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Astermark J, Blatný J, Königs C, Hermans C, Jiménez-Yuste V, Hart DP. Considerations for shared decision management in previously untreated patients with hemophilia A or B. Ther Adv Hematol 2023; 14:20406207231165857. [PMID: 37113810 PMCID: PMC10126613 DOI: 10.1177/20406207231165857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/04/2023] [Indexed: 04/29/2023] Open
Abstract
Recent advances in therapeutics are now providing a wide range of options for adults and children living with hemophilia. Although therapeutic choices are also increasing for the youngest individuals with severe disease, challenges remain about early management decisions, as supporting data are currently limited. Parents and healthcare professionals are tasked with helping children achieve an inclusive quality of life and maintain good joint health into adulthood. Primary prophylaxis is the gold standard to optimize outcomes and is recommended to start before 2 years of age. A range of topics need to be discussed with parents to aid their understanding of the decisions they can make and how these will affect the management of their child/children. For those with a family history of hemophilia, prenatal considerations include the possibility of genetic counseling, prenatal investigations, and planning for delivery, together with monitoring of the mother and neonate, as well as diagnosis of the newborn and treatment of any birth-associated bleeding. Subsequent considerations, which are also applicable to families where infant bleeding has resulted in a new diagnosis of sporadic hemophilia, involve explaining bleed recognition and treatment options, practical aspects of initiating/continuing prophylaxis, dealing with bleeds, and ongoing aspects of treatment, including possible inhibitor development. Over time, optimizing treatment efficacy, in which individualizing therapy around activities can play a role, and long-term considerations, including retaining joint health and tolerance maintenance, become increasingly important. The evolving treatment landscape is creating a need for continually updated guidance. Multidisciplinary teams and peers from patient organizations can help provide relevant information. Easily accessible, multidisciplinary comprehensive care remains a foundation to care. Equipping parents early with the knowledge to facilitate truly informed decision-making will help achieve the best possible longer-term health equity and quality of life for the child and family living with hemophilia. Plain language summary Points to be taken into account to help families make decisions to best care for children born with hemophilia Medical advances are providing a range of treatment options for adults and children with hemophilia. There is, however, relatively limited information about managing newborns with the condition. Doctors and nurses can help parents to understand the choices for infants born with hemophilia. We describe the various points doctors and nurses should ideally discuss with families to enable informed decision-making. We focus on infants who require early treatment to prevent spontaneous or traumatic bleeding (prophylaxis), which is recommended to start before 2 years of age. Families with a history of hemophilia may benefit from discussions before pregnancy, including how an affected child would be treated to protect against bleeds. When mothers are pregnant, doctors can explain investigations that can provide information about their unborn child, plan for the birth, and monitor mother and baby to minimize bleed risks at delivery. Testing will confirm whether the baby is affected by hemophilia. Not all infants with hemophilia will be born to families with a history of the condition. Identification of hemophilia for the first time in a family (which is 'sporadic hemophilia') occurs in previously undiagnosed infants who have bleeds requiring medical advice and possibly hospital treatment. Before any mothers and babies with hemophilia are discharged from hospital, doctors and nurses will explain to parents how to recognize bleeding and available treatment options can be discussed. Over time, ongoing discussions will help parents to make informed treatment decisions:• When and how to start, then continue, prophylaxis.• How to deal with bleeds (reinforcing previous discussions about bleed recognition and treatment) and other ongoing aspects of treatment. ○ For instance, children may develop neutralizing antibodies (inhibitors) to treatment they are receiving, requiring a change to the planned approach.• Ensuring treatment remains effective as their child grows, considering the varied needs and activities of their child.
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Affiliation(s)
| | - Jan Blatný
- Department of Pediatric Hematology, University
Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Christoph Königs
- Clinical and Molecular Hemostasis, Department
of Pediatrics, University Hospital Frankfurt, Goethe University, Frankfurt,
Germany
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of
Hematology, Cliniques Universitaires Saint-Luc, Université catholique de
Louvain (UCLouvain), Brussels, Belgium
| | - Victor Jiménez-Yuste
- Hematology Department, Hospital Universitario
La Paz, Autónoma University, Madrid, Spain
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2
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Santos AO, Ricciardi JBS, Pagnano R, Pereira LFM, Sakuma ET, Matsuda MMN, Bernardes ES, Araújo EB, Brunetto SQ, Takahashi MES, Brunetto EM, Zulli R, Ozelo MC, Etchebehere ECSC. Knee radiosynovectomy with 153Sm-hydroxyapatite compared to 90Y-hydroxyapatite: initial results of a prospective trial. Ann Nucl Med 2021; 35:232-240. [PMID: 33389651 DOI: 10.1007/s12149-020-01557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. PURPOSE The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. METHODS Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. RESULTS After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12 months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. CONCLUSION Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12 months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children.
