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Fornari A, Antonazzo IC, Rocino A, Preti D, Fragomeno A, Cucuzza F, Ceresi N, Santoro C, Ferretti A, Facchetti R, Cozzolino P, Biasoli C, Cassone C, Coppola A, Cortesi PA, Mantovani LG. The psychosocial impact of haemophilia from patients' and caregivers' point of view: The results of an Italian survey. Haemophilia 2024; 30:449-462. [PMID: 38147066 DOI: 10.1111/hae.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/29/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUD A huge amount of data about psychosocial issues of people with haemophilia (PwH) are available; however, these materials are fragmentary and largely outdated, failing to reflect the impact of current treatment strategies. AIM Describing the influence of illness on psychosocial aspects of adult PwH (≥18 years) and caregivers of children with haemophilia (CPwH) without inhibitors, in Italy. METHODS Surveys (for adult PwH, CPwH and haemophilia specialists) were developed by a multidisciplinary working group and conducted from November 2019 to June 2020. RESULTS A total of 120 PwH without inhibitors and 79 CPwH completed the survey. Adult patients reported a significant impairment in many psychosocial aspects, including working activities, relations with family members and social relations. Caregivers generally reported better scores in all aspects of the survey. Mobility, Pain and Mental health domains of EQ-5D were the most frequently impaired in both patients and caregivers, reducing the perceived quality of life. Genetic counselling was an important issue, 53% of CPwH declaring unawareness of their carrier status, as well as the psychological support offered by the reference center, 67.0% of respondents reporting that no psychological support was provided at the time of diagnosis communication. CONCLUSION This study provides information about PwH's and CPwH's point of view in the current scenario of continuous innovations in haemophilia treatment and management furthermore, updated insights on psychosocial problems faced by patients and caregivers are reported.
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Affiliation(s)
- Arianna Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Angiola Rocino
- UOC di Ematologia-Centro Emofilia e Trombosi, Ospedale del Mare-ASL NA1, Napoli, Italy
| | - Daniele Preti
- Italian Federation of Haemophilia Associations (FedEmo), Rome, Italy
| | - Anna Fragomeno
- Italian Federation of Haemophilia Associations (FedEmo), Rome, Italy
| | - Francesco Cucuzza
- Italian Federation of Haemophilia Associations (FedEmo), Rome, Italy
| | - Nicola Ceresi
- Italian Federation of Haemophilia Associations (FedEmo), Rome, Italy
| | - Cristina Santoro
- Haematology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Antonietta Ferretti
- Haematology, University Hospital Policlinico Umberto I, Rome, Italy
- Haemorrhagic and Thrombotic Diseases Service, Area of Haematology, Fondazione Policlinico Universitario 'A. Gemelli', IRCCS, Rome, Italy
| | - Rita Facchetti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | | | - Chiara Biasoli
- Haemophilia Centre and Transfusion Department, Bufalini Hospital, Cesena, Italy
| | - Cristina Cassone
- Italian Federation of Haemophilia Associations (FedEmo), Rome, Italy
| | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- IRCCS Multimedica, Sesto San Giovanni, Italy
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2
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Zhang L, Zhang P, Chen W. Treatment regimens, patient reported outcomes and health-related quality of life in children with moderate and severe hemophilia A in China: using real-world data. Orphanet J Rare Dis 2023; 18:232. [PMID: 37542281 PMCID: PMC10403888 DOI: 10.1186/s13023-023-02835-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Prophylaxis therapy for children with moderate and severe hemophilia A (HA) is the optimal treatment regimen. The real-world treatment regimens, patient-reported outcomes, and health-related quality of life (HRQoL) in children with moderate and severe HA in China are less known. OBJECTIVE This study aimed to describe real-world treatment regimens and evaluate the association of treatment regimens with comprehensive patient-reported outcomes including bleeds, chronic pain, target joints, disability, and HRQoL in children under 18 years old with HA in China. METHODS Real-world data of a nationwide online cross-sectional survey in 2021 and patients' coagulation factor utilization data from self-management records from 2020 to 2021 were merged. 373 eligible children were included and categorized by treatment regimens according to the Chinese guideline: on-demand, short-term prophylaxis, and long-term prophylaxis treatment. RESULTS Currently, in China, 4.8% of children with HA are receiving full-dose long-term prophylaxis treatment. Prophylaxis treatment was a significant positive predictor of better patient-reported outcomes and HRQoL. For children with prophylaxis treatment, there were significantly fewer annual bleeds (p < 0.001), lower frequency of chronic pain(p < 0.001), and higher health utility scores(p < 0.01) and EQ-VAS scores(p < 0.05) than children with on-demand treatment. CONCLUSION Accessible long-term prophylaxis treatment should be promoted for children with moderate and severe HA in China and regular monitoring of their outcomes and HRQoL should be carried out.
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Affiliation(s)
- Luying Zhang
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Peng Zhang
- School of Public Health, Fudan University, Shanghai, 200032, China
- School of Humanities, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, 200032, China.
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3
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Mahlangu JN, Lamas JL, Morales JC, Malan DR, Šalek SZ, Wang M, Boggio LN, Hegemann I, Mital A, Cardinal M, Zhu T, Sun P, Arkin S. A phase 1b/2 clinical study of marstacimab, targeting human tissue factor pathway inhibitor, in haemophilia. Br J Haematol 2023; 200:229-239. [PMID: 35999026 DOI: 10.1111/bjh.18420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 02/06/2023]
Abstract
A phase 1b/2, three-month study of marstacimab, a human monoclonal antibody targeting tissue factor pathway inhibitor (TFPI), was conducted in participants with haemophilia A or B, with or without inhibitors. Participants assigned to four cohorts received escalating weekly doses based on inhibitor status (without inhibitors: 300 mg, a single 300-mg loading dose with subsequent 150-mg doses, or 450 mg; with inhibitors: 300 mg). Safety outcomes were treatment-emergent adverse events (TEAEs), injection site reactions, clinical and laboratory parameter changes. Efficacy was assessed by annualised bleeding rates (ABRs). Pharmacokinetics and pharmacodynamics (PD) were also evaluated. Among 26 treated participants [haemophilia A without inhibitor, n = 16 (61.5%); haemophilia A with inhibitor, n = 7 (26.9%); haemophilia B, n = 3 (11.5%)], 24 completed the study. Overall, 80.8% experienced TEAEs. ABR during treatment was significantly reduced versus an external on-demand control group (p < 0.0001) and versus pretreatment ABR (p < 0.0001), with significant reductions observed across all dose cohorts. Marstacimab exposure generally increased in a dose-related manner, with steady-state concentration reached by day 57. Changes in pharmacodynamic biomarkers occurred across all dose cohorts. Marstacimab was safe and well tolerated. Clinically meaningful reductions in ABR and treatment-related changes for all PD biomarkers indicated effective targeting of TFPI. (Clinicaltrials.gov identifier, NCT02974855).
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Affiliation(s)
- Johnny N Mahlangu
- University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Service, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | | | | | - Daniel R Malan
- Phoenix Pharma, Mount Croix, Port Elizabeth, South Africa
| | | | - Michael Wang
- University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado, USA
| | - Lisa N Boggio
- Rush Hemophilia and Thrombophilia Center, Chicago, Illinois, USA
| | - Inga Hegemann
- Haemophilia Comprehensive Care Center, University Hospital, Zurich, Switzerland
| | | | | | - Tong Zhu
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
| | - Pengling Sun
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
| | - Steven Arkin
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
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4
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Islam MR, Rahman MM, Ahasan MT, Sarkar N, Akash S, Islam M, Islam F, Aktar MN, Saeed M, Harun-Or-Rashid M, Hosain MK, Rahaman MS, Afroz S, Bibi S, Rahman MH, Sweilam SH. The impact of mucormycosis (black fungus) on SARS-CoV-2-infected patients: at a glance. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:69341-69366. [PMID: 35986111 PMCID: PMC9391068 DOI: 10.1007/s11356-022-22204-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 05/28/2023]
Abstract
The emergence of various diseases during the COVID-19 pandemic made health workers more attentive, and one of the new pathogens is the black fungus (mucormycosis). As a result, millions of lives have already been lost. As a result of the mutation, the virus is constantly changing its traits, including the rate of disease transmission, virulence, pathogenesis, and clinical signs. A recent analysis revealed that some COVID-19 patients were also coinfected with a fungal disease called mucormycosis (black fungus). India has already categorized the COVID-19 patient black fungus outbreak as an epidemic. Only a few reports are observed in other countries. The immune system is weakened by COVID-19 medication, rendering it more prone to illnesses like black fungus (mucormycosis). COVID-19, which is caused by a B.1.617 strain of the SARS-CoV-2 virus, has been circulating in India since April 2021. Mucormycosis is a rare fungal infection induced by exposure to a fungus called mucormycete. The most typically implicated genera are Mucor rhyzuprhizopusdia and Cunninghamella. Mucormycosis is also known as zygomycosis. The main causes of infection are soil, dumping sites, ancient building walls, and other sources of infection (reservoir words "mucormycosis" and "zygomycosis" are occasionally interchanged). Zygomycota, on the other hand, has been identified as polyphyletic and is not currently included in fungal classification systems; also, zygomycosis includes Entomophthorales, but mucormycosis does not. This current review will be focused on the etiology and virulence factors of COVID-19/mucormycosis coinfections in COVID-19-associated mucormycosis patients, as well as their prevalence, diagnosis, and treatment.
