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Bakhsh E. Impact of Replacement Therapy on Pregnancy Outcomes in Hemophilia Carriers: A Historical Cohort Study in Saudi Arabia. Life (Basel) 2024; 14:623. [PMID: 38792643 PMCID: PMC11122275 DOI: 10.3390/life14050623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
This retrospective cohort study evaluates the safety and efficacy of replacement therapy with regard to pregnancy outcomes in hemophilia carriers. Hemophilia carriers face elevated bleeding risks during pregnancy, necessitating meticulous management, including replacement therapy with clotting factors. This research examines the records of 64 pregnant hemophilia carriers at King Fahad Medical City, Riyadh, from January 2010 to December 2023, analyzing their demographic details, hemophilia type and severity, replacement therapy specifics, and pregnancy outcomes. The study found that 62.5% of the participants had hemophilia A, with 43.8% categorized as severe. Most subjects (87.5%) received recombinant factor VIII at a median dosage of 30 IU/kg weekly. Adverse pregnancy outcomes included gestational hypertension (15.6%), preterm labor (18.8%), and postpartum hemorrhage (12.5%). The cesarean section rate was 28.1%. Neonatal outcomes were generally favorable, with median birth weights at 3100 g and mean Apgar scores of 8.2 and 9.1 at 1 and 5 min, respectively. Logistic regression analysis revealed no significant association between adverse events and therapy type or dosage, though a trend towards significance was noted with once-weekly administration (p = 0.082). The study concludes that replacement therapy is a viable method for managing hemophilia in pregnant carriers, leading to generally favorable maternal and neonatal outcomes. However, it underscores the importance of individualized treatment plans and close monitoring to effectively manage the risks associated with hemophilia during pregnancy.
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Affiliation(s)
- Ebtisam Bakhsh
- Internal Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
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Holle LA, Pantazis JC, Turecek PL, Wolberg AS. Clot formation and fibrinolysis assays reveal functional differences among hemostatic agents in hemophilia A plasma. Res Pract Thromb Haemost 2024; 8:102337. [PMID: 38426025 PMCID: PMC10901841 DOI: 10.1016/j.rpth.2024.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
Background Measuring the activity of hemostatic agents used to treat hemophilia A often requires drug-specific assays. In vitro assays show hemophilic clots have abnormal characteristics, including prolonged clotting time and decreased resistance to fibrinolysis. The ability of certain agents to correct these parameters in vitro is associated with hemostatic efficacy in vivo. Objectives To compare effects of established and emerging hemostatic agents on clot formation and fibrinolysis in hemophilia A plasma. Methods Pooled and individual hemophilia A platelet-poor plasmas were spiked with replacement (recombinant factor VIII [rFVIII], PEGylated rFVIII, polysialylated rFVIII, and porcine rFVIII) or bypassing (emicizumab, rFVIIa, and activated prothrombin complex concentrate) products. Effects on tissue factor-initiated clot formation and fibrinolysis were measured by turbidity. Results Compared to normal pooled plasma, hemophilia-pooled plasma showed reduced clot formation and increased fibrinolysis, and all replacement agents improved these characteristics. rFVIII and PEGylated rFVIII produced similar effects at similar concentrations, whereas polysialylated rFVIII produced slightly higher and porcine rFVIII slightly lower effects at these concentrations. Bypassing agents enhanced clot formation and stability, but patterns differed from replacement agents. The clotting rate showed a concentration-response relationship for all agents. High concentrations of all products produced effects that exceeded the normal range in at least some parameters. Responses of individual donors varied, but all agents improved clot formation and stability in all donors tested. Conclusion Clotting and fibrinolysis assays reveal hemostatic effects of replacement and bypassing therapies at clinically relevant concentrations. These assays may help characterize hemostatic agents and optimize dosing.