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Affiliation(s)
- Allan O Santos
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil.
| | - Janaina B S Ricciardi
- Hemophilia Unit of Hemocentro UNICAMP, University of Campinas (UNICAMP), Campinas, Brazil
| | - Rodrigo Pagnano
- Department of Orthopedics and Traumatology of the Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luis Fernando M Pereira
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Emerson T Sakuma
- Division of Ultrasound of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Margareth M N Matsuda
- Radiopharmacy Center of the Nuclear and Energy Research Institute (IPEN/CNEN), São Paulo, Brazil
| | - Emerson S Bernardes
- Radiopharmacy Center of the Nuclear and Energy Research Institute (IPEN/CNEN), São Paulo, Brazil
| | - Elaine B Araújo
- Radiopharmacy Center of the Nuclear and Energy Research Institute (IPEN/CNEN), São Paulo, Brazil
| | - Sérgio Q Brunetto
- Center of Biomedical Engineering, University of Campinas, Campinas, Brazil
| | | | - Edna M Brunetto
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Roberto Zulli
- Hemophilia Unit of Hemocentro UNICAMP, University of Campinas (UNICAMP), Campinas, Brazil
| | - Margareth C Ozelo
- Hemophilia Unit of Hemocentro UNICAMP, University of Campinas (UNICAMP), Campinas, Brazil
| | - Elba C S C Etchebehere
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
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Ribeiro T, Abad A, Feldman BM. Developing a new scoring scheme for the Hemophilia Joint Health Score 2.1. Res Pract Thromb Haemost 2019; 3:405-411. [PMID: 31294328 PMCID: PMC6611477 DOI: 10.1002/rth2.12212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/15/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The Hemophilia Joint Health Score (HJHS) is a validated outcome tool developed for the assessment of joint health in people with hemophilia. The ordinal joint score assesses 9 items in 6 index joints. It is recognized as an optimal measurement of arthropathy in children and young adults. The aim of this study was to develop an updated scoring system for the HJHS that may overcome the limitations of its current ordinal scoring structure. METHODS A survey was developed using 1000Minds decision-making software. Respondents were provided with discrete choice tasks of ranking alternatives to determine the preference weight, or relative importance, placed on different criteria for each HJHS item. The survey was distributed to an anonymous sample of health care professionals with extensive experience in the physical examination of joints in people with hemophilia. RESULTS A total of 64 musculoskeletal health care professionals participated; with a 64% survey completion rate. The HJHS item weights provide a sum to 1.0; the highest-ranked item was extension loss (0.139) followed by swelling (0.121), whereas the lowest was duration of swelling (0.057) followed by muscle atrophy (0.08). Compared to the original, the relative efficiency of the new score was 5.4. CONCLUSIONS Observed differences in preference weights for HJHS items highlight the potential under- or overestimation of true joint health using the current ordinal scoring system. An updated scoring system using weighted items may improve the precision of HJHS assessment, leading to improved clinical management of joint health, while providing a robust research tool.
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Affiliation(s)
- Tiago Ribeiro
- Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Audrey Abad
- Child Health Evaluative Sciences Program, Research InsitituteThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Brian M. Feldman
- Child Health Evaluative Sciences Program, Research InsitituteThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsFaculty of Medicine and the Institute of Health Policy Management & EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoOntarioCanada
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Abstract
Advances in the development of effective and safe treatments for haemophilia over the last 50 years have resulted in a significant increase in the life expectancy of persons with haemophilia (PWH). The management of this new cohort of middle-aged and elderly PWH is challenging because of the opposing risks of haemophilia and age-related cardiovascular disease and malignancy. Furthermore, this cohort of ageing PWH has the additional comorbidities of human immunodeficiency virus/hepatitis C and chronic haemophilic arthropathy. This article reviews the prevalence, underlying mechanisms and treatment strategies for managing these comorbidities. International collaboration is essential for registry data and further prospective trials to inform optimal evidence-based management for this rare disorder in the future.
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Affiliation(s)
- Susan Shapiro
- Oxford Haemophilia and Thrombosis Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
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5
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Abstract
The focus of care providers, patients and families is the ability to tailor care for persons with haemophilia (PWH) across the lifespan. Care requires knowledge of the bleeding disorder and age-related complications, risk of therapeutic interventions, and evaluation of individual characteristics that contribute to outcomes. The ultimate goal is to live a normal life without the burden of bleeding, for PWH and carriers. A wide range of therapeutic options is required to achieve personalized care. Over the last decade, substantial therapeutic advantages have been achieved in the treatment of haemophilia that include the development of a robust array of factor concentrates, novel haemostatic agents, and increased knowledge and awareness of disease associated outcomes and risk factors. Significant strides on the road to accessible gene therapy have been realized. This increased range of therapeutic modalities provides options for development and implementation of care plans for each patient at each stage of life that are more flexible compared to prior care regimens. Paradigms for management of haemophilia are changing. As a community, we must work together to use these resources wisely, to learn from outcomes with new therapies and diagnostic tools, to assure all patients can achieve improved care and outcomes regardless of disease state or country of origin.