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Affiliation(s)
- Md. Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Tanjimul Ahasan
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Nadia Sarkar
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Shopnil Akash
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Mahfuzul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Most. Nazmin Aktar
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Mohd Saeed
- Department of Biology, College of Sciences, University of Hail, Hail, Saudi Arabia
| | - Md. Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Kawsar Hosain
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Sadia Afroz
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Shabana Bibi
- Department of Biosciences, Shifa Tameer-E-Millat University, Islamabad, Pakistan
- Yunnan Herbal Laboratory, College of Ecology and Environmental Sciences, Yunnan University, Kunming, 650091 China
| | - Md. Habibur Rahman
- Department of Pharmacy, Southeast University, Banani, Dhaka 1213 Bangladesh
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju, 26426 Korea
| | - Sherouk Hussein Sweilam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942 Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Egyptian Russian University, Cairo-Suez Road, Badr City, 11829 Egypt
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5
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Foubert A, Roussel N, Chantrain VA, Hermans C, Lambert C, Lobet S, Meeus M. Pain coping behaviour strategies in people with haemophilia: A systematic literature review. Haemophilia 2022; 28:902-916. [PMID: 35850157 DOI: 10.1111/hae.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the fact that joint bleeds (haemarthrosis) frequently occur in people with haemophilia (PwH) with invalidating arthropathies as result, the clinical pain experience has received only limited attention. A sudden increase in pain intensity can be linked to a bleed, but in most cases, no acute bleed is confirmed. Nevertheless, a patient's perception of an acute bleed as cause of the pain might impact the patients' behaviour in response to pain. It is therefore essential to gain more insight into pain coping strategies seen in PwH. AIM This systematic review aims to identify the range of pain coping behaviour strategies used among PwH and the factors associated with pain coping behaviour. METHODS This review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines (PRISMA). PubMed and Web of Science were systematically screened for relevant literature using keyword combinations related to adult PwH, pain and pain coping behaviour strategies. Risk of bias was assessed with the modified Newcastle-Ottowa Scale. RESULTS Eleven full text articles (nine cross-sectional and two comparative studies) consisting of 1832 PwH met the inclusion criteria. Due to the heterogeneity of the study samples, quality of evaluation instruments and varying risk of bias, it was difficult to draw conclusions regarding the used pain coping behaviour strategies and associated factors. CONCLUSION Literature on pain coping behaviour strategies and associated factors in PwH is still scarce and describes heterogenous results. Validated haemophilia-specific instruments are warranted to inventory pain coping behaviour in a standardized way.
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Affiliation(s)
- Anthe Foubert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, www.paininmotion.be.,Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Nathalie Roussel
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Valérie-Anne Chantrain
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, www.paininmotion.be.,Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Cédric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Clinique universitaires Saint-Luc, Brussels, Belgium
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Hematology, Clinique universitaires Saint-Luc, Brussels, Belgium
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Hematology, Clinique universitaires Saint-Luc, Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, www.paininmotion.be.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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6
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Hodroj MH, El Hasbani G, Al-Shamsi HO, Samaha H, Musallam KM, Taher AT. Clinical burden of hemophilia in older adults: Beyond bleeding risk. Blood Rev 2021; 53:100912. [PMID: 34887154 DOI: 10.1016/j.blre.2021.100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 01/18/2023]
Abstract
The prospect of hemophilia patients has dramatically improved in the last few decades with the introduction of various interventions that can effectively treat or prevent their bleeding risk. The life expectancy of patients can now reach that of the healthy population, but this has paved the way for several previously unrecognized morbidities to manifest in older adults with hemophilia. Such clinical complications are attributed to suboptimal management or poor access to effective therapy during childhood as well as chronicity and prolonged exposure to the underlying pathophysiology of the disease and its treatment. Complications common in the aging population are also becoming increasingly relevant in this vulnerable patient subgroup. In this review, we highlight peculiarities of such morbidities including chronic viral infections and liver disease, debilitating joint impairment and bone disease, cardiovascular and chronic kidney disease, and cancers. We also reflect on topics of special interest in adulthood such as sexuality.
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Affiliation(s)
| | | | - Humaid O Al-Shamsi
- Burjeel Medical City, Abu Dhabi, United Arab Emirates; Emirates Oncology Society, Dubai, United Arab Emirates; University of Sharjah, Sharjah, United Arab Emirates
| | - Hanady Samaha
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Ali T Taher
- American University of Beirut Medical Center, Beirut, Lebanon.
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Olasupo OO, Lowe MS, Krishan A, Collins P, Iorio A, Matino D. Clotting factor concentrates for preventing bleeding and bleeding-related complications in previously treated individuals with haemophilia A or B. Cochrane Database Syst Rev 2021; 8:CD014201. [PMID: 34407214 PMCID: PMC8407508 DOI: 10.1002/14651858.cd014201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The hallmark of severe hemophilia (A or B) is recurrent bleeding into joints and soft tissues with progressive joint damage, despite on-demand treatment. Prophylaxis has long been used, but not universally adopted, because of medical, psychosocial, and cost controversies. OBJECTIVES To determine the effectiveness of clotting factor concentrate prophylaxis in managing previously-treated individuals with hemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. In addition, we searched MEDLINE and Embase and online trial registries. Most recent search of Group's Coagulopathies Trials Register: 24 February 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs evaluating people with hemophilia A or hemophilia B, who were previously treated with clotting factor concentrates to manage their hemophilia. DATA COLLECTION AND ANALYSIS Two authors independently reviewed trials for eligibility, assessed risk of bias and extracted data. The authors used the GRADE criteria to assess the certainty of the evidence. MAIN RESULTS Ten trials (including 608 participants) were eligible for inclusion. Eight of the trials (477 participants) had arms comparing two or more prophylactic regimens to one another and four of the trials (n = 258) compared prophylaxis to on-demand treatment (two trials had multiple arms and were included in both comparisons). Comparison of two or more prophylactic regimens For trials comparing one prophylaxis regimen to another, given the heterogeneity of the data, none of the data were pooled for this comparison. Considering the individual trials, three trials reported the primary outcome of joint bleeding, and none showed a dfference between dosing regimens (low-certainty evidence). For the secondary outcome of total bleeding events, prophylaxis with a twice-weekly regimen of FIX likely results in reduced total bleeds compared to a once-a-week regimen of the same dose, mean difference (MD) 11.2 (5.81 to 16.59) (one trial, 10 participants, low-certainty evidence). Transient low-titer anti-FVIII inhibitors were reported in one of the trials. Blood-transmitted infections were not identified. Other adverse events reported include hypersensitivity, oedema, and weight gain. These were, however, rare and unrelated to study drugs (very low-certainty evidence). Comparison of prophylactic and on-demand regimens Four of the trials (258 participants) had arms that compared prophylaxis to on-demand treatment. Prophylaxis may result in a large decrease in the number of joint bleeds compared to on-demand treatment, MD -30.34 (95% CI -46.95 to -13.73) (two trials, 164 participants, low-certainty evidence). One of these trials (84 participants) also reported the long-term effects of prophylaxis versus on-demand therapy showing improved joint function, quality of life, and pain; but no differences between groups in joint structure when assessed by magnetic resonance imaging (MRI). In one trial (84 participants) validated measures for joint health and pain assessment showed that prophylaxis likely improves joint health compared to an on-demand regimen with an estimated change difference of 0.94 points (95% CI 0.23 to 1.65) and improves total pain scores, MD -17.20 (95% CI -27.48 to -6.92 (moderate-certainty evidence). Two trials (131 participants) reported that prophylaxis likely results in a slight increase in adverse events, risk ratio 1.71 (1.24 to 2.37) (moderate-certainty evidence). No inhibitor development and blood-transmitted infections were identified. Overall, the certainty of the body of evidence was judged to be low because of different types of bias that could have altered the effect. AUTHORS' CONCLUSIONS: There is evidence from RCTs that prophylaxis, as compared to on-demand treatment, may reduce bleeding frequency in previously-treated people with hemophilia. Prophylaxis may also improve joint function, pain and quality of life, even though this does not translate into a detectable improvement of articular damage when assessed by MRI. When comparing two different prophylaxis regimens, no significant differences in terms of protection from bleeding were found. Dose optimization could, however, result in improved efficacy. Given the heterogeneity of the data, pooled estimates were not obtained for most comparisons. Well-designed RCTs and prospective observational controlled studies with standardised definitions and measurements are needed to establish the optimal and most cost-effective treatment regimens.
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Affiliation(s)
- Omotola O Olasupo
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Megan S Lowe
- Department of Health Sciences, McMaster University, Hamilton, Canada
| | - Ashma Krishan
- School of Health Sciences, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Peter Collins
- Arthur Bloom Haemophilia Centre, Heath Park, School of Medicine, Cardiff University, Cardiff, UK
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Davide Matino
- Department of Internal Medicine, McMaster University, Hamilton, Canada
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8
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Nichols TC, Levy H, Merricks EP, Raymer RA, Lee ML. Preclinical evaluation of a next-generation, subcutaneously administered, coagulation factor IX variant, dalcinonacog alfa. PLoS One 2020; 15:e0240896. [PMID: 33112889 PMCID: PMC7592742 DOI: 10.1371/journal.pone.0240896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/05/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction The rapid clearance of factor IX necessitates frequent intravenous administrations to achieve effective prophylaxis for patients with hemophilia B. Subcutaneous administration has historically been limited by low bioavailability and potency. Dalcinonacog alfa was developed using a rational design approach to be a subcutaneously administered, next-generation coagulation prophylactic factor IX therapy. Aim This study aimed to investigate the pharmacokinetic, pharmacodynamic, and safety profile of dalcinonacog alfa administered subcutaneously in hemophilia B dogs. Methods Two hemophilia B dogs received single-dose daily subcutaneous dalcinonacog alfa injections for six days. Factor IX antigen and activity, whole blood clotting time, and activated partial thromboplastin time were measured at various time points. Additionally, safety assessments for clinical adverse events and evaluations of laboratory test results were conducted. Results There was an increase in plasma factor IX antigen with daily subcutaneous dalcinonacog alfa. Bioavailability of subcutaneous dalcinonacog alfa was 10.3% in hemophilia B dogs. Daily subcutaneous dosing of dalcinonacog alfa demonstrated the effects of bioavailability, time to maximal concentration, and half-life by reaching a steady-state activity sufficient to correct severe hemophilia to normal, after four days. Conclusion The increased potency of dalcinonacog alfa facilitated the initiation and completion of the Phase 1/2 subcutaneous dosing study in individuals with hemophilia B.