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Affiliation(s)
- Lori A. Holle
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jacob C. Pantazis
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Peter L. Turecek
- Plasma-Derived Therapies R&D, Baxalta Innovations GmbH – Takeda, Vienna, Austria
| | - Alisa S. Wolberg
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Ai D, Cui C, Tang Y, Wang Y, Zhang N, Zhang C, Zhen Y, Li G, Huang K, Liu G, Chen Z, Zhang W, Wu R. Machine learning model for predicting physical activity related bleeding risk in Chinese boys with haemophilia A. Thromb Res 2023; 232:43-53. [PMID: 37931538 DOI: 10.1016/j.thromres.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Physical activity is a crucial part of an active lifestyle for haemophiliac children. However, the fear of bleeds has been identified as barriers to participating physical activity for haemophiliac children even with prophylaxis. Lack of evidence and metrics driven by data is key problem. OBJECTIVES We aim to develop machine learning models based on clinical data with multiple potential factors considered to predict risk of physical activity bleeding for haemophilia children with prophylaxis. METHODS From this cohort study, we collected information on 98 haemophiliac children with adequate prophylaxis (trough FVIII:C level > 1 %). The involved potential predictor variables include demographic information, treatment information, physical activity, joint evaluation, and pharmacokinetic parameters, etc. We applied CoxPH, Random Survival Forests (RSF) and DeepSurv to construct prediction models for the risk of bleeding during physical activities. All three survival analysis models were internally and externally validated. RESULTS A total of 98 patients were enrolled in this study. Their median age was 7.9 (5.5, 10.2) years. The CoxPH, RSF and DeepSurv models' discriminative and calibration abilities were all high, and the RSF model had the best performance (Internal validation: C-index, 0.7648 ± 0.0139; Brier Score, 0.1098 ± 0.0015; External validation: C-index, 0.7260 ± 0.0154; Brier Score, 0.0930 ± 0.0018). The prediction curves demonstrated that the developed RSF model can distinguish the risks well between bleeding and non-bleeding patients, as well as patients with different levels of physical activity. Meanwhile, the feature importance analysis confirmed that physical activity bleeding was deduced by comprehensive effects of various factors, and the importance of different factors on bleeding outcome is discrepant. CONCLUSIONS This study revealed from the mechanism that it is necessary to incorporate multiple factors to accurately predict physical activity related bleeding risk. In clinical practice, the designed machine learning models can provide guidance for children with haemophilia A to positively participate in physical activity.
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Affiliation(s)
- Di Ai
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Chang Cui
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yongqiang Tang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Yan Wang
- Department of Rehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ningning Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenyang Zhang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Yingzi Zhen
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Gang Li
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kun Huang
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Guoqing Liu
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Wensheng Zhang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Runhui Wu
- Haemophilia Comprehensive Care Center, Hematology Center, Beijing Key Laboratory of Pediatric Hematology-Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China.
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Ljung R, de Kovel M, van den Berg HM. Primary prophylaxis in children with severe haemophilia A and B-Implementation over the last 20 years as illustrated in real-world data in the PedNet cohorts. Haemophilia 2023; 29:498-504. [PMID: 36571801 DOI: 10.1111/hae.14729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The prophylactic regimen in children with severe haemophilia is suggested in various publications and guidelines. Few data exist on its implementation in clinical practice. AIM To investigate the implementation of primary prophylaxis based on real-life data from PedNet during the last 20 years. METHODS All children from the PedNet cohort (n = 1260) with severe haemophilia A (SHA) or severe haemophilia B (SHB), FVIII/IX < .01 IU/mL, born between 2000 and 2009 (Cohort I; SHA n = 662; SHB n = 88) and 2010-2019 (Cohort II; SHA n = 598; SHB n = 94) were included. RESULTS In SHA, the median age at start of prophylaxis was 17.3 months (IQR; 12.5-26.1) in Cohort I which decreased to 13.1 months (IQR; 10.4-19.1) in Cohort II (p < .000). "Once-a-week" prophylaxis at start increased from 49% to 68% (SHA) and 38% to 70% (SHB). FVIII doses were reduced from median 43.5 (IQR; 34.6-49.0) to 30.9 IU/kg (IQR; 26.3-46.3), while dosing with FIX did not change. After 2010 approximately 60% of the patients with SHA and SHB started prophylaxis before any joint bleed. The number of CVADs needed in both cohorts was around 30%. Incidences of inhibitors were unchanged: SHA (∼31%) and SHB (∼10%). Sporadic cases were diagnosed significantly later (median 8.3 months; IQR; 3.7-11.9) and they had more joint bleeds before start of prophylaxis. CONCLUSION Primary prophylaxis nowadays starts at an earlier age: before any joint bleed (60% of patients with SHA and SHB). Approximately 70% started on a once-weekly schedule with significantly reduced doses in SHA but unchanged in SHB.