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Affiliation(s)
- S Gupta
- Indiana Hemophilia and Thrombosis Center, Inc., Indianapolis, IN, USA
| | - A D Shapiro
- Indiana Hemophilia and Thrombosis Center, Inc., Indianapolis, IN, USA
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Abstract
BACKGROUND Prophylaxis with clotting factor replacement products is recommended by the Medical and Scientific Advisory Council of the National Hemophilia Foundation as the optimal therapy for the prevention of bleeding episodes in individuals with severe hemophilia A or B (< 1 IU per dL endogenous factor VIII or factor IX activity, respectively). Prophylaxis is associated with an improved health-related quality of life and has been shown to be cost-effective compared with on-demand therapy. However, the overall cost of treatment remains high, particularly among patients with a greater propensity to bleed. The overall value of hemophilia treatments and their associated benefits, measured in quality-adjusted life-years (QALYs), and dollar costs compared with other interventions can be evaluated through the use of cost-utility analyses (CUAs). Previous CUA studies in hemophilia have focused primarily on patients with more severe forms of hemophilia and on prophylaxis compared with on-demand treatment. However, to our knowledge, no studies to date have utilized QALYs as a standardized outcome measure to systematically evaluate the relative cost-effectiveness of current hemophilia treatment options. OBJECTIVE To systematically review the CUA literature of hemophilia treatments and demonstrate the challenges in producing cost-utility evidence compared with other rare diseases. METHODS We conducted a systematic literature review using the Tufts Medical Center Cost-Effectiveness Analysis Registry and the National Health Service Economic Evaluation Database for English-language CUAs published from 2000 through 2015 with the search terms hemophilia, haemophilia, factor VIII, or factor IX. Two trained reviewers independently reviewed every study to extract relevant data. Incremental cost-effectiveness ratios were converted to 2014 U.S. dollars using exchange rates for currency conversion and the Consumer Price Index to adjust for inflation. RESULTS Our search yielded 52 studies, 11 of which met our inclusion criteria. The cost-effectiveness of hemophilia treatments varied widely based on variations in the study designs, including differences in time horizon, discount rates, and medical interventions. CONCLUSIONS We found the cost-effectiveness of hemophilia treatments to be broadly comparable to that of other orphan drugs. Improved standardization of future CUA studies will be important for further evaluation of the cost-effectiveness of hemophilia treatments. DISCLOSURES This research was funded by Biogen, which provided an unrestricted research grant to the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. Biogen and Sobi reviewed and provided feedback on the manuscript. The authors had full editorial control of the manuscript and provided final approval of all content. The authors report no conflict of interest regarding the material discussed in this article. Neumann and Chambers are employed at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. Thorat was an employee of Center for Evaluation Value and Risk in Health, Tufts Medical Center when the analyses were carried out. Chambers has participated on advisory boards for Sanofi and Astellas Pharma.
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Affiliation(s)
- Teja Thorat
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - James D. Chambers
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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7
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R CB, A TO, S PA, J CJ, F Q, J NM, JA LP. Using the Hemophilia Joint Health Score for assessment of children: Reliability of the Spanish version. Physiother Theory Pract 2018; 35:341-347. [DOI: 10.1080/09593985.2018.1443356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Cuesta-Barriuso R
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
- Real Fundación Victoria Eugenia, Madrid, Spain
- Fishemo-Federación Española de Hemofilia, Madrid, Spain
| | - Torres-Ortuño A
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Pérez-Alenda S
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Carrasco Juan J
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Querol F
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Nieto-Munuera J
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - López-Pina JA
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
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8
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Suckling LB, Stephensen D, Cramp MC, Mahaffey R, Drechsler WI. Identifying biomechanical gait parameters in adolescent boys with haemophilia using principal component analysis. Haemophilia 2017; 24:149-155. [DOI: 10.1111/hae.13362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 12/22/2022]
Affiliation(s)
- L. B. Suckling
- School of Health, Sport & Bioscience; University of East London; Stratford London UK
| | | | - M. C. Cramp
- Allied Health Professions; University of the West of England; Bristol UK
| | - R. Mahaffey
- School of Sport; Health and Applied Sciences; St Mary's University Twickenham; UK
| | - W. I. Drechsler
- Faculty of Life Sciences & Medicine; Kings College London; London UK
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9
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Mannucci PM, Iacobelli M. Progress in the contemporary management of hemophilia: The new issue of patient aging. Eur J Intern Med 2017; 43:16-21. [PMID: 28532688 DOI: 10.1016/j.ejim.2017.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 01/09/2023]
Abstract
The management of inherited coagulation disorders such as hemophilia A and B has witnessed dramatic progresses since the last few decades of the last century. Accordingly, persons with hemophilia (PWH) now enjoy a life expectancy at birth not different from that of males in the general population, at least in high income countries. Nowadays, a substantial proportion of PWH are aging, like their peers in the general population. This outstanding progress is accompanied by problems that are in part similar to those of any old person (multiple concomitant diseases and the resulting intake of multiple drugs other than those specific for hemophilia treatment). In addition, older PWH suffer from the consequences of the comorbidities that developed when their treatment was at the same time poorly available and unsafe. Typical hemophilia comorbidities affect the musculoskeletal system following joint and muscle bleeds, but also the liver and kidney are often impaired due to previous bloodborne infections such as viral hepatitis and HIV. Thus, the comorbidities of hemophilia superimposed on the multimorbidity and polypharmacy associated with aging create peculiar problems in the current management of these patients, that demand the coordinated holistic intervention of internists, geriatricians and clinical pharmacologists in addition to the care traditionally provided by pediatricians and hematologists.
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Wang M, Álvarez-Román MT, Chowdary P, Quon DV, Schafer K. Physical activity in individuals with haemophilia and experience with recombinant factor VIII Fc fusion protein and recombinant factor IX Fc fusion protein for the treatment of active patients: a literature review and case reports. Blood Coagul Fibrinolysis 2016; 27:737-44. [PMID: 27116081 DOI: 10.1097/MBC.0000000000000565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The World Federation of Hemophilia and the National Hemophilia Foundation encourage people with haemophilia (PWH) to participate in routine physical activity. The benefits of physical activity for PWH include improvements in joint, bone, and muscle health. Accordingly, a number of studies suggest that levels of physical activity among PWH are similar to those of their healthy peers, especially among individuals who began prophylaxis at an early age (≤3 years). Importantly, several studies found either no increased risk or only a transient increase in risk of bleeding with more intensive physical activity compared with less intensive physical activity. Data on optimal prophylaxis regimens for PWH who participate in physical/sporting activities; however, remain sparse. Long-acting recombinant factor VIII Fc fusion protein (rFVIIIFc) and recombinant factor IX Fc fusion protein (rFIXFc) demonstrated efficacy for the prevention and treatment of bleeding episodes in Phase 3 clinical trials of participants with haemophilia A and B, respectively, with most individuals able to maintain or increase their physical activities. This manuscript reviews the current literature that describes physical activity in PWH. Additionally, case studies are presented to provide supplemental information to clinicians illustrating the use of rFVIIIFc and rFIXFc in physically active patients with haemophilia A and B, respectively. These case reports demonstrate that it is possible for patients to be physically active and maintain good control of their haemophilia with extended interval prophylactic dosing using rFVIIIFc or rFIXFc.