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Affiliation(s)
- Timothy C. Nichols
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Howard Levy
- Catalyst Biosciences, South San Francisco, California, United States of America
- * E-mail:
| | - Elizabeth P. Merricks
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Robin A. Raymer
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Martin L. Lee
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
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9
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Miesbach W, Kittler S, Bauhofer A, Königs C, Becker T, Nemes L, Staus A, Schüttrumpf J. Long-term analysis of the benefit of prophylaxis for adult patients with severe or moderate haemophilia A. Haemophilia 2020; 26:467-477. [PMID: 32293085 DOI: 10.1111/hae.13988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Prophylaxis with factor VIII (FVIII) concentrates in children with haemophilia A (HA) is current standard of care. The benefit of prophylactic treatment for adult HA patients is not commonly accepted. AIM To investigate the benefit of prophylaxis over on-demand treatment in adult and elderly patients with severe or non-severe HA in a real-life setting. METHODS Data from 163 patients comprising 1202 patient-years were evaluated for 7.5 (±5.3) years. The effects on the annual bleeding rate (ABR, including spontaneous and traumatic bleeds) of treatment with a plasma-derived FVIII concentrate, the patient's age and disease severity were investigated. The effect of changing the treatment from on demand to continuous prophylaxis on the patients' ABRs was further analysed. RESULTS Prophylaxis had the greatest effect on the ABRs of patients of any age with severe or non-severe HA. The difference in ABR of all patients treated on demand (median 31.4; interquartile range (IQR) 27.6; N = 83) compared with those treated prophylactically (median 1.3; IQR 3.6; N = 122) was statistically significant (P < .05), even for patients with non-severe HA (median 8.4; IQR 15.5; N = 11) vs median 1.5; IQR 4.2 (N = 17), P < .05). Patients, aged up to 88 years, switching from on demand to continuous prophylaxis showed the lowest median ABR (1.1; N = 51) after their regimen change. CONCLUSION Any (even low-frequency) prophylaxis results in lower ABR than on-demand treatment. Patients switching to prophylaxis benefitted the most, irrespective of age or HA severity. Prophylactic treatment-even tertiary-is the regimen of choice for patients of any age, including elderly patients, with severe or non-severe HA.
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Affiliation(s)
- Wolfgang Miesbach
- Haemophilia Centre, Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt/Main, Germany
| | | | | | - Christoph Königs
- Haemophilia Centre, Department of Paediatrics, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | | | - László Nemes
- National Haemophilia Centre and Haemostasis Department, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
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10
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Sudevan R, Beenakumari AA, Ganapathy R, Unni M, Vidyadharan G, Sidharthan N. Intermediate Dose Prophylaxis in Adults with Haemophilia: A Clinical Audit from a Resource Limited Setting. Indian J Hematol Blood Transfus 2019; 36:374-376. [PMID: 32425392 DOI: 10.1007/s12288-019-01189-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/13/2019] [Indexed: 11/27/2022] Open
Abstract
To address the scarcity of real world data on adult prophylaxis from developing world, a short term intermediate dose prophylaxis in adult haemophilia A patients was initiated. A total of eight patients aged > 18 years with moderate/severe haemophilia A were given an average dose of 23 IU/kg recombinant factor VIII (rFVIII) concentrate twice weekly for 2 months. A clinical audit was done on completion of four months. The mean age of the participants was 31.63 (± 6.98) years. The mean bleed rate during two months of episodic versus prophylactic regimen was 5.13 versus 0.63 (p = 0.01) and that of work days lost, hospital visits for hemophilia care were 30.63 (± 24.69) versus zero days, 20.63 (± 16.19) versus zero days respectively. The mean of factor VIII consumed during prophylaxis was 13,500 IU/month (i.e., 23 IU/kg/dose).The median time gap between prophylactic infusion to trough level was 67.50 h (60-74 h) and the median trough level observed was 2.50% (range 1-5%). The results of our clinical audit show that Intermediate dose prophylaxis with rFVIII concentrates in young adult patients with moderate/severe haemophilia A appears to be effective in reducing the frequency of bleeds.
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Affiliation(s)
- Remya Sudevan
- 1Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Aswathy Ashok Beenakumari
- 2Department of Hemato-Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rema Ganapathy
- 2Department of Hemato-Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Manoj Unni
- 2Department of Hemato-Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Geeta Vidyadharan
- 3Department of Hematopathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Neeraj Sidharthan
- 2Department of Hemato-Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Physical activity improved by adherence to prophylaxis in an Italian population of children, adolescents and adults with severe haemophilia A: the SHAPE Study. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 18:152-158. [PMID: 31184581 DOI: 10.2450/2019.0040-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Physical activity in people with haemophilia (PWH) reduces the development of severe arthropathy, but it must be performed after regular, proper prophylaxis. Strict adherence to treatment is crucial to achieving effectiveness and established outcomes. The primary aim of this study was to collect prospective data on adherence to prophylaxis for over 36 months. A secondary aim was to verify whether adherence correlates with physical activity. MATERIALS AND METHODS Italian patients with severe haemophilia A treated on prophylaxis with octocog alfa were included in the study. Physical findings were assessed by the Haemophilia and Exercise Project (HEP)-Test-Q and the Early Prophylaxis Immunologic Challenge (EPIC)-Norfolk Physical Activity Questionnaire; orthopaedic status was assessed by the Hemophilia Joint Health Score (HJHS). Adherence was measured as percentage of empty vials returned with respect to the prescribed amount. RESULTS Forty-two PWH were enrolled: 31% children, 21.4% adolescents, and 47.6% adults. Type, frequency and impact of physical activities differed among the three groups. The HEP-Test-Q showed the highest impairments in the domains "endurance" and "strength/co-ordination". Eight percent of patients were classified as adherent to prophylaxis. Among them, 50% had at least one bleeding episode in the year before enrolment; this percentage dropped during the three years of the study. While remaining stable in the "non-adherent" group, the HJHS score decreased in the "adherent" patients. The mean number of school/work days lost was lower in adherent patients (from 3.4±6.8 to 0.2±0.9) than in non-adherent ones. DISCUSSION PWH with better orthopaedic scores reported better physical performance. Adherence to long-term prophylaxis proved to be high and correlated with a reduction in bleeds, target joints, school/work days lost, and with a performance improvement in endurance sports activities over time.
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12
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Torres-Ortuño A, Cuesta-Barriuso R, Nieto-Munuera J, Galindo-Piñana P, López-Pina JA. Coping strategies in young and adult haemophilia patients: A tool for the adaptation to the disease. Haemophilia 2019; 25:392-397. [PMID: 30994251 DOI: 10.1111/hae.13743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chronic diseases, after diagnosis, involve changes that have to favour coping with the new situation. The resources used will help control, manage and adapt to the disease. The psychological aspects may be influencing how the individual faces the situation. AIM To assess whether perceptions or beliefs and illness behaviour influence the choice of coping strategies for young and adult patients with haemophilia. METHODS Multicenter cross-sectional descriptive study. We recruited 63 patients with haemophilia A and B, adolescents, young and adults, and both types of treatment. A clinical and sociodemographic data sheet, the Coping Strategies Inventory (CSI), the Illness Perception Questionnaire-revised (IPQ-R) and the Illness Behaviour Questionnaire (IBQ) were used. RESULTS Patients with haemophilia use appropriate coping strategies, both cognitive and behavioural. Most of them are on-demand treatment, and despite arthropathy, they perceive good control of haemophilia. However, patients in prophylactic treatment are those employed more maladaptive coping strategies, less perception of control and hypochondriacal behaviour to the disease. The age variable may be relevant but we did not find significant differences. CONCLUSIONS Coping strategies used by patients with haemophilia are adequate. Although it is noted that the perception of the disease, its controllability or not, affects illness behaviour and consequently how coping with haemophilia. These are based on personal characteristics, cognitive and attitudinal dispositions that the individual consciously use to solve or face adverse situations. The analysis of coping styles of patients could be a tool for professionals to manage properly the disease.
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Affiliation(s)
- Ana Torres-Ortuño
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain.,Royal Foundation Victoria Eugenia, Madrid, Spain
| | - Joaquín Nieto-Munuera
- 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
| | - José Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
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13
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Gene therapy in hemophilia A: a cost-effectiveness analysis. Blood Adv 2019; 2:1792-1798. [PMID: 30042145 DOI: 10.1182/bloodadvances.2018021345] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023] Open
Abstract
Gene therapy provides a potential phenotypic cure for hemophilia, yet the cost of this novel treatment is high, tempering enthusiasm and raising questions regarding cost vs benefit. To evaluate the cost-effectiveness of gene therapy treatment of severe hemophilia A compared with prophylaxis with factor VIII (FVIII), we developed a Markov state-transition model to estimate the costs and effectiveness of severe hemophilia A treatment strategies from a United States health care system perspective. Quality-adjusted life-years (QALYs) were the effectiveness measure. In the base case, hypothetical cohorts of 30-year-old patients received gene therapy or FVIII prophylaxis. We obtained model probabilities and utilities from the literature and costs from Medicare reimbursement data. One-way and probabilistic sensitivity analyses were performed to test the robustness of results. Over a 10-year time horizon, total per-person gene therapy strategy costs were $1.0M and resulted in 8.33 QALYs, whereas prophylaxis cost $1.7M and resulted in 6.62 QALYs. Thus, gene therapy dominated prophylaxis (costs less and was more effective). Gene therapy remained dominant unless initial costs exceeded $1.6M and were <$100 000 per 1 QALY gained compared with prophylaxis if initial costs were <$1.7M. Results were not sensitive to variation of all other parameters over clinically plausible ranges. In a probabilistic sensitivity analysis simultaneously varying all parameters 3000 times over parameter distributions, gene therapy was dominant in 92% of model iterations. Treatment of severe hemophilia A with gene therapy is likely to be cost-saving or cost-effective compared with FVIII prophylaxis.
