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Castaman G, Jimenez-Yuste V, Gouw S, D'Oiron R. Outcomes and outcome measures. Haemophilia 2024; 30 Suppl 3:112-119. [PMID: 38504408 DOI: 10.1111/hae.14990] [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: 01/19/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Advances in haemophilia treatment have resulted in a near-normal life expectancy, lower burden of bleeding and treatment, and improved quality of life in high-income countries. Bleeding rate is approaching zero and novel parameters should be evaluated to assess the efficacy of treatment not only from the clinical point of view by using new methodologies (e.g. joint health assessment), but also from the patient's perspective (e.g. pain, quality of life, treatment satisfaction). METHODS AND RESULTS This approach should be aimed at combining objective clinical methodologies and patient-reported outcomes (PROs). However, some instruments used for assessing PROs are still suboptimal and not properly validated. Recent evidence suggests that these tools can take advantage from a more personalized designed approach and could be effectively improved and serve to facilitate the patient's self-evaluation. For other congenital bleeding disorders (BDs), a set of patient-relevant outcomes has been also defined that overlap substantially those of haemophilia, including bleeding, side effects and complications, and PROs, such as pain, physical functioning, impact on daily life including school and work and mental health. There is a growing focus on addressing women-specific outcomes in BDs, reflecting an increased awareness of the unique challenges faced by women in this context. However, the development of tailored tools is imperative to further advance the progress in managing women with BDs, ensuring more accurate monitoring and personalized care. CONCLUSIONS How incorporating these outcome measures in the process of approval of novel treatments for these disorders by regulatory authorities remains to be established.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | - Samanta Gouw
- Department of Paediatric Haematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roseline D'Oiron
- Bicêtre Hospital AP-HP, University of Paris-Saclay and UMR_S1176 INSERM, Le Kremlin-Bicêtre, Paris, France
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Álvarez-Román MT, Jiménez-Yuste V, Martín-Salces M, De la Corte-Rodríguez H, Bonanad S, Núñez R, Fernández-Mosteirín N, García-Frade LJ, Martinoli C, Kim HK. A post hoc comparative real-world analysis of HEAD-US score for joint health assessment of patients with severe haemophilia A and B in Spain. Haemophilia 2024; 30:513-522. [PMID: 38282205 DOI: 10.1111/hae.14924] [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: 04/25/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
AIM Joint damage due to haemarthrosis can be effectively monitored with point-of care ultrasound using the Haemophilia Early Arthropathy Detection with US (HEAD-US) scoring system. A post hoc comparative analysis of the joint status of patients with severe haemophilia A (HA) or B (HB) was performed. METHODS The databases of two observational, cross-sectional studies that recruited patients with HA or HB from 12 Spanish centres were analysed to compare the status of the elbows, knees and ankles in patients with severe disease according to treatment modality. The HEAD-US score was calculated in both studies by the same trained operators. RESULTS Overall, 95 HA and 41 HB severe patients were included, with a mean age of 35.2 ± 11.8 and 32.7 ± 14.2 years, respectively. The percentage of patients who received prophylaxis, over on-demand (OD) treatment, was much higher in HA (91.6%) than in HB (65.8%) patients. With a similar number of target joints, the HEAD-US score was zero in 6.3% HA and 22.0% HB patients (p < .01), respectively. The HA population showed significantly worse HEAD-US scores. Whilst osteochondral damage occurred more frequently in patients OD or tertiary prophylaxis, our data suggest that articular damage is less prominent in primary/secondary prophylaxis, regardless of the type of haemophilia. These latter treatment modalities were also associated with a lower prevalence of synovial hypertrophy, particularly in HB patients. CONCLUSION This post hoc analysis indicates that joint status seems to be significantly influenced by haemophilia type (HA or HB) and treatment modality in these severe Spanish populations with severe disease. Continuing HEAD-US monitoring for the early detection and management of intra-articular abnormalities, as well as more efficiently tailored therapies should be warranted.
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Affiliation(s)
| | | | | | | | | | - Ramiro Núñez
- Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | | | - Carlo Martinoli
- Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Bladen M, Harbidge H, Drechsler W, Duport G, Mahaffey R, van der Net J, Pérez-Alenda S, Sayers F, Strike K, Timmer M, Stephensen D. Identifying performance-based outcome measures of physical function in people with haemophilia (IPOP). Haemophilia 2023; 29:1611-1620. [PMID: 37840142 DOI: 10.1111/hae.14886] [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: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Recent recommendations of core outcome sets for haemophilia highlight the need for including measures of performance-based physical health and physical function sustainability. To date, there is no consensus on what outcomes might be of value to clinicians and patients. AIM To identify instruments of performance-based physical function to monitor musculoskeletal health in people with haemophilia that are practical in the clinical setting. METHODS Utilising components from the Activities and Participation Category of the WHO International Classification of Functioning (WHO-ICF), a consensus-based, decision analysis approach was used to: identify activities people with haemophilia have most difficulty performing; identify quantitative performance-based measures of identified activities via a scoping review; and obtain views on acceptability of the tests utilising a DELPHI approach. RESULTS Eleven activities were identified: maintaining a standing position, walking long distances, walking up and down stairs, walking on different surfaces, running, hopping, jumping, squatting, kneeling, undertaking a complex lower limb task, undertaking a complex upper limb task. Following a 2-round DELPHI survey of international physiotherapists, the 6-min walk test, timed up and down stairs, 30-s sit to stand, single leg stance, tandem stance, single hop for distance (children only) and timed up and go (adults only) reached consensus. CONCLUSION This study is the first step in defining a core set of performance-based instruments to monitor physical health and sustainability of physical function outcomes in people with haemophilia. Establishing the psychometric properties of the instruments and whether they are meaningful to people with haemophilia is essential.