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Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences, Department of Paediatrics, Lund University, Lund, Sweden
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Sarmiento Doncel S, Díaz Mosquera GA, Cortes JM, Agudelo Rico C, Meza Cadavid FJ, Peláez RG. Haemophilia A: A Review of Clinical Manifestations, Treatment, Mutations, and the Development of Inhibitors. Hematol Rep 2023; 15:130-150. [PMID: 36810557 PMCID: PMC9944491 DOI: 10.3390/hematolrep15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/07/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
The purpose of this narrative review was to provide an overview that allows readers to improve their understanding of hemophilia A, which is considered a genetic disease with a high impact on the quality of life of people who suffer from it is considered one of the diseases with the highest cost for health systems (In Colombia it is part of the five diseases with the greatest economic impact). After this exhaustive review, we can see that the treatment of hemophilia is on the way to precision medicine, which involves genetic variables specific to each race and ethnicity, pharmacokinetics (PK), as well as environmental factors and lifestyle. Knowing the impact of each of these variables and their relationship with the efficacy of treatment (prophylaxis: regular infusion of the missing clotting factor VIII in order to prevent spontaneous bleeding) will allow for individualizing the medical behavior in a cost-effective way. For this is required to build more strong scientific evidence with statistical power that allows us to infer.
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Affiliation(s)
- Samuel Sarmiento Doncel
- Integral Solutions SD SAS, Integral Solutions Research, Bogota 110121, Colombia
- Life Sciences and Health Research Group, Graduates School, CES University, Medellin 050021, Colombia
| | | | | | - Carol Agudelo Rico
- Integral Solutions SD SAS, Integral Solutions Research, Bogota 110121, Colombia
| | - Francisco Javier Meza Cadavid
- Integral Solutions SD SAS, Integral Solutions Research, Bogota 110121, Colombia
- Hospital Universitario San Jorge, Pereira 660002, Colombia
| | - Ronald Guillermo Peláez
- Life Sciences and Health Research Group, Graduates School, CES University, Medellin 050021, Colombia
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Wang J, Gu J, Chen H, Wu Q, Xiong L, Qiao B, Zhang Y, Xiao H, Tong Y. A Novel Deletion Mutation of the F8 Gene for Hemophilia A. Diagnostics (Basel) 2022; 12:diagnostics12112876. [PMID: 36428936 PMCID: PMC9689134 DOI: 10.3390/diagnostics12112876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Hemophilia A (HA) is an X-linked recessive blood coagulation disorder caused by a variety of abnormalities in F8 gene, resulting in the absence of impaired molecule production of factor VIII (FVIII) in the plasma. The genetic testing of the F8 gene encoding FVIII is used for confirmation of HA diagnosis, which significantly reduced serious complications of this disease and, ultimately, increased life expectancy. Methods: Sanger sequencing was performed in F8 gene exons of the suspected patients with blood coagulation-related indicators. Results: A novel F8 indel variant c.6343delC, p.Leu2115SerfsTer28 in exon 22 of the F8 gene was identified in the suspected families. The infant with this novel variant appeared the symptom of minor bleeding and oral cavity bleeding, and decreased activity of FVIII, which is consistent with that of F8 deleterious variants. The 3'D protein structural analysis of the novel variant shows a change in FVIII protein stability, which may be responsible for the pathogenesis of HA. Conclusions: A novel deleterious variant was identified in our case, which expands the F8 variants spectrum. Our result is helpful for HA diagnosis and benefits carrier detection and prenatal diagnosis. Our study also reveals that mutation screening of the F8 gene should be necessary for HA suspected patients.
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Affiliation(s)
- Jingwei Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Clinical Molecular Diagnosis Institute, Wuhan University, Wuhan 430060, China
| | - Jian Gu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Hongbing Chen
- Department of Pulmonary and Critical Care Medicine of Renmin Hospital, Wuhan University, Wuhan 430060, China
| | - Qian Wu
- Clinical Molecular Diagnosis Institute, Wuhan University, Wuhan 430060, China
| | - Liang Xiong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Bin Qiao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yan Zhang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Hongjun Xiao
- Medical Vocational and Technical School, Wuhan University, Wuhan 430060, China
- Correspondence: (H.X.); (Y.T.); Tel.: +86-27-88041911 (H.X.); +86-27-88041911 (Y.T.)
| | - Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Clinical Molecular Diagnosis Institute, Wuhan University, Wuhan 430060, China
- Correspondence: (H.X.); (Y.T.); Tel.: +86-27-88041911 (H.X.); +86-27-88041911 (Y.T.)