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Cuesta-Barriuso R, Torres-Ortuño A, Galindo-Piñana P, Nieto-Munuera J, Duncan N, López-Pina JA. Validation of the VERITAS-Pro treatment adherence scale in a Spanish sample population with hemophilia. Patient Prefer Adherence 2017; 11:653-660. [PMID: 28392680 PMCID: PMC5375636 DOI: 10.2147/ppa.s126828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to conduct a validation in Spanish of the Validated Hemophilia Regimen Treatment Adherence Scale - Prophylaxis (VERITAS-Pro) questionnaire for use in patients with hemophilia under prophylactic treatment. PATIENTS AND METHODS The VERITAS-Pro scale was adapted through a process of back translation from English to Spanish. A bilingual native Spanish translator translated the scale from English to Spanish. Subsequently, a bilingual native English translator translated the scale from Spanish to English. The disagreements were resolved by agreement between the research team and translators. Seventy-three patients with hemophilia, aged 13-62 years, were enrolled in the study. The scale was applied twice (2 months apart) to evaluate the test-retest reliability. RESULTS Internal consistency reliability was lower on the Spanish VERITAS-Pro than on the English version. Test-retest reliability was high, ranging from 0.83 to 0.92. No significant differences (P>0.05) were found between test and retest scores in subscales of VERITAS-Pro. In general, Spanish patients showed higher rates of nonadherence than American patients in all subscales. CONCLUSION The Spanish version of the VERITAS-Pro has high levels of consistency and empirical validity. This scale can be administered to assess the degree of adherence of prophylactic treatment in patients with hemophilia.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid
- Fishemo, Centro Especial de Empleo, Spanish Federation of Hemophilia
- Royal Foundation Victoria Eugenia, Madrid
- Correspondence: Rubén Cuesta-Barriuso, Royal Foundation Victoria Eugenia, 4 Sinesio Delgado Street, 28029 Madrid, Spain, Tel +34 91 314 6508, Fax +34 91 314 5965, Email
| | - Ana Torres-Ortuño
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Pilar Galindo-Piñana
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Joaquín Nieto-Munuera
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Natalie Duncan
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - José Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
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Yao W, Xiao J, Cheng X, Feng G, Li C, Zhang X, Hu Q, Xu W, Sun J, Yang R, Li X, Zhou R, Lian S, Gu J, Wu J, Zhao Y, Wu R. The Efficacy of Recombinant FVIII Low-Dose Prophylaxis in Chinese Pediatric Patients With Severe Hemophilia A: A Retrospective Analysis From the ReCARE Study. Clin Appl Thromb Hemost 2016; 23:851-858. [PMID: 27920236 DOI: 10.1177/1076029616679507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study explores the efficacy of recombinant factor VIII (rFVIII) low-dose prophylaxis in Chinese pediatric patients with severe hemophilia A from the Retrospective Study in Chinese Pediatric Hemophilia A Patients With rFVIII Contained Regular Prophylaxis (ReCARE) population. Methods: This is additional analysis of the multicenter, retrospective ReCARE study, in which the annual bleeding rate (ABR), annual joint bleeding rate (AJBR), and safety of >12-week, low dose (10-30 IU/kg/wk) rFVIII prophylaxis divided into primary, secondary, and tertiary groups based on the joint status and joint bleeding history were analyzed. Results: A total of 57 patients (median age: 8.2 [0.4-17.3] years) from the ReCARE study receiving primary (n = 3), secondary (n = 21), and tertiary (n = 33) prophylaxes were included. Low-dose prophylaxis had significant bleeding reduction in all 3 groups compared to the baseline ( S = 408.5, P < .001), with median ABR rates of −4.0 (−8.0 to −3.1), −4.0 (−24.0 to 8.0), and −13.9 (−110.6 to 20.6) in the primary, secondary, and tertiary groups, respectively, with a significant difference between the secondary and tertiary groups ( P = .008). Median AJBR reduction rates were −2.3 (−6.3 to 8.4) and −14.9 (−61.5 to 19.1) in the secondary and tertiary groups, respectively. But there was no significant difference in AJBRs between the secondary and tertiary groups ( P = .061), which was related to damaged joint status. Hence, longer prophylaxis was associated with better prevention of joint bleeding ( P = .024). Conclusion: Despite significant ABR/AJBR reduction in all 3 groups, the efficacy of the primary prophylaxis was better than the secondary and tertiary prophylaxes.