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Li J, Liu W, Guo XJ, Ding XL, Lyu BM, Xiao J, Sun QL, Li DS, Zhang WF, Zhong JC, Li CP, Yang RC. [HEAD-US-C quantitative ultrasound assessment scale in evaluation of joint damage in patients with moderate or severe hemophilia A received on-demand versus prophylaxis replacement therapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:817-821. [PMID: 30369202 PMCID: PMC7348284 DOI: 10.3760/cma.j.issn.0253-2727.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
目的 探讨血友病关节超声评估量表(Haemophilic Early Arthropathy Detection with UltraSound in China,HEAD-US-C)对中间型/重型血友病A患者按需、预防治疗关节损伤评估的适用性。 方法 回顾性分析2015年6月至2017年7月70例接受肘、膝、踝关节超声检查的中间型及重型血友病A患者,应用HEAD-US-C超声评估量表及血友病关节健康评分量表2.1版(HJHS2.1)进行关节状况评分。对按需、预防治疗患者HEAD-US-C、HJHS评分进行相关性分析。 结果 70例中间型及重型血友病A患者共接受919例次关节超声检查。在中间型血友病患者中,按需、预防治疗组患者中位年靶关节出血次数差异无统计学意义[1(0,7)对1(0,5),z=1.271,P=0.137]。按需治疗组中位HEAD-US-C评分[1(0,6)对0.5(0,3),z=0.177,P=0.046]及HJHS评分[2(0,4)对2(0,3),z=0.375,P=0.007]明显高于预防治疗组。重型血友病患者按需、预防治疗组中位HEAD-US-C评分分别为4(0,7)、1(0,6)(z=2.189,P=0.008),中位HJHS评分分别为4(1,6)、2(0,5)(z=3.646,P<0.001),年靶关节出血次数分别为3(0,8)、2(0,8)(z=0.780,P=0.037),按需治疗组均高于预防治疗组。按需、预防治疗组患者HEAD-US-C评分与HJHS评分均存在正相关关系(P值均<0.05)。重型患者按需、预防治疗组HEAD-US-C评分与HJHS评分的相关系数分别为0.739(95%CI 0.708~0.767)、0.865(95%CI 0.848~0.880),95%CI不重合(P<0.05),预防治疗组两评分系统间具有更强的相关性。 结论 中间型/重型血友病A患者预防治疗疗效明显优于按需治疗。HEAD-US-C超声评估量表可有效评估中间型/重型血友病A患者按需、预防治疗关节损伤状况,与HJHS系统一致性较好,可为临床疗效评估提供客观指标。
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Affiliation(s)
- J Li
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | | | | | | | | | | | | | | | | | | | | | - R C Yang
- Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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15
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Inhibitor development, safety and efficacy of Advate ® among previously treated patients with hemophilia A in a postmarketing surveillance in Japan. Int J Hematol 2019; 109:336-345. [PMID: 30604312 DOI: 10.1007/s12185-018-02574-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
Rurioctocog alfa (recombinant factor VIII: Advate®) is available for the control of bleeding in patients with hemophilia A in Japan. To evaluate the inhibitor development, safety, and efficacy of rurioctocog alfa, a non-interventional and observational postmarketing surveillance was conducted on 352 previously treated Japanese patients aged 1-76 years with ≥ 4 exposure days under the conditions of routine clinical practice. A post-hoc comparison of the mean annualized bleeding rates which required treatment with rurioctocog alfa detected a statistically significant difference (P < 0.0001) between patients treated on regular prophylaxis (8.5 bleeds/year) and patients treated on an on-demand basis (36.6 bleeds/year). Favorable prophylactic and on-demand hemostatic efficacy ("excellent" or "good") were shown in 88.5-100% of patients across all treatment regimens. A total of 22 events of adverse drug reactions were reported in 13 male patients. Of the 352 patients, 3 (0.9%) patients, all of whom had ≤ 50 exposure days before enrollment, developed de novo FVIII inhibitor. No deaths or allergic reactions were reported. Rurioctocog alfa was found to be well-tolerated and effective among patients with hemophilia A in a postmarketing routine clinical practice.
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Gruppo RA, Malan D, Kapocsi J, Nemes L, Hay CRM, Boggio L, Chowdary P, Tagariello G, von Drygalski A, Hua F, Scaramozza M, Arkin S. Phase 1, single-dose escalating study of marzeptacog alfa (activated), a recombinant factor VIIa variant, in patients with severe hemophilia. J Thromb Haemost 2018; 16:1984-1993. [PMID: 30151972 DOI: 10.1111/jth.14247] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 11/29/2022]
Abstract
Essentials Marzeptacog alfa (activated) [MarzAA] is a novel variant of activated human factor VII. A phase 1 dose escalation trial of MarzAA was conducted in subjects with severe hemophilia. MarzAA was safe and tolerated at intravenous doses up to 30 μg kg-1 Data observed support further trials for hemophilia patients with inhibitors to factors VIII/IX. SUMMARY Background Marzeptacog alfa (activated) (MarzAA), a new recombinant activated human factor VII (rFVIIa) variant with four amino acid substitutions, was developed to provide increased procoagulant activity and a longer duration of action in people with hemophilia. Objectives To investigate the safety, tolerability, immunogenicity, pharmacokinetics (PK) and pharmacodynamics (PD) of single ascending intravenous bolus doses of MarzAA in non-bleeding patients with congenital hemophilia A or B with or without inhibitors. Methods This international, phase 1, open-label study (NCT01439971) enrolled males aged 18-64 years with severe hemophilia A or B, with or without FVIII or FIX inhibitors. Subjects were assigned to single-dose MarzAA cohorts (0.5, 4.5, 9, 18 or 30 μg kg-1 ). Blood sampling was performed predose and postdose, and subjects were monitored for 60 days postdose. Safety endpoints included adverse events, vital sign changes, electrocardiograms, laboratory abnormalities, and immunogenicity; secondary endpoints included evaluation of PK and PD. Results Overall, in 25 patients, MarzAA was well tolerated at all dose levels tested, and was not associated with dose-limiting toxicity. No treatment-emergent severe or serious adverse events occurred. MarzAA showed linear dose-response PK across the 4.5-30 μg kg-1 dose range, with a terminal half-life of ⁓ 3.5 h. Dose-dependent shortening of the activated partial thromboplastin time and prothrombin time, and evidence of an increase in peak thrombin as determined with a thrombin generation assay, were observed at all doses. Conclusions MarzAA was tolerated at doses up to 30 μg kg-1 . The safety profile and pharmacological effects observed support further clinical trials for the treatment of hemophilic patients with inhibitors.
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Affiliation(s)
- R A Gruppo
- Comprehensive Hemophilia and Thrombosis Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - D Malan
- Phoenix Pharma Pty Ltd, Mount Croix, Port Elizabeth, South Africa
| | - J Kapocsi
- Semmelweis University 1st Department of Medicine, Budapest, Hungary
| | - L Nemes
- National Hemophilia Center and Hemostasis Department, Medical Center of the Hungarian Defense Forces, Budapest, Hungary
| | - C R M Hay
- University Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - L Boggio
- Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA
| | - P Chowdary
- KD Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - G Tagariello
- Department of Medicine, Hemophilia Center, Castelfranco Veneto Hospital, Castelfranco, Italy
| | | | - F Hua
- Applied BioMath, Concord, MA, USA
| | - M Scaramozza
- Early Clinical Development, Pfizer Worldwide R&D, Pfizer Inc., Cambridge, MA, USA
| | - S Arkin
- Rare Disease Research Unit, Pfizer Inc., Cambridge, MA, USA
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Na JH, Yoo KY, Kim JY, Park SK, Kim SK, Choi EJ. Educational Interventions to Enhance Adherence to Prophylactic Treatment in Korean Hemophilia Patients. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.1.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Ji Hyun Na
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | | | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sang Kyu Park
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Ki Kim
- Department of Pediatrics,Inha University College of Medicine, Incheon, Korea
| | - Eun Jin Choi
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
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18
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Eheberg D, Oldenburg J, Tiede A, Schramm W, Berger K, Schopohl D. Prophylaktische Faktorsubstitution bei schwerer Hämophilie A. Hamostaseologie 2017; 34:291-300. [DOI: 10.5482/hamo-14-03-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/12/2014] [Indexed: 11/05/2022] Open
Abstract
ZusammenfassungProphylaxe kann bei Erwachsenen mit schwerer Hämophilie A klinisch notwendig sein. Ziel war es, die prophylaktische Faktor-VIII-Substitution bei erwachsenen Patienten mit Hämophilie in Deutschland ökonomisch zu bewerten. Patienten, Methoden: Für die Analysen wurde ein Entscheidungsmodell erstellt: Zeithorizont ein Jahr; Perspektive gesetzliche Krankenkassen; Referenzpatient (RP) und zwei Patientenprofile. Die Berech-nungen basieren auf Daten aus einer struktu-rierten Literatursuche, -analyse und einer Pharmakovigilanzstudie mit Patienten zu Therapiewechsel On-demand/Prophylaxe (OD/Proph). Ergebnisse: RP: 45 Jahre, 20 Blutungen p.a. OD, 16 vermiedene Blutungen mit 8,5 I.U./kg/d Proph, Zusatzkosten 141 113 Euro p.a.; Profil 1: 50 Jahre, 55 Blutungen p.a. OD, Faktorverbrauch pro Blutung 20 I.U./kg höher als bei R P, 39 vermiedene Blutungen mit 8,5 I.U./kg/d Proph, Zusatzkosten 19 134 Euro p.a.; Profil 2: 60 Jahre, 35 Blutungen p.a. OD, Faktorverbrauch pro Blutung 40–80 I.U./kg höher als bei R P, 34 vermiedene Blutungen mit 11 I.U./kg/d Proph, Einsparung 660 Euro p.a. Schlussfolgerung: In der indivi-duellen Situation kann eine prophylaktische Faktorsubstitution bei erwachsenen Patienten auch ökonomisch sinnvoll sein. Um künftig diesen Effekt umfassend zu bewerten, werden longitudinale Daten aus dem Versorgungsalltag inklusive klinischer Outcomes, Lebensqua-lität und Adhärenz benötigt.