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Huang K, Ai D, Li G, Zhen Y, Wang Y, Zhang N, Huo A, Liu G, Chen Z, Wu R. Individualised prophylaxis based on personalised target trough FVIII level optimised clinical outcomes in paediatric patients with severe haemophilia A. Haemophilia 2022; 28:e209-e218. [PMID: 35850182 PMCID: PMC9796890 DOI: 10.1111/hae.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION As standard care of severe haemophilia A (SHA), prophylaxis should be individualised. AIM This study aimed to investigate the effectiveness of this new-proposed individualised prophylaxis protocol. METHODS Boys with SHA were enrolled and followed a PK-guided, trough-level escalating protocol of prophylaxis after a six-month observational period. In the next 2 years, clinical assessments including joint bleeds, ultrasound (US) scores and Haemophilia Joint Health Score (HJHS) in both sides of ankles, knees and elbows were conducted every 6 months as a scoring system, which determined whether the trough level's escalation. Adjustment of dosing regimen was based on WAPPS-Hemo. RESULTS Fifty-eight SHA boys were finally analysed. Their age and bodyweight were 5.3(2.8,6.9) years and 21.5(16,25) kg. During the study, 47 escalations were conducted. At study exit, the patient number and proportion of different trough level groups were: < 1 IU/dl, 17.2% (10/58); 1-3 IU/dl, 53.5% (31/58); 3-5 IU/dl, 15.5% (9/58); > 5 IU/dl, 13.8% (8/58). Significantly reduced annualised bleeding rate [4(0,8) to 0(0,2), p < .0001] and annualised joint bleeding rate [2(0,4) to 0(0,.25), p < .0001] was observed at study exit as well as the continuous trend of increased zero bleeding proportion (ZBP) (27.6%-69.0%) and zero joint bleeding proportion (46.5%-81.3%). Besides, 85% (6/7) of the target joints vanished. Statistical improvements of US scores (p = .04) and HJHS (p = .02) were also reported at study exit. CONCLUSION Our results showed the effectiveness of our protocol based on individualised target trough level and emphasise the importance of personalised prophylaxis.
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Affiliation(s)
- Kun Huang
- Hematology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Di Ai
- Hematology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Gang Li
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yingzi Zhen
- Hematology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yan Wang
- Rehabilitation Department, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Ningning Zhang
- Radiology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Aihua Huo
- Radiology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Guoqing Liu
- Hematology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Runhui Wu
- Hematology Center, Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
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Núñez R, Álvarez-Román MT, Bonanad S, González-Porras JR, De La Corte-Rodriguez H, Berrueco R, Jiménez-Yuste V. The Limitations and Unmet Needs of the Five Cornerstones to Guarantee Lifelong Optimization of Prophylaxis in Hemophilia Patients. TH OPEN 2022; 6:e365-e377. [DOI: 10.1055/s-0042-1757745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
AbstractProphylaxis to prevent bleeding is highly recommended for hemophilia patients. The development of new drugs and tools for modeling personalized prophylaxis provides the means for people with hemophilia to lead active lives with a quality of life comparable to that of nonhemophilic individuals. The choice of regimens must be made on a highly individual basis. Unfortunately, reference guides neither always concur in their recommendations nor provide directions to cover all possible scenarios. In this review, a group of experts identify the significant limitations and unmet needs of prophylaxis, taking advantage of their clinical experience in the disease, and supported by a rigorous literature update. To perform a more systematic and comprehensive search for gaps, the main cornerstones that influence decisions regarding prophylactic patterns were first identified.Bleeding phenotype, joint status, physical activity, pharmacokinetics/medication properties, and adherence to treatment were considered as the primary mainstays that should allow physicians guiding prophylaxis to secure the best outcomes. Several challenges identified within each of these topics require urgent attention and agreement. The scores to assess severity of bleeding are not reliable, and lead to no consensus definition of severe bleeding phenotype. The joint status is to be redefined in light of new, more efficient treatments with an agreement to establish one scale as the unique reference for joint health. Further discussion is needed to establish the appropriateness of high-intensity physical activities according to patient profiles, especially because sustaining trough factor levels within the safe range is not always warranted for long periods. Importantly, many physicians do not benefit from the advantages provided by the programs based on population pharmacokinetic models to guide individualized prophylaxis through more efficient and cost-saving strategies. Finally, ensuring correct adherence to long-term treatments may be time-consuming for practitioners, who often have to encourage patients and review complex questionnaires.In summary, we identify five cornerstones that influence prophylaxis and discuss the main conflicting concerns that challenge the proper long-term management of hemophilia. A consensus exercise is warranted to provide reliable guidelines and maximize benefit from recently developed tools that should notably improve patients' quality of life.