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Affiliation(s)
- Wanru Yao
- Department of Haematology, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Juan Xiao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaoling Cheng
- Department of Haematology, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Guoshuang Feng
- Department of Haematology, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Changgang Li
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, China
| | | | - Qun Hu
- Department of Hematology, TongJi Medical College of HUST, Wuhan, China
| | - Weiqun Xu
- Department of Hematology, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Renchi Yang
- Department of Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Xiaojing Li
- Department of Hematology, Chengdu Women and Children’s Central Hospital, Chengdu, China
| | - Rongfu Zhou
- Department of Hematology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Shimei Lian
- Department of Hematology, Dalian Municipal Central Hospital, Dalian Medical University, Dalian, China
| | - Jian Gu
- Department of Hematology, Northern Jiangsu People’s Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
| | - Junde Wu
- Department of Medical Affairs, Bayer Healthcare Co Ltd, Building Bayer Center, Beijing, China
| | - Yongqiang Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Runhui Wu
- Department of Haematology, Beijing Children’s Hospital, Capital Medical University, Beijing, China
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Schrijvers LH, Kars MC, Beijlevelt-van der Zande M, Peters M, Schuurmans MJ, Fischer K. Unravelling adherence to prophylaxis in haemophilia: a patients' perspective. Haemophilia 2015; 21:612-21. [PMID: 25858411 DOI: 10.1111/hae.12660] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/27/2022]
Abstract
Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to prophylactic treatment, from a patients' perspective. To develop a grounded theory, a qualitative study using individual in-depth interviews was performed to understand experiences, perceptions and beliefs concerning adherence to prophylaxis. From two Dutch treatment centres, 21 adults with haemophilia using prophylaxis were interviewed. Patients were asked how they experience their task to administer prophylaxis and how they adhere to this. The interviews were transcribed, coded and analysed in an iterative process, leading to the development of the grounded theory. Adherence was determined by the position of prophylaxis in life. The position of prophylaxis was determined by the perception of prophylaxis and the ability to exert prophylaxis. Patients' perception was influenced by two main factors: acceptance of haemophilia and feeling/fearing symptoms. The ability to exert prophylaxis was influenced by understanding haemophilia and prophylaxis and planning/infusion skills. The combination of different perceptions and skills led to four main positions of prophylaxis in life: (i) prophylaxis integrated in life, (ii) prophylaxis according to doctors' advice, struggling with irregular situations, (iii) prophylaxis is too much to handle, (iv) prophylaxis is a confrontation with illness. The adherence level gradually decreased from position 1 to 4. This information can be used to design tailored interventions to promote adherence.
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Affiliation(s)
- L H Schrijvers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | | | - M Peters
- Haemophilia Treatment Centre, Academical Medical Center Amsterdam, Amsterdam, the Netherlands
| | - M J Schuurmans
- Faculty of Health Care, Nursing Science, University of Applied Science, Utrecht, the Netherlands.,Nursing Science, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
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14
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Abstract
Abstract
Prophylactic application of clotting factor concentrates is the basis of modern treatment of severe hemophilia A. In children, the early start of prophylaxis as primary or secondary prophylaxis has become the gold standard in most countries with adequate resources. In adults, prophylaxis is reasonably continued when started as primary or secondary prophylaxis in childhood to maintain healthy joint function. Initial data support that adult patients with already existing advanced joint arthropathy benefit from tertiary prophylaxis with significantly lowered number of bleeds, almost complete absence of target joints, and less time off from work. Current prophylactic regimens, although very effective, do not completely prevent joint disease in a long-term perspective. Joint arthropathy in primary prophylaxis develops over many years, sometimes over a decade or even longer time periods. The ankle joints are the first and most severely affected joints in those patients and thus may serve in outcome assessment as an indicator of early joint arthropathy when followed by ultrasound or magnetic resonance imaging. Optimized outcome and best use of available resources is expected from individualization of therapy regimens, which comprises the individual’s bleeding pattern, condition of the musculoskeletal system, level of physical activity and the pharmacokinetic profile of the substituted coagulation factor, and most recently includes novel products with extended half-lives.
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15
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Abstract
INTRODUCTION Patients with haemophilia commonly develop arthropathy secondary to recurrent haemarthroses. Although modern treatment with replacement coagulation factors has reduced the prevalence of end-stage arthropathy, total joint replacement is still required in a small group of patients. These patients may be at higher risk of complications and the outcome of surgery may not be comparable to reports of outcomes of total joint replacement in the general population. The purpose of this study was to describe the change in function in patients undergoing total knee replacement for haemophilic arthropathy. PATIENTS AND METHODS Patients undergoing total knee arthroplasty in a tertiary centre had prospective evaluations of patient reported outcome measures and range of movement. Their post-operative function was evaluated in a combined orthopaedic-haematology clinic. Eight male patients underwent 13 total knee replacements from 1999 to 2007 and were followed up for a median of 78 months (range 17-116). RESULTS The median Oxford knee score improved from 45.5 pre-operatively to 28 (p = 0.049). There was a similar improvement in SF-12 physical (p = 0.017) and Knee Society scores (objective p = 0.001; function p = 0.002). Four total knee replacements were performed in patients with inhibitor antibodies and were treated with recombinant activated factor VIIa. These patients had reduced range of movement (p = 0.047). No patients suffered deep infection. CONCLUSIONS Total knee replacement in patients with haemophiliac arthropathy resulted in improvement in range of movement and function. The presence of factor VIII inhibitors resulted in reduced range of movement, but similar patient reported outcome measures.
