017; 27:159-171. [PMID: 28900823 PMCID: PMC5770500 DOI: 10.1007/s11136-017-1696-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Abstract
Background The treatment of bleeding disorders improved in the last decades. However, the effect of growing up with bleeding disorders on developmental, emotional, and social aspects is understudied. Therefore, this study assesses HRQOL, developmental milestones, and self-esteem in Dutch young adults (YA) with bleeding disorders compared to peers. Methods Ninety-five YA (18–30 years) with bleeding disorders (78 men; mean 24.7 years, SD 3.5) and 17 women (mean 25.1 years, SD 3.8) participated and completed the Pediatric Quality of Life Inventory Young Adult version, the Course of Life Questionnaire, and the Rosenberg Self-Esteem Scale. Differences between patients with bleeding disorders and their peers, and between hemophilia severity groups, were tested using Mann–Whitney U tests. Results YA men with bleeding disorders report a slightly lower HRQOL on the total scale, physical functioning, and school/work functioning in comparison to healthy peers (small effect sizes). YA men with severe hemophilia report more problems on the physical functioning scale than non-severe hemophilia. YA men with bleeding disorders achieved more psychosexual developmental milestones than peers, but show a delay in ‘paid jobs, during middle and/or high school.’ A somewhat lower self-esteem was found in YA men with bleeding disorders in comparison to peers (small effect size). For YA women with bleeding disorders, no differences were found on any of the outcomes in comparison to peers. Conclusion This study demonstrates some impairments in HRQOL and self-esteem in YA men with bleeding disorders. By monitoring HRQOL, problems can be identified early, especially with regard to their physical and professional/school functioning.
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Affiliation(s)
- P F Limperg
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - L Haverman
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M Coppens
- Department of Vascular Medicine, Hemophilia Comprehensive Care Treatment Center, AMC, Amsterdam, The Netherlands
| | - C Valk
- Department of Vascular Medicine, Hemophilia Comprehensive Care Treatment Center, AMC, Amsterdam, The Netherlands
| | - M J H A Kruip
- Department of Hematology, Hemophilia Comprehensive Care Treatment Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Eikenboom
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - M Peters
- Department of Pediatric-Hematology, Emma Children's Hospital and Hemophilia Comprehensive Care Treatment Center, AMC, Amsterdam, The Netherlands
| | - M A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
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Tobase P, Mahajan A, Francis D, Leavitt AD, Giermasz A. A gap in comprehensive care: Sexual health in men with haemophilia. Haemophilia 2017; 23:e389-e391. [DOI: 10.1111/hae.13276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 12/31/2022]
Affiliation(s)
- P. Tobase
- Hemophilia Treatment Center; University of California; San Francisco CA USA
| | - A. Mahajan
- Hemophilia Treatment Center; University of California; San Francisco CA USA
| | - D. Francis
- Hemophilia Treatment Center; University of California; San Francisco CA USA
| | - A. D. Leavitt
- Hemophilia Treatment Center; University of California; San Francisco CA USA
| | - A. Giermasz
- Hemophilia Treatment Center; University of California; San Francisco CA USA
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Chaturvedi S, Clancy M, Schaefer N, Oluwole O, McCrae KR. Depression and post-traumatic stress disorder in individuals with hereditary hemorrhagic telangiectasia: A cross-sectional survey. Thromb Res 2017; 153:14-18. [PMID: 28314138 PMCID: PMC5420428 DOI: 10.1016/j.thromres.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is characterized by frequent severe bleeding, particularly epistaxis, and life-threatening complications including stroke, brain abscess and heart failure. The psychological impact of HHT is not known. We conducted this cross sectional study to determine the prevalence of depression and post-traumatic stress disorder (PTSD) related to HHT. METHODS A survey tool comprising demographic and clinical information and two validated self-administered questionnaires, the PTSD checklist for DSM-5 (PCL-5) and Beck Depression Inventory-II (BDI-II), was distributed to individuals with HHT. Associations with clinical and demographic variables with depression and PTSD were evaluated in a logistic regression model. RESULTS A total of 222 individuals responded to the survey. Of these, 185 completed either the BDI II or PCL-5 and were included in the analysis. Median age was 54years and 142 (76.8%) were female. An existing diagnosis of depression, anxiety disorder and PTSD was present in 81 (43.8%), 59 (31.9%) and 16(8.6%) respondents, respectively. BDI-II scores>13 indicating at least mild depressive symptoms were present in 142 (88.7%) patients and 52 (28.1%) patients had a positive screen for PTSD (PCL-5 score≥38). On multivariable analysis, depression [OR 2.17 (95% CI 1.045-4.489), p=0.038], anxiety disorder [OR 2.232 (95% CI 1.066-4.676), p=0.033], and being unemployed [OR 2.234 (95% CI 1.46-4.714), p=0.019) were associated with PTSD. CONCLUSION We report a high prevalence of depressive and PTSD symptoms in individuals with HHT. While selection bias may lead to overestimation of prevalence in this study, our results are concerning and clinicians should remain vigilant for signs of psychological distress and consider screening for these disorders.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Olalekan Oluwole
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Keith R McCrae
- Department of Cellular and Molecular Medicine, Cleveland Clinic, United States; Hematologic Oncology and Blood Disorders, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States.