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Affiliation(s)
- Ramiro Núñez
- Hemophilia Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | | | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, Hospital Universitari i Politècnic La Fe, València, Spain
| | - José Ramón González-Porras
- Hematology Department, Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (Ibsal), Salamanca, Spain
| | | | - Rubén Berrueco
- Pediatric Hematology Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP-HSJD0), Barcelona, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Jiménez-Yuste
- Department of Hematology and Hemotherapy, La Paz University Hospital-IdiPaz, Madrid, Spain
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Shima M, Takedani H, Kitsukawa K, Taki M, Ishiguro A, Nagao A, Yamaguchi-Suita H, Kyogoku Y, Yoshida S, Nogami K. AOZORA: long-term safety and joint health in paediatric persons with haemophilia A without factor VIII inhibitors receiving emicizumab - protocol for a multicentre, open-label, phase IV clinical study. BMJ Open 2022; 12:e059667. [PMID: 35697445 PMCID: PMC9196178 DOI: 10.1136/bmjopen-2021-059667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Persons with haemophilia A (PwHA) commonly experience regular bleeding into joints, which may result in joint damage and complications such as degenerative arthritis. Emicizumab has previously demonstrated efficacy in reducing the occurrence of joint bleeds and target joints, along with having a favourable safety profile; however, data on the long-term effects on joint health are lacking. The AOZORA study will evaluate the long-term safety and joint health of paediatric PwHA without factor (F)VIII inhibitors taking emicizumab; here, we report the details of the study protocol and baseline data. METHODS AND ANALYSIS AOZORA is a multicentre, open-label, phase IV clinical study in Japan that aims to enrol approximately 30 PwHA aged <12 years without FVIII inhibitors. The primary endpoints include a long-term safety evaluation of adverse events, laboratory test abnormalities and FVIII inhibitor development; and a long-term joint health assessment using MRI and the Hemophilia Joint Health Score. Exploratory endpoints include characterising participants' physical activities and the number of activity-related bleeds requiring coagulation factor treatment. Currently, 30 participants have been enrolled, including 20 emicizumab-naïve participants and 10 who transferred from HOHOEMI, a previous study in paediatric PwHA. ETHICS AND DISSEMINATION The AOZORA study was approved by the Institutional Review Boards of Nara Medical University and the St Marianna University Group. The study will be conducted in compliance with the Declaration of Helsinki, the standards stipulated in paragraph 3 of Article 14 and Article 80-2 of the Pharmaceuticals, Medical Devices and Other Therapeutic Products Act, the Ministerial Ordinance on Good Clinical Practice and the Ministerial Ordinance on Good Post-marketing Study Practice. Data will be published in peer-reviewed journals and presented at Global congresses. TRIAL REGISTRATION NUMBER JapicCTI-194701.