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Affiliation(s)
- P J Jenkins
- Specialist Registrar, Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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16
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Lock J, Raat H, Duncan N, Shapiro A, Beijlevelt M, Peters M, Tamminga RYJ, Leebeek FWG, Moll HA, Cnossen MH. Adherence to treatment in a Western European paediatric population with haemophilia: reliability and validity of the VERITAS-Pro scale. Haemophilia 2014; 20:616-23. [DOI: 10.1111/hae.12463] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J. Lock
- Department of Paediatric Haematology; Erasmus MC - Sophia Children's Hospital; Rotterdam Netherlands
| | - H. Raat
- Department of Public Health; Erasmus MC, University Medical Centre Rotterdam; Rotterdam Netherlands
| | - N. Duncan
- Department of Haematology; Indiana Haemophilia and Thrombosis Centre; Indianapolis IN USA
| | - A. Shapiro
- Department of Haematology; Indiana Haemophilia and Thrombosis Centre; Indianapolis IN USA
| | - M. Beijlevelt
- Department of Paediatric Haematology; Academic Medical Centre Amsterdam; Amsterdam Netherlands
| | - M. Peters
- Department of Paediatric Haematology; Academic Medical Centre Amsterdam; Amsterdam Netherlands
| | - R. Y. J. Tamminga
- Department of Paediatric Haematology; University Medical Centre Groningen; Groningen Netherlands
| | - F. W. G. Leebeek
- Department of Haematology; Erasmus MC, University Medical Centre Rotterdam; Rotterdam Netherlands
| | - H. A. Moll
- Department of General Paediatrics; Erasmus MC - Sophia Children's Hospital; Rotterdam Netherlands
| | - M. H. Cnossen
- Department of Paediatric Haematology; Erasmus MC - Sophia Children's Hospital; Rotterdam Netherlands
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17
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Abstract
Hemophilia has evolved from an often fatal hereditary bleeding disorder to a disorder for which safe and effective treatment is available. However, there are several challenges remaining in the treatment of hemophilia. Prophylaxis to prevent bleeding is costly and requires frequent intravenous injections, which are cumbersome for patients. Venous access is often difficult to achieve, especially in small children where central venous lines may need to be implanted. Development of inhibitory antibodies makes treatment of acute bleeds difficult and prophylaxis in patients with inhibitors must also be better addressed. In order to improve treatment, new products are being developed, some of which are already in clinical trials. There are several approaches to prolonging half-lives such as PEGylation, Fc fusion and albumin fusion. Increased activity has been demonstrated in preclinical trials for factor IX and in a human trial with factor VII where the activity of the molecules has been increased by manipulation of the molecular composition. Additional approaches, including blockage of inhibitors of clotting, are also under investigation. Factor VIII and factor IX gene therapy have become a tangible possibility since phase I data recently have been published. Results are promising and there is hope that in the near future substantial progress will be made, perhaps making hemophilia the first genetic condition to be cured.
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Affiliation(s)
- Karin Knobe
- Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, SE-205 02 Malmö, Sweden
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18
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Bladen M, Main E, Hubert N, Koutoumanou E, Liesner R, Khair K. Factors affecting the Haemophilia Joint Health Score in children with severe haemophilia. Haemophilia 2013; 19:626-31. [PMID: 23534671 DOI: 10.1111/hae.12108] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2013] [Indexed: 11/30/2022]
Abstract
Joint damage from bleeding episodes leads to physical or functional limitations in people with haemophilia. Various factors may influence the frequency and severity of joint damage. This study examined whether age, prophylaxis, history of high-titre inhibitors (HTI) and bleeding events influenced the Haemophilia Joint Health Score (HJHS) in children. Medical and physiotherapy notes of boys with severe haemophilia, aged 4-18 years, were reviewed to identify factors associated with increased HJHS. The HJHS of 83 boys (median age: 11) ranged from 0 to 25, with 44/83 (53%) having a score of zero. The median HJHS was 0 (mean 2.6). In the non-HTI group, the HJHS for boys on late prophylaxis was 2.68 times higher than those who started early and the HJHS was on average 10% higher for every additional recent bleed. In this group the odds of having a zero score fell by 30% for every year increase in age. Boys with a history of HTI had higher HJHS scores than the non-HTI group, and age, number of recent bleeds and tolerized status were positively associated with HJHS. The score rose on average by 28% for every year of age and by 76% for non-tolerized boys. This study provides further evidence supporting early prophylaxis use and the importance of immune tolerance therapy. The HJHS is a useful tool for identifying and tracking changes in joint health with respect to therapy or disease progression. With improvements in haemophilia treatment, the disproportionate number of zero scores will continue to make interpretation of the HJHS challenging.
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Affiliation(s)
- M Bladen
- Haemophilia Centre, Great Ormond St Hospital for Children, NHS Foundation Trust, London, UK.
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19
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Hilliard P, Zourikian N, Blanchette V, Chan A, Elliott B, Israels SJ, Nilson J, Poon MC, Laferriere N, Van Neste C, Jarock C, Wu J, McLimont M, Feldman B. Musculoskeletal health of subjects with hemophilia A treated with tailored prophylaxis: Canadian Hemophilia Primary Prophylaxis (CHPS) Study. J Thromb Haemost 2013; 11:460-6. [PMID: 23301594 DOI: 10.1111/jth.12113] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Full-dose prophylaxis is very effective at minimizing joint damage but is costly. Tailored prophylaxis has been proposed as a way of reducing costs while still protecting joints. OBJECTIVE To report detailed findings in index joints of 56 subjects with severe hemophilia A entered into the Canadian Hemophilia Prophylaxis Study, and treated with tailored prophylaxis, after 13 years. METHODS Boys with severe hemophilia A (< 2% factor) and normal joints were enrolled between the ages of 1 and 2.5 years. Initial treatment consisted of once-weekly factor infusions, with the frequency escalating in a stepwise fashion when breakthrough bleeding occurred. During the first 5 years, subjects were examined every 3 months using the modified Colorado Physical Evaluation (PE) scale; subsequently, every 6 months. The Childhood Health Assessment Questionnaire (CHAQ) was administered at each visit. RESULTS Median age at study entry was 19 months (range 12-30 months); median follow-up was 92 months (range 2-156). The median PE score was 2, 3 and 3 at ages 3, 6 and 10 years. Persistent findings were related to swelling, muscle atrophy and loss of range of motion. The median score for each of these items (for the six index joints) was 0 at ages 3, 6 and 10 years. The median overall CHAQ score was 0 at ages 3, 6 and 10 years, indicating excellent function. CONCLUSIONS Canadian boys treated with tailored primary prophylaxis exhibit minimal joint change on physical examination and minimal functional disability.
