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Li C, Zhang X, Zhao Y, Wu R, Hu Q, Xu V, Sun J, Yang R, Li X, Zhou R, Lian S, Gu J, Wu J, Hou Q. Status and trend analysis of prophylactic usage of recombinant factor VIII in Chinese pediatric patients with hemophilia A: ReCare - a retrospective, phase IV, non-interventional study. Curr Med Res Opin 2017; 33:1571-1578. [PMID: 28532239 DOI: 10.1080/03007995.2017.1333489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND No study has reported the status and chronological trend of prophylactic recombinant factor VIII (rFVIII) use in Chinese pediatric patients with hemophilia A (HA). OBJECTIVE We aimed to analyze the status and trend of rFVIII-containing prophylaxis in Chinese pediatric patients with HA. METHODS ReCARE (Retrospective study in Chinese pediatric hemophilia A patients with rFVIII contained REgular prophylaxis) was a retrospective study conducted in 12 hemophilia treatment centers across China. The trend of prophylaxis was evaluated by determining the mean duration of prophylaxis, mean injection frequency (per week), mean dose of each injection (IU/kg), mean total dose injected/week (IU) and proportion of rFVIII consumption relative to factor VIII (FVIII) consumption over the study period. RESULTS We analyzed 183 male pediatric patients with HA (mean age, 7.1 ± 4.23 years), who received intermittent prophylaxis between 1 November 2007 and 31 May 2013. The mean duration of prophylaxis with rFVIII increased from 16.72 weeks in 2008 to 32.77 in 2012. Per injection dose of rFVIII increased significantly from 2008 to 2013 (25.89 to 28.31 IU/kg, p < .001). An increase was also reported in the mean total FVIII consumed (699.97 ± 173.25 IU in 2008 and 891.30 ± 730.341 in 2013) and mean proportion of rFVIII used (33.33 ± 57.73% in 2008 to 85.50 ± 29.077% in 2013). CONCLUSION Our data revealed an overall improvement in treatment dosage and duration with an increase in the number of patients receiving prophylaxis. The total proportion of rFVIII also increased gradually indicating the development of economy and safety awareness. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT02263066).
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Affiliation(s)
- Changgang Li
- a Department of Hematology and Oncology , Shenzhen Children's Hospital , Shenzhen , China
| | - Xinsheng Zhang
- b Hemophilia Treatment Centre, Shandong Blood Centre , Jinan , China
| | - Yongqiang Zhao
- c Department of Hematology , Peking Union Medical College Hospital , Beijing , China
| | - Runhui Wu
- d Hematology/Oncology Centre, Beijing Children's Hospital , Capital Medical University , Beijing , China
| | - Qun Hu
- e Department of Hematology , Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST) , Hankou , Wuhan , China
| | - Vicky Xu
- f Department of Hematology , The Children's Hospital, Zhengjiang University School of Medicine , Hangzhou , China
| | - Jing Sun
- g Department of Hematology , Nan fang Hospital, Southern Medical University , Guangzhou , China
| | - Renchi Yang
- h Thrombosis and Hemostasis Centre , Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Tianjin , China
| | - Xiaojing Li
- i Department of Hematology , Chengdu Women & Children's Central Hospital , Chengdu , China
| | - Rongfu Zhou
- j Department of Hematology , Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing , China
| | - Shinmei Lian
- k Department of Hematology , Dalian Municipal Central Hospital, Dalian Medical University , Dalian , China
| | - Jian Gu
- l Department of Hematology , Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University , Yangzhou , China
| | - Junde Wu
- m Bayer HealthCare Pharmaceuticals Inc. , Beijing , China
| | - Qingsong Hou
- m Bayer HealthCare Pharmaceuticals Inc. , Beijing , China
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Iorio A, Fischer K, Blanchette V, Rangarajan S, Young G, Morfini M. Tailoring treatment of haemophilia B: accounting for the distribution and clearance of standard and extended half-life FIX concentrates. Thromb Haemost 2017; 117:1023-1030. [PMID: 28357444 DOI: 10.1160/th16-12-0942] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/08/2017] [Indexed: 01/23/2023]