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Thomson T, Strandberg-Larsen M, Gater A. Haemophilia B: impact on patients and economic burden of disease. Thromb Haemost 2017; 106:398-404. [DOI: 10.1160/th11-03-0193] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/18/2011] [Indexed: 11/05/2022]
Abstract
SummaryWorldwide, haemophilia is the most common hereditary bleeding disorder. The incidence of haemophilia B, however, is considerably less than haemophilia A and consequently appears to have received less attention in the research literature. This article aims to summarise the available evidence documenting the patient and economic burden associated with haemophilia B and current methods of disease management. Both the immediate and long-term clinical consequences of haemophilia B can have significant implications for patients in terms of functional limitations and diminished health-related quality of life (HRQOL). Evidence demonstrates that primary prophylaxis is the optimal strategy for replacing missing clotting factor IX (FIX) and managing haemophilia B. Use of recombinant FIX (rFIX) over plasma-derived FIX (pd-FIX) is also generally preferred for safety reasons. Prophylaxis using currently available rFIX products, however, requires a demanding regimen of intravenous infusions 2–3 times a week which may have significant implications for adherence and ultimately the long-term efficacy of such regimens. Only limited assessments of the cost-effectiveness of prophylactic versus on-demand FIX treatment regimens have been conducted to date. Prophylaxis, however, is generally more costly as greater quantities of FIX are consumed. Any reduction in FIX replacement dosing frequency is expected to improve patient adherence and contribute to improved clinical outcomes, further supporting the costeffectiveness of such interventions. Although a rare disease, as economic constraints for healthcare increase, generating further information regarding the key clinical, patient and economic outcomes associated with haemophilia B will be essential for supporting improvements in care for people with haemophilia B.
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Abstract
In recent decades, several improvements in hemophilia care have resulted in increased quality of life and life expectancy for those affected by this inherited hemorrhagic condition. Nowadays, individuals with hemophilia enjoy a life expectancy at birth close to that of males in the general population. As a consequence of the increasing age of the hemophilia population, a growing number of these patients develop age-related co-morbidities, such as cardiovascular disease and cancer, the management of which represents a new challenge for caregivers at hemophilia treatment centers. This narrative review focuses on the clinical problems arising in older people with hemophilia, with particular attention to the optimal therapeutic strategies.
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Khair K, Mazzucconi MG, Parra R, Santagostino E, Tsakiris DA, Hermans C, Oldenburg J, Spotts G, Steinitz-Trost K, Gringeri A. Pattern of bleeding in a large prospective cohort of haemophilia A patients: A three-year follow-up of the AHEAD (Advate in HaEmophilia A outcome Database) study. Haemophilia 2017; 24:85-96. [DOI: 10.1111/hae.13361] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/19/2023]
Affiliation(s)
- K. Khair
- Haemophilia Comprehensive Care Centre; Great Ormond Street Hospital for Children; NHS Foundation Trust; London UK
| | | | - R. Parra
- Unidad de Hemofilia-Banc de Sang i Teixits; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - E. Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; IRCCS Fondazione Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - D. A. Tsakiris
- Diagnostic Hematology; University Hospital; Basel Switzerland
| | - C. Hermans
- Haemophilia Clinic; Division of Haematology; St-Luc University Hospital; Brussels Belgium
| | - J. Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine; Bonn University Clinic; Bonn Germany
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Cost-effectiveness analysis of pharmacokinetic-driven prophylaxis vs. standard prophylaxis in patients with severe haemophilia A. Blood Coagul Fibrinolysis 2017; 28:425-430. [DOI: 10.1097/mbc.0000000000000610] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Coppola A, D'Ausilio A, Aiello A, Amoresano S, Toumi M, Mathew P, Tagliaferri A. Cost-effectiveness analysis of late prophylaxis vs. on-demand treatment for severe haemophilia A in Italy. Haemophilia 2017; 23:422-429. [DOI: 10.1111/hae.13185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Affiliation(s)
- A. Coppola
- Regional Reference Centre for Coagulation Disorders; Federico II University Hospital Naples; Naples Italy
| | | | | | | | - M. Toumi
- Aix-Marseille University; Marseille France
| | | | - A. Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders; University Hospital of Parma; Parma Italy
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Choice of factor VIII/IX regimen in adolescents and young adults with severe or moderately severe haemophilia. A French national observational study (ORTHem 15-25). Thromb Res 2017; 151:17-22. [PMID: 28088606 DOI: 10.1016/j.thromres.2016.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/19/2016] [Accepted: 12/23/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The value and challenges of long-term prophylaxis (LTP) in adolescents and young adults need further characterisation. AIM To determine the proportions of adolescents and young adults with severe or moderately severe haemophilia in France under LTP and treatment on demand (OD). METHODS Patients 15 to 25years old with haemophilia A or B, factor VIII/IX ≤2% and no current inhibitor could be included if they had been under factor VIII/IX treatment at least 12months and kept a treatment and bleeding diary. RESULTS LTP was administered to 169/212 patients (79.7%) and OD treatment to 40/212 patients (18.9%). The most frequent reasons for initiating LTP were joint bleeding, target joints and frequent bleeds; whereas OD treatment was most often selected on the basis of mild bleeding phenotype or because of constraints on LTP. The mean annual bleed rate (ABR) in the OD group (6.33) was higher than in the LTP group (3.07, p<0.001). Mean ABR did not differ significantly between age strata (15-18, >18-21 and >21-25years), but was significantly higher for patients with severe haemophilia (4.02) as compared to those with moderate haemophilia (1.97, p=0.002). No significant difference was observed in mean ABR for joint bleeds between the LTP and OD groups. Physician reported LTP compliance was good or excellent in 97.0% of patients. CONCLUSION LTP is the predominant factor VIII/IX treatment among adolescents and young adults with severe or moderately severe haemophilia in France. LTP was associated with low ABR and high compliance.
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Ragni MV, Yabes JG, Fogarty PF, Josephson NC, Kessler CM, Neff AT, Raffini L, Brummel-Ziedins K, Moore CG. Pilot randomized, non-inferiority, cross-over trial of once-weekly vs. three times-weekly recombinant factor VIII prophylaxis in adults with severe haemophilia A. Haemophilia 2016; 23:e43-e46. [PMID: 27943502 DOI: 10.1111/hae.13131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M V Ragni
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
| | - J G Yabes
- Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - P F Fogarty
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - C M Kessler
- Georgetown University Medical Center, Washington, DC, USA
| | - A T Neff
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Raffini
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - K Brummel-Ziedins
- Department of Biochemistry, University of Vermont, Colchester, VT, USA
| | - C G Moore
- Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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Mizrahi T, St-Louis J, Young NL, Ménard F, Zourikian N, Dubé E, Rivard GE. Adherence to treatment regimen and bleeding rates in a prospective cohort of youth and young adults on low-dose daily prophylaxis for severe hemophilia A. BMC HEMATOLOGY 2016; 16:26. [PMID: 27833753 PMCID: PMC5101823 DOI: 10.1186/s12878-016-0067-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/31/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND When availability and/or affordability of anti-hemophilic factor concentrates are limited, optimal prophylaxis regimens in severe hemophilia A (HA) remain to be determined. In selected situations, low-dose daily prophylaxis (LDDP) may be an effective and economical option. The goal of our study was to evaluate if subjects on a LDDP regimen could achieve adherence and good clinical outcome. METHODS Seventeen subjects (age between 15.2 and 28.4) on LDDP suffering from severe/moderate HA were followed prospectively for 2 to 3 years as part of a health-related quality of life (HRQoL) study. Bleeding and treatments data were collected using electronic diaries and validated every three months. The SF-36 questionnaire was administered at the beginning of the study and then every 6 months until the end of the study. RESULTS The subjects (mean age 22.0, median 21.9, standard deviation 4.06), were all from a single centre and on LDDP for at least 12 months as part of their routine care before entering the study. Fifteen subjects were prescribed a daily dose of 500 IU factor VIII (FVIII) and 2 subjects received 1000 IU FVIII per day, resulting into a median dose of 7.1 IU/kg/day (ranging from 4 to 13 IU/kg/day) and of 2591 IU/kg/year. Median adherence (the percentage of the prescribed daily dose received) was 84 % (mean 80 %, range 57 % to 94 %) throughout the study. Seventy-six bleeds in the 6 index joints and 51 other types of bleeds were observed throughout the study. The median annualized bleeding rate in joints (ABRjoints) was 0.7 and the median annualized bleeding rate for all bleeds (ABRall) was 1.6. The Physical Component and Mental Component Summary scores of SF-36, and the Hemophilia Joint Health Score were not significantly different over the course of the study (respective medians of 49.8, 52.4 and 16.0 at entry; vs. 52.5, 51.5 and 16.0 upon exit). CONCLUSIONS This prospective longitudinal study in youth and young adults shows that LDDP may be associated with low ABRs, adequate adherence and HRQoL comparable to previously reported.