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Affiliation(s)
- P Hilliard
- Department of Rehabilitation Services, Hospital for Sick Children, University of Toronto, Toronto, Canada
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20
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Schrijvers LH, Uitslager N, Schuurmans MJ, Fischer K. Barriers and motivators of adherence to prophylactic treatment in haemophilia: a systematic review. Haemophilia 2013; 19:355-61. [PMID: 23279084 DOI: 10.1111/hae.12079] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 11/26/2022]
Abstract
Long-term adherence to prophylactic therapy is the key to successful prevention of bleeds in severe haemophilia. The present study aims to provide a systematic review of the literature on the determinants of adherence to prophylaxis in haemophilia. A literature search in the largest medical databases in Oct 2011 yielded 880 articles, which were reduced to 72 by further selection on title. Twenty-eight articles were excluded due to inclusion criteria. Full paper evaluation of 44 articles yielded five relevant articles that were critically appraised using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement and items extracted from the critical appraisal criteria for cohort studies (Dutch Cochrane Centre). After critical appraisal, 2/5 studies were considered as the best evidence available. The results of these two studies were further used in the synthesis for description of the determinants of adherence. This concerned a total of 245 subjects in all age groups. Data were collected using questionnaires and interviews. Motivators for a high adherence were as follows: experience of symptoms, a positive belief of necessity of treatment and a good relationship with the health care provider. Important barriers were defined as: infrequent or absence of symptoms and increasing age. Two high-quality studies were identified. Reported determinants of adherence to prophylaxis were age, symptoms, beliefs, and the relation with the health care provider. This information may provide a first step towards a strategy to promote adherence in haemophilia, with an important focus on age-specific interventions and patient education.
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Affiliation(s)
- L H Schrijvers
- Van Creveldkliniek, Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
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21
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Jaszczur-janus I, Janus A, Wrzosek Z, Kuliszkiewicz-janus M. Rehabilitation of people with haemophilia. Part II – Surgical treatment and rehabilitation procedure guidelines. Physiotherapy 2013; 21. [DOI: 10.2478/physio-2013-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AbstractIn the first article of the series about the rehabilitation of haemophilic patients, the issues related to the aetiology of the disease, its clinical picture, changes in locomotor system, and substitution therapy have been discussed. In this paper the authors present the orthopaedic treatment methods and the guidelines for rehabilitation procedures after intraarticular and intramuscular haemorrhages. They also describe the physical examination and medical interview of a patient with plasmatic diathesis. Also, they point out the specificities of therapeutic procedure which has to take into account not only the changes in locomotor system but also haemostatic abnormalities and substitution therapy. The authors have divided the rehabilitation process into three phases, depending on the patient’s clinical status.
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22
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Saulyte Trakymiene S, Clausen N, Poulsen LH, Ingerslev J, Rageliene L. Progression of haemophilic arthropathy in children: a Lithuanian--Danish comparative study. Haemophilia 2012; 19:212-8. [PMID: 23167920 DOI: 10.1111/hae.12058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
Abstract
Recurrent bleeding into joints initiates a sequence of events leading to a progressive joint damage in people with severe haemophilia. This is a continuous process during childhood and adolescence, therefore joint abnormalities may be minimal on physical examination in very young children - even those receiving on-demand treatment. The aim of our study was to quantify the burden of arthropathy in Lithuanian patients who had been treated exclusively by on-demand substitution and compare their physical joint health with age-matched Danish patients who received prophylaxis from an early age. Boys, aged 4-17 years, with severe haemophilia and no signs of inhibitors were included in the study. Joint outcome based on the Haemophilia Joint Health Score (HJHS) was analysed in two different treatment groups and compared within the matched pairs. In total, 32 (16 in each treatment group) patients were enroled. A total of 192 joints were evaluated. Joint status according to treatment strategy was strikingly different: 27.4 for on-demand vs. 3.3 for prophylaxis (<0.001) group. Significance of the difference in joint status comparing different treatment strategies was equally strong both in younger (4-9 years) and older (10-17 years) patient groups: 2.2 vs. 12.5 (P = 0.0002) and 3.9 vs. 36.3 (P < 0.0001) respectively. The results further demonstrate the unequivocal effect of prophylaxis on joint status and give an insight into early and late manifestations of joint impairment based on the HJHS in haemophilia patients with treatment on-demand compared with joint changes that may develop over the time with the preventative treatment.
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Affiliation(s)
- S Saulyte Trakymiene
- Clinic of Children's Diseases, Vilnius University and Centre for Pediatric Hematology/Oncology, Children's Hospital, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
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23
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ZÜLFIKAR B, AYDOGAN G, SALCIOGLU Z, ONER AF, KAVAKLI K, GURSEL T, ZÜLFIKAR H. Efficacy of FEIBA for acute bleeding and surgical haemostasis in haemophilia A patients with inhibitors: a multicentre registry in Turkey. Haemophilia 2011; 18:383-91. [DOI: 10.1111/j.1365-2516.2011.02693.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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TEITEL J, BERNTORP E, DOLAN G, FISCHER K, GRINGERI A, KESSLER C, LAMBERT T, LEISSINGER C, NEMES L, SHIMA M. A consensus statement on clinical trials of bypassing agent prophylaxis in inhibitor patients. Haemophilia 2011; 17:516-21. [DOI: 10.1111/j.1365-2516.2010.02440.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Affiliation(s)
- L A Valentino
- Department of Pediatrics and Internal Medicine, Rush University Medical Center, Chicago, IL 60612-3833, USA.