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Affiliation(s)
- Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Hideyuki Takedani
- Department of Joint Surgery, IMSUT Hospital, The University of Tokyo, Tokyo, Japan
| | - Kaoru Kitsukawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masashi Taki
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akira Ishiguro
- Division of Hematology, National Center for Child Health and Development, Tokyo, Japan
| | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Yui Kyogoku
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Seitaro Yoshida
- Clinical Development Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
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10
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Germini F, Noronha N, Abraham Philip B, Olasupo O, Pete D, Navarro T, Keepanasseril A, Matino D, de Wit K, Parpia S, Iorio A. Risk factors for bleeding in people living with hemophilia A and B treated with regular prophylaxis: A systematic review of the literature. J Thromb Haemost 2022; 20:1364-1375. [PMID: 35395700 DOI: 10.1111/jth.15723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge about the risk for bleeding in patients with hemophilia (PWH) would be relevant for patients, stakeholders, and policy makers. OBJECTIVES To perform a systematic review of the literature on risk assessment models (RAMs) and risk factors for bleeding in PWH on regular prophylaxis. METHODS We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception through August 2019. In duplicate, reviewers screened the articles for inclusion, extracted data, and assessed the risk for bias using the Quality in Prognostic Studies (QUIPS) tool. A qualitative synthesis of the results was not performed due to high heterogeneity in risk factors, outcomes definition and measurement, and statistical analysis of the results. RESULTS From 1843 search results, 10 studies met the inclusion criteria. No RAM for the risk for bleeding in PWH was found. Most studies included only PWH A or both PWH A and B and were conducted in North America or Europe. Only one study had a low risk for bias in all the domains. Eight categories of risk factors were identified. The risk for bleeding was increased when factor levels were lower and in people with a significant history of bleeding or who engaged in physical activities involving contact. CONCLUSIONS Our findings suggest that plasma factor levels, history of bleeds, and physical activity should be considered for the derivation analysis when building a RAM for bleeding in PWH, and the role of other risk factors, including antithrombotic treatment and obesity, should be explored.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Noella Noronha
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Binu Abraham Philip
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Omotola Olasupo
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Drashti Pete
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Navarro
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arun Keepanasseril
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Davide Matino
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kerstin de Wit
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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11
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Carcao M, Gouider E, Wu R. Low dose prophylaxis and antifibrinolytics: Options to consider with proven benefits for persons with haemophilia. Haemophilia 2022; 28 Suppl 4:26-34. [PMID: 35521737 DOI: 10.1111/hae.14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Prophylaxis has become standard of care for persons with severe phenotype haemophilia (PWsH). However, 'standard prophylaxis' with either factor or non-factor therapies (emicizumab) is prohibitively expensive for much of the world. We sought to evaluate whether haemophilia care can be provided at a lower cost yet achieve good results using Lower dose/Lower frequency prophylaxis (LDP) and with increasing use of antifibrinolytics (Tranexamic acid and Epsilon amino caproic acid). METHODS We identified 12 studies that collectively included 335 PWsH using LDP. Additionally, we undertook a literature search regarding the benefits of antifibrinolytics in haemophilia care. RESULTS Identified studies show that LDP is far superior to no prophylaxis (On demand [OD] therapy) resulting in significant patient benefits. Patients on LDP showed (in comparison to patients OD) on average: 72% less total bleeds; 75% less joint bleeds; 91% less days lost from school; 77% less hospital admission days; and improved quality of life measures. These benefits come at similar or only slightly higher (< 2-fold greater) costs than OD therapy. Antifibrinolytics are effective adjunctive agents in managing bleeds (oral, nasal, intracranial, possibly other) and providing haemostasis for surgeries (particularly oral surgeries). Antifibrinolytics can substitute for more expensive factor concentrates or can reduce the use of such concentrates. There is evidence to show that antifibrinolytics may be used in conjunction with factor concentrates/emicizumab for more effective/less costly prophylaxis. CONCLUSIONS The use of LDP along with appropriate and increased use of antifibrinolytics offers less resourced countries good options for managing patients with haemophilia.
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Affiliation(s)
- Manuel Carcao
- Haemophilia Clinic and Haemostasis Program, Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emna Gouider
- Hemophilia Treatment Centre, Aziza Othmana Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Runhui Wu
- Haemophilia Comprehensive Care Centre, Haematology Centre, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, Beijing, China
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12
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Shetty S, Bansal S, Kshirsagar S, Rangarajan S, Hajirnis K, Phadke V. Low-dose prophylaxis and its impact on the health of haemophilia patients. Vox Sang 2022; 117:900-912. [PMID: 35437811 DOI: 10.1111/vox.13278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES There is convincing evidence to show that low-dose prophylaxis (LDP) results in reduction in annualized bleeding rate (ABR) and better health-related quality of life (HRQoL) compared with on-demand or episodic treatment (ET) in haemophilia patients. The aim is to review various LDP protocols practised for the treatment of haemophilia, specifically in resource-limited countries. METHODS A literature survey was made of articles published in English language in PubMed and EMBASE without any time limit using keywords 'low dose', 'prophylaxis' and 'haemophilia' in different combinations. RESULTS A total of 19 reports involving LDP in patients with haemophilia were included in this review. Almost all studies reported reduction in ABR, improvement in joint function, pain and HRQoL compared with ET, but this did not fully translate into significant improvement in structural arthropathy already caused by earlier bleeds, suggesting that LDP may be less or ineffective in either stopping or reversing the damage. Individualized dose escalation protocols based on pharmacokinetic (PK) or clinical parameters were found to be superior to fixed LDP protocols and cost-effective compared with standard dose protocols. CONCLUSION The developing countries can initiate LDP as the first step of prophylaxis, but certainly this should not be the final goal of the health care system in any country. Due to the complex pathophysiological mechanisms underlying haemophilic arthropathy, long-term data on LDP in haemophilia patients are warranted.