Abstract
The prophylactic administration of factor IX (FIX) is considered the most effective treatment for haemophilia B. The inter-individual variability and complexity of the pharmacokinetics (PK) of FIX, and the rarity of the disease have hampered identification of an optimal treatment regimens. The recent introduction of extended half-life recombinant FIX molecules (EHL-rFIX), has prompted a thorough reassessment of the clinical efficacy, PK and pharmacodynamics of plasma-derived and recombinant FIX. First, using longer sampling times and multi-compartmental PK models has led to more precise (and favourable) PK for FIX than was appreciated in the past. Second, investigating the distribution of FIX in the body beyond the vascular space (which is implied by its complex kinetics) has opened a new research field on the role for extravascular FIX. Third, measuring plasma levels of EHL-rFIX has shown that different aPTT reagents have different accuracy in measuring different FIX molecules. How will this new knowledge reflect on clinical practice? Clinical decision making in haemophilia B requires some caution and expertise. First, comparisons between different FIX molecules must be assessed taking into consideration the comparability of the populations studied and the PK models used. Second, individual PK estimates must rely on multi-compartmental models, and would benefit from adopting a population PK approach. Optimal sampling times need to be adapted to the prolonged half-life of the new EHL FIX products. Finally, costs considerations may apply, which is beyond the scope of this manuscript but might be deeply connected with the PK considerations discussed in this communication.
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Affiliation(s)
- Alfonso Iorio
- Alfonso Iorio, McMaster University, 1280 Main St West, Hamilton, ON L8S 4K1, Canada, Tel.: +1 905 525 9140 ext 22421, Fax: +1 905 526 8447, E-mail:
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Hazendonk H, Fijnvandraat K, Lock J, Driessens M, van der Meer F, Meijer K, Kruip M, Gorkom BLV, Peters M, de Wildt S, Leebeek F, Cnossen M, Mathôt R. A population pharmacokinetic model for perioperative dosing of factor VIII in hemophilia A patients. Haematologica 2016; 101:1159-1169. [PMID: 27390359 DOI: 10.3324/haematol.2015.136275] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
The role of pharmacokinetic-guided dosing of factor concentrates in hemophilia is currently a subject of debate and focuses on long-term prophylactic treatment. Few data are available on its impact in the perioperative period. In this study, a population pharmacokinetic model for currently registered factor VIII concentrates was developed for severe and moderate adult and pediatric hemophilia A patients (FVIII levels <0.05 IUmL-1) undergoing elective, minor or major surgery. Retrospective data were collected on FVIII treatment, including timing and dosing, time point of FVIII sampling and all FVIII plasma concentrations achieved (trough, peak and steady state), brand of concentrate, as well as patients' and surgical characteristics. Population pharmacokinetic modeling was performed using non-linear mixed-effects modeling. Population pharmacokinetic parameters were estimated in 75 adults undergoing 140 surgeries (median age: 48 years; median weight: 80 kg) and 44 children undergoing 58 surgeries (median age: 4.3 years; median weight: 18.5 kg). Pharmacokinetic profiles were best described by a two-compartment model. Typical values for clearance, intercompartment clearance, central and peripheral volume were 0.15 L/h/68 kg, 0.16 L/h/68 kg, 2.81 L/68 kg and 1.90 L/68 kg. Interpatient variability in clearance and central volume was 37% and 27%. Clearance decreased with increasing age (P<0.01) and increased in cases with blood group O (26%; P<0.01). In addition, a minor decrease in clearance was observed when a major surgical procedure was performed (7%; P<0.01). The developed population model describes the perioperative pharmacokinetics of various FVIII concentrates, allowing individualization of perioperative FVIII therapy for severe and moderate hemophilia A patients by Bayesian adaptive dosing.