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Affiliation(s)
- Terry Mizrahi
- CHU Sainte-Justine, University of Montreal, 3175, chemin de la Côte-Ste-Catherine, H3T 1C5 Montreal, Quebec Canada
| | - Jean St-Louis
- CHU Sainte-Justine, University of Montreal, 3175, chemin de la Côte-Ste-Catherine, H3T 1C5 Montreal, Quebec Canada
| | | | - Francine Ménard
- CHU Sainte-Justine, University of Montreal, 3175, chemin de la Côte-Ste-Catherine, H3T 1C5 Montreal, Quebec Canada
| | - Nichan Zourikian
- CHU Sainte-Justine, University of Montreal, 3175, chemin de la Côte-Ste-Catherine, H3T 1C5 Montreal, Quebec Canada
| | - Evemie Dubé
- CHU Sainte-Justine, University of Montreal, 3175, chemin de la Côte-Ste-Catherine, H3T 1C5 Montreal, Quebec Canada
| | - Georges E Rivard
- CHU Sainte-Justine, University of Montreal, 3175, chemin de la Côte-Ste-Catherine, H3T 1C5 Montreal, Quebec Canada
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Adult severe haemophilia A patients under long-term prophylaxis with factor VIII in routine clinical practice. Blood Coagul Fibrinolysis 2016; 26:509-14. [PMID: 25767895 DOI: 10.1097/mbc.0000000000000261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is no clear consensus on the best practice for long-term prophylaxis in adults with severe haemophilia A. This is a single-centre prospective case series study. We describe here the demographic data, type and reason of prophylaxis in adult patients (>18 years old) with severe (<1%) haemophilia A, treated in our centre from 2006 to 2013. Prophylaxis was tailored according to pharmacokinetic studies and posterior factor VIII (FVIII) trough level adjustment. We analysed FVIII consumption, bleeding rate, adherence and adverse events in this group of patients. In adult patients who initiated long-term prophylaxis during this period, we compared FVIII consumption and bleeding rate with the previous on-demand period. We analysed data from 18 patients. Median annual FVIII consumption was 2374.2 IU/kg/year. Among the patients receiving tertiary prophylaxis, initiated from 2006 onwards, the annual FVIII consumption was 2557.8 vs. 1696.8 IU/kg per year during the on-demand period (P = 0.312). In this group of patients, there was a decrease in annual bleeding events of 88.3% during prophylaxis compared with the on-demand therapy (P < 0.0001). A high adherence to prophylaxis was observed (84%). No cases of anaphylaxis or symptomatic thromboembolic events were recorded. In adult severe haemophilia A patients, the type of and reason to indicate long-term prophylaxis are diverse nowadays. FVIII consumption varies depending on the justification of prophylaxis. The observations reported provide further support for the efficacy of long-term prophylaxis in adult haemophilia A patients.
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Brekkan A, Berntorp E, Jensen K, Nielsen EI, Jönsson S. Population pharmacokinetics of plasma-derived factor IX: procedures for dose individualization. J Thromb Haemost 2016; 14:724-32. [PMID: 26806557 DOI: 10.1111/jth.13271] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Population pharmacokinetic (POPPK) models describing factor IX (FIX) activity levels in plasma, in combination with individual FIX measurements, may be used to individualize dosing in the treatment of hemophilia B. OBJECTIVES The aim was to reevaluate a previously developed POPPK model for FIX activity and to explore the number and timing of FIX samples required in pharmacokinetic (PK) dose individualization. METHODS The POPPK model was reevaluated using an extended data set. Several sampling schedules, varying with respect to the timing and number of samples, were evaluated in a simulation study with relative dose errors compared between schedules. The performance of individually calculated doses was compared with commonly prescribed FIX doses with respect to the number of patients with a trough FIX activity > 0.01 U mL(-1) . RESULTS AND CONCLUSIONS A three-compartment PK model best described the FIX activity levels. The number and timing of samples greatly influenced imprecision in dose prediction. Schedules with single samples taken on both day 2 and day 3 were identified as being convenient schedules with an acceptable performance level. Individually calculated doses performed better with respect to patient target attainment than a fixed 40 U kg(-1) dose regardless of how many samples were available to calculate individual doses. The results of this study suggest that PK dose tailoring with limited sampling may be applicable for plasma-derived FIX products.
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Affiliation(s)
- A Brekkan
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - E Berntorp
- Clinical Coagulation Research Unit, Skåne University Hospital, Malmö, Sweden
| | - K Jensen
- Clinical Coagulation Research Unit, Skåne University Hospital, Malmö, Sweden
| | - E I Nielsen
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - S Jönsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Gue D, Squire S, McIntosh K, Bartholomew C, Summers N, Sun H, Yang M, Jackson S. Joining the patient on the path to customized prophylaxis: one hemophilia team explores the tools of engagement. J Multidiscip Healthc 2015; 8:527-34. [PMID: 26675989 PMCID: PMC4676616 DOI: 10.2147/jmdh.s93579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The relationship between hemophilia team interventions and achievement of optimal clinical outcomes remains to be elucidated. The British Columbia Hemophilia Adult Team has previously reported results of a comprehensive approach to individualize prophylaxis that has resulted in substantially reduced bleeding rates. In order to facilitate knowledge exchange and potential replication, it was important to gain a thorough understanding of the team's approach. METHODS A focus group of the British Columbia Hemophilia Adult Team was conducted to identify specific roles and processes that might be contributing to the prophylaxis regimen outcomes in this clinic. The focus group consisted of two workshops; one to describe the individual and collective roles of the clinic team in providing clinical care and guiding patients toward individualized prophylaxis; and the other to describe the patient journey from initial contact through reaching a successful engagement with the clinic. RESULTS Analysis of the results revealed team roles and processes that underpinned a shared decision-making relationship with the patient with a particular focus on supporting the patient's autonomy. Within this relationship, team focus shifts away from "adherence" toward the process whereby patients design and implement prophylaxis regimens resulting in reduction or elimination of bleeding episodes. LIMITATIONS Using the current methodology, it is not possible to demonstrate a causal link between specific team processes and improved bleeding rates in patients. CONCLUSION Through the active support of patient autonomy in all aspects of decisions related to hemophilia management, the British Columbia Hemophilia Adult Team approach de-emphasizes "adherence" as the primary goal, and focuses on a prophylaxis plan that is customized by the patient and aligned with his priorities. Adoption of this comprehensive team approach facilitates shared goals between the patient and the team that may optimize treatment adherence, but more importantly, reduce bleeding rates.
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Affiliation(s)
- Deborah Gue
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada ; School of Nursing, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Squire
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada
| | - Kam McIntosh
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada
| | - Claude Bartholomew
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada
| | - Nicole Summers
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada
| | - Haowei Sun
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada
| | - Ming Yang
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada
| | - Shannon Jackson
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St Paul's Hospital, Vancouver, BC, Canada ; Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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30
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Tiede A, Oldenburg J, Lissitchkov T, Knaub S, Bichler J, Manco‐Johnson MJ. Prophylaxis vs. on‐demand treatment with Nuwiq
®
(Human‐cl rh
FVIII
) in adults with severe haemophilia A. Haemophilia 2015; 22:374-80. [DOI: 10.1111/hae.12859] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 01/25/2023]
Affiliation(s)
- A. Tiede
- Hannover Medical School Clinic for Haematology, Haemostaseology, Oncology and Stem Cell Transplantation HannoverGermany
| | - J. Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine Bonn Germany
| | - T. Lissitchkov
- Specialised Hospital for Active Treatment “Joan Pavel” Sofia Bulgaria
| | - S. Knaub
- Octapharma AG Lachen Switzerland
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Pabinger I, Heistinger M, Muntean W, Reitter-Pfoertner SE, Rosenlechner S, Schindl T, Schuster G, Streif W, Thom K, Male C. [Treatment of haemophilia in Austria]. Wien Klin Wochenschr 2015; 127 Suppl 3:S115-30. [PMID: 26525378 DOI: 10.1007/s00508-015-0872-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
This guideline which is endorsed by the Austrian Society of Haemophilia, the Austrian Society of Paediatrics, and the Austrian Society of Haematology & Medical Oncology is intended to give a clear and practical guidance for diagnosing and treating haemophilia in Austria. In the treatment of haemophilia there are few controlled interventional trials, and recommendations usually have a rather low level of evidence.The main basis for this paper are the new international guidelines by the World Federation of Hemophilia, published in 2013. These were adapted according to the local situation and experience.Covered topics are diagnostics, control visits, pharmacological treatment options, prophylaxis and treatment in children and adults, possible problems arising in haemophilia carriers and special aspects like home therapy, options for venous catheters, management of various traumas, bleedings and interventions, including dental procedures, and last not least inhibitors and their treatment.
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Affiliation(s)
- Ingrid Pabinger
- Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Max Heistinger
- 1. Medizinische Abteilung, LKH Klagenfurt, Klagenfurt, Österreich
| | - Wolfgang Muntean
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Sylvia-Elisabeth Reitter-Pfoertner
- Klinische Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | | | - Thomas Schindl
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | | | - Werner Streif
- Department für Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Katharina Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Christoph Male
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
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How I use bypassing therapy for prophylaxis in patients with hemophilia A and inhibitors. Blood 2015; 126:153-9. [DOI: 10.1182/blood-2014-10-551952] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/25/2015] [Indexed: 11/20/2022] Open
Abstract
Abstract
Inhibitor development poses a significant challenge in the management of hemophilia because once an inhibitor is present, bleeding episodes can no longer be treated with standard clotting factor replacement therapy. Consequently, patients with inhibitors are at increased risk for difficult-to-control bleeding and complications, particularly arthropathy and physical disability. Three clinical trials in patients with inhibitors have demonstrated that prophylaxis with a bypassing agent reduces joint and other types of bleeding and improves health-related quality of life compared with on-demand bypassing therapy. In hemophilia patients without inhibitors, the initiation of prophylaxis with factor (F) VIII or FIX prior to the onset of recurrent hemarthroses can prevent the development of joint disease. Whether this is also true for bypassing agent prophylaxis remains to be determined.
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Principles of treatment and update of recommendations for the management of haemophilia and congenital bleeding disorders in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 12:575-98. [PMID: 25350962 DOI: 10.2450/2014.0223-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Prophylaxis therapy in paediatric patients with haemophilia: a survey of clinical management trends in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:631-8. [PMID: 26057481 DOI: 10.2450/2015.0333-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/18/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although current treatment guidelines recommend prophylaxis in paediatric patients with haemophilia, specific indications for and barriers to the prescription of prophylaxis in the paediatric haemophiliac population have not been established. The aim of this web-based survey of clinicians at Haemophilia Treatment Centres in Italy was to identify factors for and against the initiation of prophylactic coagulation factor replacement therapy in paediatric patients with haemophilia. MATERIALS AND METHODS A literature search was conducted to identify factors to include in the survey. Seventeen clinicians from Italian Haemophilia Centres were invited to complete the web-based survey and to rank factors in favour of and those that acted as barriers to prophylaxis in terms of "importance" and "influence" on a numerical scale (0=not important to 100=very important). Any factors for which there was a large discrepancy in results from the survey were further "ranked" by clinicians at an interactive question and answer session at a symposium. RESULTS A total of 13 web surveys were returned; the most highly scored factors favouring prophylaxis were "bleeding frequency", "bleeding severity" and "presence of target joints", and the most highly scored barriers were "parents' acceptance", "venous access" and "compliance to therapy". Other important factors favouring prophylaxis were "severity of coagulation defect" and "orthopaedic score". DISCUSSION This survey gives helpful clinician-derived information for people treating haemophiliacs in Italy, to help the treatment-providers orient themselves better regarding the prescription of prophylaxis for paediatric patients.