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Predictors of quality of life among adolescents and young adults with a bleeding disorder. Health Qual Life Outcomes 2017; 15:67. [PMID: 28388906 PMCID: PMC5383972 DOI: 10.1186/s12955-017-0643-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) in adolescents and young adults with bleeding disorders is under-researched. We aimed to describe factors related to HRQoL in adolescents and young adults with hemophilia A or B or von Willebrand disease. METHODS A convenience sample of volunteers aged 13 to 25 years with hemophilia or von Willebrand disease completed a cross-sectional survey that assessed Physical (PCS) and Mental (MCS) Component Summary scores on the SF-36 questionnaire. Quantile regression models were used to assess factors associated with HRQoL. RESULTS Of 108 respondents, 79, 7, and 14% had hemophilia A, hemophilia B, and von Willebrand disease, respectively. Most had severe disease (71%), had never developed an inhibitor (65%), and were treated prophylactically (68%). Half of patients were aged 13 to 17 years and most were white (80%) and non-Hispanic (89%). Chronic pain was reported as moderate to severe by 31% of respondents. Median PCS and MCS were 81.3 and 75.5, respectively. Quantile regression showed that the median PCS for women (61% with von Willebrand disease) was 13.1 (95% CI: 2.4, 23.8; p = 0.02) points lower than men. Ever developing an inhibitor (vs never) was associated with a 13.1-point (95% CI: 4.7, 21.5; p < 0.01) PCS reduction. MCS was 10.0 points (95% CI: 0.7, 19.3; p = 0.04) higher for prophylactic infusers versus those using on-demand treatment. Compared with patients with no to mild chronic pain, those with moderate to severe chronic pain had 25.5-point (95% CI: 17.2, 33.8; p < 0.001) and 10.0-point (95% CI: 0.8, 19.2; p = 0.03) reductions in median PCS and MCS, respectively. CONCLUSIONS Efforts should be made to prevent and manage chronic pain, which was strongly related to physical and mental HRQoL, in adolescents and young adults with hemophilia and von Willebrand disease. Previous research suggests that better clotting factor adherence may be associated with less chronic pain.
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Sidonio R, Holot N, Cooper DL. Evaluating the psychosocial impact of hemophilia B: The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study. Eur J Haematol 2017; 98 Suppl 86:3-4. [PMID: 28319335 DOI: 10.1111/ejh.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
The needs of individuals living with hemophilia B, especially those with mild or moderate hemophilia and affected females, are not well understood. The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) initiative was developed in an effort to obtain greater insights into the unique issues and challenges faced by those with hemophilia B. This study explored the impact of hemophilia B on education, employment, engagement in physical activities and other psychosocial aspects of the lives of affected individuals and their families. The B-HERO-S findings reveal a number of unmet needs in the hemophilia B population, and these results may be leveraged to inform patient outreach and education initiatives.
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Affiliation(s)
- Robert Sidonio
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Boban A, Lambert C, Hermans C. Is the cardiovascular toxicity of NSAIDS and COX-2 selective inhibitors underestimated in patients with haemophilia? Crit Rev Oncol Hematol 2016; 100:25-31. [PMID: 26899022 DOI: 10.1016/j.critrevonc.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/31/2016] [Accepted: 02/08/2016] [Indexed: 11/15/2022] Open
Abstract
Joint pain secondary to chronic arthropathy represents one of the most common and debilitating complications of haemophilia, often requiring analgesic care. When compared with nonselective non-steroidal anti-inflammatory drugs (ns-NSAIDs), selective COX-2 inhibitors (coxibs) offer the major advantage of not increasing the bleeding risk, thus being a better choice of analgesics for haemophilia patients. However, several studies have highlighted the cardiovascular risks posed by coxibs and NSAIDs. Given the assumed protection against thrombosis conferred by the deficiency in coagulation factors VIII or IX, these precautions regarding the use of coxibs and NSAIDs have never really been taken into account in haemophilia management. However, contrary to what has long been suspected, haemophilia patients are indeed affected by the same cardiovascular risk factors as nonhaemophiliac patients. Further studies should be conducted to evaluate the impact of NSAIDs on cardiovascular risks and the prevalence of hypertension in haemophilia patients.
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Affiliation(s)
- Ana Boban
- Haemostasis and Thrombosis Unit, Division of Haematology, Haemophilia Clinic, Saint-Luc University Hospital, Brussels, Belgium; Division of Haematology, Department of Internal medicine, University Hospital Zagreb, Medical School of Zagreb, Croatia.
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Haematology, Haemophilia Clinic, Saint-Luc University Hospital, Brussels, Belgium.
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Haemophilia Clinic, Saint-Luc University Hospital, Brussels, Belgium.
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Witkop M, Guelcher C, Forsyth A, Quon D, Hawk S, Curtis R, Cutter S, Molter D, Cooper DL. Challenges in transition to adulthood for young adult patients with hemophilia: Quantifying the psychosocial issues and developing solutions. Am J Hematol 2015; 90 Suppl 2:S1-2. [PMID: 26619191 DOI: 10.1002/ajh.24217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/13/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Doris Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children; Los Angeles California
| | - Sarah Hawk
- Oklahoma Center for Bleeding Disorders; Oklahoma City Oklahoma
| | | | - Susan Cutter
- Penn Comprehensive Hemophilia and Thrombosis Center, University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Don Molter
- Indiana Hemophilia and Thrombosis Center; Indianapolis Indiana
| | - David L. Cooper
- Clinical Development, Medical and Regulatory Affairs, Novo Nordisk Inc; Plainsboro, New Jersey
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