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Affiliation(s)
- Hendrika Hazendonk
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam
| | | | - Janske Lock
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam
| | | | - Felix van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center
| | - Karina Meijer
- University of Groningen, Department of Hematology, University Medical Center Groningen
| | - Marieke Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam
| | - Britta Laros-van Gorkom
- Department of Hematology, Radboud university medical center, Sophia Children's Hospital Rotterdam
| | - Marjolein Peters
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam
| | - Saskia de Wildt
- Intensive Care and Department of Pediatric Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam Department of Pharmacology, Radboud university medical center, The Netherlands
| | - Frank Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam
| | - Marjon Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam
| | - Ron Mathôt
- Hospital Pharmacy-Clinical Pharmacology, Academic Medical Center Amsterdam, The Netherlands
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Page D, Crymble S, Lawday K, Long M, Stoffman J, Waterhouse L, Wilton P. Penny wise, pound foolish: an assessment of Canadian Hemophilia/inherited bleeding disorder comprehensive care program services and resources. Haemophilia 2016; 22:531-6. [DOI: 10.1111/hae.12913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- D. Page
- Canadian Hemophilia Society; Montreal QC Canada
| | - S. Crymble
- St. Michael's Hospital; Toronto ON Canada
| | - K. Lawday
- Canadian Hemophilia Society; Montreal QC Canada
| | - M. Long
- Canadian Hemophilia Society; Montreal QC Canada
| | - J. Stoffman
- Manitoba Bleeding Disorders Program; Winnipeg MB Canada
| | - L. Waterhouse
- Hemophilia/Pediatric Thrombosis Program; Hamilton Health Sciences Corporation; Hamilton ON Canada
| | - P. Wilton
- Canadian Hemophilia Society; Montreal QC Canada
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Jackson SC, Yang M, Minuk L, Sholzberg M, St-Louis J, Iorio A, Card R, Poon MC. Prophylaxis in older Canadian adults with hemophilia A: lessons and more questions. BMC HEMATOLOGY 2015; 15:4. [PMID: 25692030 PMCID: PMC4331146 DOI: 10.1186/s12878-015-0022-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although prophylaxis is a standard of care for young children in developed countries, known to reduce the severity of hemophilic arthropathy, older adults with existing arthropathy have not traditionally used prophylaxis. Recent studies have shown that adults with hemophilia A are increasingly adopting prophylaxis but the characteristics of this treatment in older adults are not well understood. This multicenter observational study was conducted to describe how secondary/tertiary prophylaxis is being used in older adults (≥40 years of age) in comparison to younger adults with severe hemophilia A. METHODS Eligible adult (≥18 years of age) Canadian males with baseline FVIII:C ≤2% from the participating centres were observed over a 2 year period. RESULTS Of the 220 adult severe hemophilia patients enrolled, 70% (155/220) used prophylaxis during the observational period. Only 27% (60/220) are older adults with very few >60 years of age. A lower proportion of older adults use prophylaxis compared to younger adults (58% vs. 75%, p = 0.016), with most patients in both groups using continuous prophylaxis (92 and 94% respectively). When considering all treatment modalities together, younger subjects use more factor concentrate than older subjects (2437 u/kg/year vs. 1702 u/kg/year, p = 0.027); however, older subjects on prophylaxis use 3447 u/kg/year and had an ABR of 12 while those on demand use 560 u/kg/year and had an ABR of 13. CONCLUSION A significant number of older adults use secondary/tertiary continuous prophylaxis in Canada, accounting for a significant fraction of factor concentrate utilization.
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Affiliation(s)
- Shannon C Jackson
- />Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
- />British Columbia Provincial Bleeding Disorders Program – Adult Division, 1081 Burrard Street, Comox Building, Room 217, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Ming Yang
- />British Columbia Provincial Bleeding Disorders Program – Adult Division, 1081 Burrard Street, Comox Building, Room 217, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Leonard Minuk
- />Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | | | - Jean St-Louis
- />CHU-Sainte-Justine and Department of Medicine, University of Montreal, Montreal, QC Canada
| | - Alfonso Iorio
- />Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, ON Canada
| | - Robert Card
- />Division of Hematology, Department of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Man-Chiu Poon
- />Division of Hematology and Hematologic Malignancies, Department of Medicine, University of Calgary, Calgary, AB Canada
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