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26
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Affiliation(s)
- V S Blanchette
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.
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27
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Rampal V, Odent T, Torchet MF, Rothschild C, Elie C, Glorion C, Padovani JP. Surgical synovectomy of the knee in young haemophiliacs: long-term results of a monocentric series of 23 patients. J Child Orthop 2010; 4:33-7. [PMID: 21286256 PMCID: PMC2811685 DOI: 10.1007/s11832-009-0229-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 12/08/2009] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment. METHOD We report a series of 23 surgical synovectomies of the knee with a median follow-up of 8.8 years. The median age of patients at surgery was 13.5 years. Clinical and radiological evaluations were made according to the Petrini and the Pettersson scores, at 1 and 5 years after surgery, and at the last follow-up. Wilcoxon and Spearman's tests were used for the statistical analysis. RESULT The Petrini score improved at 1 and 5 years (P < 0.001). Nine patients have 20 years of follow-up and a stable result. In more than half of the knees, no episode of recurrent bleeding occurred. The effect of surgery on the range of motion (ROM) was moderate and mobilisation under anaesthesia did not improve it significantly. There was a progressive worsening of the radiological score, but no correlation between clinical and radiological score was noticed (ρ = 0.08, P = 0.77). CONCLUSION Complete synovectomy gives good long-term results in term of bleeding recurrence and overall function.
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Affiliation(s)
- Virginie Rampal
- />Service d’Orthopédie Pédiatrique, Hôpital de l’Archet, Université Nice Sophia Antipolis, 151 Rte de Saint Antoine de Ginestière, 06202 Nice, France
| | - T. Odent
- />Service d’Orthopédie Pédiatrique, Hôpital Necker, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - M. F. Torchet
- />Centre d’Hémophilie, Hôpital Necker, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - C. Rothschild
- />Centre d’Hémophilie, Hôpital Necker, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - C. Elie
- />Service de Santé Publique et Médecine Sociale, Hôpital Necker, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - C. Glorion
- />Service d’Orthopédie Pédiatrique, Hôpital Necker, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - J. P. Padovani
- />Service d’Orthopédie Pédiatrique, Hôpital Necker, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
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Abstract
The current status of replacement therapy for haemophilia and the role played by nurses in Japan were investigated at 16 facilities (17 specialties) each providing care to 20 or more haemophilia A or B patients without inhibitor. The questionnaire was mailed to the nurse or physician in charge of haemophilia at each facility in August 2006, asking the nurse to fill in the questionnaire. Responses were collected on 1318 patients (haemophilia A: 1078 patients; haemophilia B: 240 patients). About 70% of these patients were reported to be severe haemophilia A or B. Overall, 26% were receiving regular prophylaxis while 74% received on-demand therapy with or without temporary prophylaxis before special events. The percentage of patients receiving primary prophylaxis was only 2%. The percentage of adherence to prophylaxis decreased with age (lowest at age 19-29) but this percentage for each age group in Japan was higher than that in the western countries. Of the nurses working at the facilities surveyed, 88% considered prophylaxis as an optimal therapy for severe haemophilia patients, although the percentage of patients receiving prophylaxis for the entire population surveyed was lower than that in the western countries. The main factor precluding introduction of prophylaxis was 'difficulty in venous access' for infants and small children. On the other hand, 'unwillingness of family members' and 'poor adherence' were the main factors precluding introduction of this therapy for those aged over 6 years.
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Affiliation(s)
- O Ono
- North Kyushu Hemophilia Center, University Hospital of Occupational and Environmental Health, Kita-Kyushu, Fukuoka, Japan.
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30
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Trakymienė SŠ, Ragelienė L. Optimal treatment for children with haemophilia: a review. Acta Med Litu 2009; 16:15-22. [DOI: 10.2478/v10140-009-0003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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DOUMA-VAN RIET DCM, ENGELBERT RHH, VAN GENDEREN FRANKR, TER HORST-DE RONDE MANONTM, DE GOEDE-BOLDER ARJA, HARTMAN ANNELIES. Physical fitness in children with haemophilia and the effect of overweight. Haemophilia 2009; 15:519-27. [DOI: 10.1111/j.1365-2516.2008.01928.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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DE MOERLOOSE P, URBANCIK W, VAN DEN BERG HM, RICHARDS M. A survey of adherence to haemophilia therapy in six European countries: results and recommendations. Haemophilia 2008; 14:931-8. [DOI: 10.1111/j.1365-2516.2008.01843.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- A Llinás
- Department of Orthopedics and Traumatology, Fundación Santa Fe de Bogotá and Fundación Cosme y Damián, Bogotá, Colombia.
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34
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Sadat U, Naik J, Hayes PD. Surgical complications in a hemophilia patient with factor VIII inhibitor and their endovascular management. Vasc Endovascular Surg 2008; 42:168-72. [PMID: 18421033 DOI: 10.1177/1538574407309319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hemophilia, an X-linked disorder due to clotting factors VIII or IX deficiency, is associated with recurrent hemorrhage into joints, soft tissue, and organs. Recombinant factor VIII concentrates are available for the treatment of bleeding complications. However, inhibitors to factor VIII develop in 25% to 35% of patients with severe hemophilia A, making the management of bleeding episodes more complex. The treatment of unusual metachronous ruptured aneurysms in a patient with hemophilia A with factor VIII inhibitor is presented, and the outcomes of endovascular and open operations are discussed.
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Affiliation(s)
- Umar Sadat
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.
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35
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Affiliation(s)
- S W Pipe
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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36
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