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Tagliaferri A, Feola G, Molinari AC, Santoro C, Rivolta GF, Cultrera DB, Gagliano F, Zanon E, Mancuso ME, Valdré L, Mameli L, Amoresano S, Mathew P, Coppola A. Benefits of prophylaxis versus on-demand treatment in adolescents and adults with severe haemophilia A: the POTTER study. Thromb Haemost 2015; 114:35-45. [PMID: 25855376 DOI: 10.1160/th14-05-0407] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/01/2015] [Indexed: 11/05/2022]
Abstract
Rigorous evidence is lacking on long-term outcomes of factor VIII (FVIII) prophylaxis initiated in adolescent or adult patients with severe haemophilia A. The prospective, open-label Prophylaxis versus On-demand Therapy Through Economic Report (POTTER) study (ClinicalTrials.gov NCT01159587) compared long-term late secondary prophylaxis (recombinant FVIII-FS 20-30 IU/kg thrice weekly) with on-demand treatment in patients aged 12 to 55 years with severe haemophilia A. The annual number of joint bleeding episodes (primary endpoint), total bleeding episodes, orthopaedic and radiologic (Pettersson) scores, health-related quality of life (HRQoL), pharmacoeconomic impact, and safety were evaluated over a > 5-year period (2004-2010). Fifty-eight patients were enrolled at 11 centres in Italy; 53 (27 prophylaxis, 26 on demand) were evaluated and stratified into 2 age subgroups (12-25 and 26-55 years). Patients receiving prophylaxis experienced a significantly lower number of joint bleeding episodes vs the on-demand group (annualised bleeding rate, 1.97 vs 16.80 and 2.46 vs 16.71 in younger and older patients, respectively; p=0.0043). Results were similar for total bleeding episodes. Prophylaxis was associated with significantly fewer target joints (p< 0.001), better orthopaedic (p=0.0019) and Pettersson (p=0.0177) scores, better HRQoL, and fewer days of everyday activities lost (p< 0.0001) but required significantly higher FVIII product consumption. The POTTER study is the first prospective, controlled trial documenting long-term benefits of late secondary prophylaxis in adolescents and adults with severe haemophilia A. The benefits of reduced bleeding frequency, improved joint status, and HRQoL may offset the higher FVIII consumption and costs.
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Affiliation(s)
- Annarita Tagliaferri
- Annarita Tagliaferri, MD, Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Via Gramsci, 14-43126, Parma, Italy, Tel.: +39 0521 703971, Fax: +39 0521 704332, E-mail:
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Fogarty PF, Mancuso ME, Kasthuri R, Bidlingmaier C, Chitlur M, Gomez K, Holme PA, James P, Kruse-Jarres R, Mahlangu J, Mingot-Castellano ME, Soni A. Presentation and management of acute coronary syndromes among adult persons with haemophilia: results of an international, retrospective, 10-year survey. Haemophilia 2015; 21:589-97. [DOI: 10.1111/hae.12652] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 01/01/2023]
Affiliation(s)
- P. F. Fogarty
- Penn Comprehensive Hemophilia and Thrombosis Program; Philadelphia PA USA
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - R. Kasthuri
- Division of Hematology and Oncology; Hemophilia and Thrombosis Center; University of North Carolina; Chapel Hill NC USA
| | | | - M. Chitlur
- Children's Hospital of Michigan; Detroit MI USA
| | | | - P. A. Holme
- Department of Haematology; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - P. James
- Queen's University; Kingston ON Canada
| | | | - J. Mahlangu
- Faculty of Health Sciences; University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital; Johannesburg South Africa
| | | | - A. Soni
- Children's Hospital of Orange County; Orange CA USA
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37
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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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Gouider E, Rauchensteiner S, Andreeva T, Al Zoebie A, Mehadzic S, Nefyodova L, Brunn M, Tueckmantel C, Meddeb B. Real-life evidence in evaluating effectiveness of treatment in Haemophilia A with a recombinant FVIII concentrate: A non-interventional study in emerging countries. Haemophilia 2015; 21:e167-e175. [DOI: 10.1111/hae.12631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- E. Gouider
- Service d'Hématologie Clinique Hôpital Aziza Othmana; Tunis Tunisia
| | | | - T. Andreeva
- Comprehensive Hemophilia Care Centre; St. Petersburg Russia
| | - A. Al Zoebie
- Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
| | - S. Mehadzic
- Klinika za Pedijatriju; Sarajevo Bosnia-Herzegovina
| | - L. Nefyodova
- Akmolinskaya Regional Hospital; Kokshetau Kazakhstan
| | - M. Brunn
- Bayer HealthCare Pharmaceuticals; Berlin Germany
| | | | - B. Meddeb
- Service d'Hématologie Clinique Hôpital Aziza Othmana; Tunis Tunisia
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39
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García-Dasí M, Aznar JA, Jiménez-Yuste V, Altisent C, Bonanad S, Mingot E, Lucía F, Giménez F, López MF, Marco P, Pérez R, Fernández MÁ, Paloma MJ, Galmes B, Herrero S, García-Talavera JA. Adherence to prophylaxis and quality of life in children and adolescents with severe haemophilia A. Haemophilia 2015; 21:458-64. [PMID: 25649244 DOI: 10.1111/hae.12618] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/30/2022]
Abstract
Treatment adherence in adolescents with chronic diseases is around 50%, and failure is more common in preventive therapy. In haemophilia, contradictory results are reported by the published studies. The objective of this study was to evaluate adherence with factor VIII (FVIII) prophylaxis in Spanish patients with severe haemophilia A between age 6 and 20 years. Data were collected retrosp-ectively in the previous 2 years. The primary endpoint was the absolute adherence index (AAI), and the endpoints were related to clinical status, age, prophylaxis regimen, responsibility for factor administration and quality of life (QoL), assessed by the Haemo-QoL questionnaires. A total of 78 patients from 14 Spanish hospitals were recruited. Adherence ranged between -64.4 and 66.7 (mean -3.08). No differences were observed between children and adolescents (7.11 vs. 6.39; P = 0.809). A statistically significant association (P < 0.010) between infra adherent group and target joint was found, as was a statistically significant difference (P < 0.010) between the number of bleeding episodes experienced by the adherent group (mean 1.4) and by infra adherents (mean 4.5). There was no significant difference between AAI and prophylactic regimen (6.35 vs. 6.96, P = 0.848), neither between AAI and the person responsible for factor administration (5.57 vs. 8.79, P = 0.326). The Haemo-QoL scores (8-12 years) were related to adherence level (P < 0.05). Adherence was approximately ideal and patients perceived a high QoL. Because of the repercussions for compliance, it is essential to work during puberty on emotional and self-acceptance aspects of the disease, as well as coping, and the patient's family, school and health team relationships.
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Affiliation(s)
- M García-Dasí
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J A Aznar
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - C Altisent
- Hospital Vall d'Hebron, Barcelona, Spain
| | - S Bonanad
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - E Mingot
- Hospital Carlos Haya, Málaga, Spain
| | - F Lucía
- Hospital Miguel Servet, Zaragoza, Spain
| | - F Giménez
- Hospital Torrecárdenas, Almería, Spain
| | | | - P Marco
- Hospital General de Alicante, Alicante, Spain
| | - R Pérez
- Hospital Virgen del Rocío, Sevilla, Spain
| | | | - M J Paloma
- Hospital Virgen del Camino, Pamplona, Spain
| | - B Galmes
- Hospital Son Espases, Mallorca, Spain
| | - S Herrero
- Hospital General de Guadalajara, Guadalajara, Spain
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40
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Ewing N, Escuriola‐Ettingshausen C, Kreuz W. Prophylaxis with FEIBA in paediatric patients with haemophilia A and inhibitors. Haemophilia 2015; 21:358-364. [DOI: 10.1111/hae.12602] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. Ewing
- City of Hope National Medical Center Duarte CA USA
| | | | - W. Kreuz
- HZRM ‐ Hemophilia Centre Rhein Main Moerfelden‐Waldorf Germany
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41
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Grosse SD, Chaugule SS, Hay JW. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:267-83. [PMID: 25585817 DOI: 10.1586/14737167.2015.1001372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost-effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost-effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mail Stop E-64, Atlanta, GA 30333, USA
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42
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Haemophilia A: pharmacoeconomic review of prophylaxis treatment versus on-demand. ScientificWorldJournal 2015; 2015:596164. [PMID: 25685844 PMCID: PMC4313676 DOI: 10.1155/2015/596164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/06/2014] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Haemophilia A is a congenital disorder of coagulation that mainly affects males and causes a considerable use of resources, especially when hemophilic patients are treated with prophylaxis. The aim of the present review was to discuss and appraise the methodological aspects and results of published economic evaluations of haemophilia A treatments in the last decade. METHODS The literature search, performed by consulting four engines, covered studies published between 2002 and 2014. Full economic evaluations published in English language were identified and included in the review. A quality assessment of the studies was also carried out based on Drummond's checklist. RESULTS After careful evaluations of the identified records, 5 studies were reviewed. Primary and secondary prophylaxis resulted cost-effective compared to on-demand therapy: the ICER of primary prophylaxis ranged from € 40.236 to € 59.315/QALY gained, while the ICER of secondary prophylaxis was € 40.229/QALY gained. Furthermore, 60% were high quality and 40% were medium quality studies. CONCLUSIONS The review underlines the cost-effectiveness of prophylaxis versus on-demand treatment and the different methodological approaches applied. Further economic evaluations are required with models that reflect the clinical reality and consumption of resources in each country.