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Affiliation(s)
- Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hannah Harbidge
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | - Wendy Drechsler
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | | | - Ryan Mahaffey
- St Mary's University, School of Sport, Health and Applied Sciences, London, UK
| | - Janjap van der Net
- Center for Child Development, Exercise and physical literacy, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Karen Strike
- Hamilton Niagara Regional Hemophilia Centre, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Merel Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
- Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK
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Jiménez-Yuste V, Álvarez-Román MT, Martín-Salces M, De la Corte-Rodríguez H, Bonanad S, Núñez R, Fernández-Mosteirín N, García-Frade LJ, Martinoli C, Kim HK. Comparative analysis of Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) scores in persons with nonsevere hemophilia A and B reveals a high degree of joint damage in both disease types. Res Pract Thromb Haemost 2023; 7:102207. [PMID: 38077820 PMCID: PMC10704514 DOI: 10.1016/j.rpth.2023.102207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 05/29/2024] Open
Affiliation(s)
| | | | | | | | - Santiago Bonanad
- Hemostasis and Thrombosis Unit, Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ramiro Núñez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Carlo Martinoli
- Department of Health Sciences (DISSAL), Università di Genova, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Rodriguez-Merchan EC. Hemophilic arthropathy: how to diagnose subclinical bleeding early and how to orthopedically treat a damaged joint. Expert Rev Hematol 2023; 16:651-658. [PMID: 37392151 DOI: 10.1080/17474086.2023.2232547] [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: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION It is important to know the current status of hemophilic arthropathy diagnoses, treatments, complications, and outcomes in developed countries. AREAS COVERED A bibliographic search in PubMed for articles published from 1 January 2019 through 12 June 2023 was performed. EXPERT OPINION In developed countries with specialized hemophilia treatment centers, primary hematological prophylaxis (started before the age of 2 years and after no more than one joint bleed) has almost completely eliminated the joint-related problems of the disease. The ideal goal of zero hemarthroses can be achieved only with intense and well-dosed prophylaxis: intravenous infusion of coagulation factor - standard half-life or extended half-life; periodic or subcutaneous injections of nonfactor products (emicizumab or fitusiran). However, hemophilic arthropathy continues to occur due to subclinical joint hemorrhages. In one study, 16% of the joints without reported hemarthroses showed signs of previous subclinical bleeding (hemosiderin deposits with/without synovial hypertrophy on magnetic resonance imaging were deemed signs of previous subclinical bleeding), rendering evidence for subclinical bleeding in people with severe hemophilia with lifelong prophylaxis treatment. Subclinical joint hemorrhages can be averted only by employing accurate and tailored prophylaxis.
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman MT, Martin-Salces M, Jimenez-Yuste V. Clinical assessment and point of care ultrasonography: How to diagnose haemophilic synovitis. Haemophilia 2021; 28:138-144. [PMID: 34668289 DOI: 10.1111/hae.14441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The ability of clinical tools to identify early joint changes is limited. Synovitis is a fundamental finding in understanding haemophilia activity and the response to its therapies; thus, there is a need for sensitive methods to better diagnose subclinical synovitis early. PURPOSE Our aim was to compare the frequency with which clinical assessment and ultrasound detected synovial hypertrophy in the most frequently affected joints in patients with haemophilia (elbows, knees and ankles). METHODS We analysed patients with haemophilia older than 16 years who came to the haemophilia centre for routine follow-up. From the clinical assessment carried out in the consultation, the swelling, pain and history of haemarthrosis were evaluated and compared with the findings of synovial hypertrophy detected by ultrasound. This comparison was also analysed independently for elbows, knees and ankles. RESULTS A total of 203 joints of 66 patients with haemophilia (mean age 34 years), most of them on secondary, tertiary prophylaxis or on demand treatment, were included. In joints with swelling, pain and history of haemarthrosis, 78% of the joints showed synovial hypertrophy on ultrasound. However, in joints with no swelling, no pain and no history of haemarthrosis, 40% presented subclinical synovial hypertrophy on ultrasound. This percentage was higher in elbows than in knees and ankles. CONCLUSION In adults with haemophilia, physical examination and point-of-care ultrasound study provide complementary data on their joint disease. However, without ultrasound, the ability to detect subclinical synovitis is considerably reduced, especially in the elbows.
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Affiliation(s)
| | - E Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Álvarez Román MT, de la Corte Rodríguez H, Bonanad Boix S, Mingot-Castellano ME, Fernández Mosteirín N. The factor VIII treatment history of non-severe hemophilia A: COMMENT. Joint damage in adult patients with mild or moderate hemophilia A evaluated with the HEAD-US system. J Thromb Haemost 2021; 19:2638-2641. [PMID: 34558785 DOI: 10.1111/jth.15475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Santiago Bonanad Boix
- Hemostasis and Thrombosis Unit, Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Eva Mingot-Castellano
- Department of Hematology, Hospital Regional Universitario de Málaga, Málaga, Spain
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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