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43
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Oldenburg J, Zimmermann R, Katsarou O, Theodossiades G, Zanon E, Niemann B, Kellermann E, Lundin B. Controlled, cross-sectional MRI evaluation of joint status in severe haemophilia A patients treated with prophylaxis vs. on demand. Haemophilia 2014; 21:171-179. [PMID: 25470205 PMCID: PMC4359687 DOI: 10.1111/hae.12539] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 01/06/2023]
Abstract
In patients with haemophilia A, factor VIII (FVIII) prophylaxis reduces bleeding frequency and joint damage compared with on-demand therapy. To assess the effect of prophylaxis initiation age, magnetic resonance imaging (MRI) was used to evaluate bone and cartilage damage in patients with severe haemophilia A. In this cross-sectional, multinational investigation, patients aged 12-35 years were assigned to 1 of 5 groups: primary prophylaxis started at age <2 years (group 1); secondary prophylaxis started at age 2 to <6 years (group 2), 6 to <12 years (group 3), or 12-18 years (group 4); or on-demand treatment (group 5). Joint status at ankles and knees was assessed using Compatible Additive MRI scoring (maximum and mean ankle; maximum and mean of all 4 joints) and Gilbert scores in the per-protocol population (n = 118). All prophylaxis groups had better MRI joint scores than the on-demand group. MRI scores generally increased with current patient age and later start of prophylaxis. Ankles were the most affected joints. In group 1 patients currently aged 27-35 years, the median of maximum ankle scores was 0.0; corresponding values in groups 4 and 5 were 17.0 and 18.0, respectively [medians of mean index joint scores: 0.0 (group 1), 8.1 (group 2) and 13.8 (group 4)]. Gilbert scores revealed outcomes less pronounced than MRI scores. MRI scores identified pathologic joint status with high sensitivity. Prophylaxis groups had lower annualized joint bleeds and MRI scores vs. the on-demand group. Primary prophylaxis demonstrated protective effects against joint deterioration compared with secondary prophylaxis.
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44
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Nugent D, Kalnins W, Querol F, Gregory M, Pilgaard T, Cooper DL, Iorio A. Haemophilia Experiences, Results and Opportunities (HERO) study: treatment-related characteristics of the population. Haemophilia 2014; 21:e26-38. [PMID: 25377442 DOI: 10.1111/hae.12545] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/25/2023]
Abstract
The HERO (Haemophilia Experiences, Results and Opportunities) quantitative surveys collected information on characteristics and perceptions of adult persons with haemophilia (PWH) and parents of children with haemophilia. The aim of this article is to describe the perceptions of PWH and parents on psychosocial aspects related to treatment. Two online surveys (one for PWH, one for parents) were conducted in 10 countries. Among 675 PWH respondents, 77% reported having responsibility for their own care; 72% of 561 parent respondents had the main responsibility for their son. PWH were most commonly treated on demand (45% of 648 adults using factor concentrate), with 32% on regular prophylaxis and 23% treated on demand with short-term prophylaxis (e.g. for sports/physiotherapy). Children were most often treated with prophylaxis (65% of 549 children using factor concentrate), with 26% treated on demand and 8% treated on demand with short-term prophylaxis. Factor was generally used as instructed at home. Some respondents (41% PWH; 30% parents) had difficulties/concerns with factor availability/affordability. PWH reported more bleeds in the last 12 months than parents reporting their son's bleeds (mean 17.8 vs. 8.7). Both PWH and parents generally perceived that overall, their (their son's) haemophilia was well controlled. Results differed by country. The HERO study captured new, patient-based data regarding many facets of life relevant to PWH, including treatment. The information conveyed in this article largely represents new insights regarding perceptions of treatment and provides initial benchmark statistics for further research.
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Affiliation(s)
- D Nugent
- Children's Hospital of Orange County and Center for Inherited Blood Disorders, Orange, CA, USA
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45
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Humphries TJ, Kessler CM. Managing chronic pain in adults with haemophilia: current status and call to action. Haemophilia 2014; 21:41-51. [DOI: 10.1111/hae.12526] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2014] [Indexed: 01/25/2023]
Affiliation(s)
| | - C. M. Kessler
- Georgetown University Medical Center; Washington DC USA
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46
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Abstract
Primary prophylaxis is the standard of care for children and adolescents with severe haemophilia; however, its role in adults is less well defined. To establish to which extent prophylaxis is currently being used in adults with severe haemophilia A, we conducted a systematic review of the literature by searching MEDLINE using the terms "prophylaxis", "adult", "severe" and "haemophilia A". Evidence-based guidelines and national studies relating to the use of prophylaxis in adults with severe haemophilia A were identified and reviewed. One published evidence-based guideline and three published studies fulfilled our inclusion criteria. A combined analysis of published data suggests that almost 45% of adult patients with severe haemophilia A are being treated with prophylaxis. Withdrawal of prophylaxis is attempted relatively infrequently; however, when attempted, around 27% of adolescents and adults with severe haemophilia do not experience an increase in bleeding tendency over a specific treatment period. Prophylaxis (primary and secondary) is an important part of haemophilia treatment that should be granted to all patients depending on their clinical presentation. Further studies are needed to better define this treatment strategy in adults.
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Affiliation(s)
- Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany.
| | - Hans-Hermann Brackmann
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
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47
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Present and future challanges in the treatment of haemophilia: a clinician's perspective. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 11 Suppl 4:s77-81. [PMID: 24333317 DOI: 10.2450/2013.012s] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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48
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Armstrong EP, Malone DC, Krishnan S, Wessler MJ. Adherence to clotting factors among persons with hemophilia A or B. ACTA ACUST UNITED AC 2014; 20:148-53. [PMID: 25001343 DOI: 10.1179/1607845414y.0000000176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Evaluate adherence to clotting factor treatment and associated outcomes for patients with hemophilia using an integrated delivery database. METHODS This was a retrospective, observational study tracking patients between 2006 and 2011. Patients with diagnosis codes for hemophilia were identified. Bleeding and complication rates were annualized over the study period. Medication adherence was assessed using prescription claims for clotting factors by examining sequential time periods of 180 days for each patient's continuous enrollment. Adherence within the time period was calculated using the 'days supply' field divided by 180 days. Under the assumption that severe patients should be treated prophylactically, patients were considered adherent within the time period if the ratio of 'days supply' to observed days was 60% or greater. RESULTS A total of 207 patients (74.9 and 25.1% hemophilia A and B, respectively) met the inclusion/exclusion criteria. There were 101 (48.8%) mild, 32 (15.5%) moderate, and 74 (35.7%) severe patients with hemophilia. The percentage of time periods where adherence to clotting factors was 60% or greater was 14% (SD = 28%) for mild disease, 21% (SD = 32%) for moderate disease, and 51% (SD = 36%) for severe disease. Among patients with severe disease, 27 (36.5%) were adherent ≤ 30% of time periods, 22 (29.7%) adherent 31-70% of the time periods, and 25 (33.8%) were adherent ≥ 71% of time periods. Joint bleeding episodes and hospitalizations were uncommon events among the three groups. CONCLUSIONS Among patients with severe disease, the majority (66.2%) were adherent <70% of the time.
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49
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Saulyte Trakymiene S, Steen Carlsson K. On-demand treatment in persons with severe haemophilia. Eur J Haematol 2014; 76:39-47. [PMID: 24957106 DOI: 10.1111/ejh.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 02/06/2023]
Abstract
There are two main modes of replacement therapy for haemophilia patients: either to stop bleeding (on-demand) or regular infusions of clotting factor to prevent bleeds (prophylaxis). Fifty yr of clinical experience have provided evidence of the superiority of prophylaxis by showing a reduction in bleeds and development of arthropathy. Prophylaxis has been described extensively in terms of efficacy and health-economic aspects; however, on-demand treatment has received less attention. The aim of this study was to critically review the published literature on PubMed and discuss potential gaps of knowledge in on-demand treatment in persons with severe haemophilia without inhibitors by focusing on two key aspects: how on-demand treatment is provided and what outcome measures have been reported. We identified 134 papers of which 112 were excluded. Of the remaining 22 papers, 16 were comparative studies between prophylaxis and on-demand treatment and six were descriptions of on-demand treatment. The results showed limited reporting on data related to the key aspects of treatment on-demand. Early studies looked at degrees of joint bleeds and different treatment regimens in finding the optimal dose. However, from the late 1980s, there was almost no research into on-demand therapy except efficacy and safety studies of new rFVIII products and studies to prove superiority of prophylaxis over treatment on-demand. The success of on-demand therapy may depend on several factors, for example time to initial dose after a bleed and duration of treatment. Data on these key factors are limited and highlight the necessity of research to optimise replacement therapy.
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Affiliation(s)
- Sonata Saulyte Trakymiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Centre for Pediatric Hematology/Oncology, Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
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50
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Aledort L, Ljung R, Mann K, Pipe S. Factor VIII therapy for hemophilia A: current and future issues. Expert Rev Hematol 2014; 7:373-85. [PMID: 24717090 DOI: 10.1586/17474086.2014.899896] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hemophilia A is a congenital, recessive, X-linked bleeding disorder that is managed with infusions of plasma-derived or recombinant factor (F) VIII. The primary considerations in FVIII replacement therapy today are the: 1) immunogenicity of FVIII concentrates, 2) role of longer-acting FVIII products, 3) prophylactic use of FVIII in children and adults with severe hemophilia A, and 4) affordability and availability of FVIII products. Improving patient outcomes by increasing the use of FVIII prophylaxis, preventing or eliminating FVIII inhibitors, and expanding access to FVIII concentrates in developing countries are the major challenges confronting clinicians who care for patients with hemophilia A.
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Affiliation(s)
- Louis Aledort
- Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1006, Newyork, NY, USA
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