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Affiliation(s)
- Shrimati Shetty
- K.J. Somaiya Hospital & Research Centre, Somaiya Ayurvihar, Mumbai, India
| | - Shweta Bansal
- K.J. Somaiya Hospital & Research Centre, Somaiya Ayurvihar, Mumbai, India
| | | | - Savita Rangarajan
- K.J. Somaiya Hospital & Research Centre, Somaiya Ayurvihar, Mumbai, India
| | - Kalpana Hajirnis
- K.J. Somaiya Hospital & Research Centre, Somaiya Ayurvihar, Mumbai, India
| | - Varsha Phadke
- K.J. Somaiya Hospital & Research Centre, Somaiya Ayurvihar, Mumbai, India
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13
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Huang K, Wang Y, Zhen Y, Li G, Wu X, Zhang N, Chen Z, Wu R. Inter-individual variability in pharmacokinetics and clinical features in pediatric patients with severe hemophilia A. Thromb Res 2022; 213:71-77. [DOI: 10.1016/j.thromres.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 01/13/2023]
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14
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Stimec J, Dover S, Pullenayegum E, Blanchette VS, Doria AS, Feldman BM, Carcao M, Rivard GE, Israels SJ, Chan AK, Steele M, Cloutier S, Klaassen RJ, Price VE, Sinha R, Laferriere N, Paradis E, Wu JKM, Babyn P. Magnetic resonance imaging in boys with severe hemophilia A: Serial and end-of-study findings from the Canadian Hemophilia Primary Prophylaxis Study. Res Pract Thromb Haemost 2021; 5:e12565. [PMID: 34703973 PMCID: PMC8520573 DOI: 10.1002/rth2.12565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study examined the structural outcomes for joints of boys with severe hemophilia A receiving frequency/dose-escalated primary prophylaxis using magnetic resonance imaging (MRI), and the importance of interval MRI changes. METHODS Forty-six subjects (27 with interval studies) were evaluated by radiographs (X-rays) and mid- and end-of-study MRIs (using the International Prophylaxis Study Group scale), as part of the Canadian Hemophilia Prophylaxis Study. The primary outcome was the presence of MRI osteochondral findings. RESULTS The median (range) time on study at the end-of-study MRI examination was 9.6 (4.8-16.0) years, during which 18 of 46 subjects (39%) had osteochondral changes in at least one joint. An interval change in MRI score of at least 1 point was observed in 44% of joints (43 ankles, 21 elbows, 4 knees); at least one joint showed this change in all 27 subjects. Self-reported interval hemarthrosis was associated with a higher likelihood of interval osteochondral change (odds ratio [OR], 1.49; 95% confidence interval [CI] = 1.08-2.06). Presence of synovial hypertrophy or hemosiderin on interval MRIs was associated with an OR of 4.71 (95% CI, 1.92-11.57) and 5.25 (95% CI, 2.05-13.40) of later osteochondral changes on MRI. DISCUSSION MRI changes were seen in 39% of subjects. Interval index joint bleeding was associated with an increased risk of later MRI changes, and earlier soft-tissue changes were associated with subsequent osteochondral changes.
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Affiliation(s)
- Jennifer Stimec
- Department of Medical ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
| | - Eleanor Pullenayegum
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Institute of Health Policy, Management & EvaluationThe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Andrea S. Doria
- Department of Medical ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Institute of Health Policy, Management & EvaluationThe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Manuel Carcao
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Georges E. Rivard
- Division of Hematology/OncologyDepartment of PediatricsCHU Sainte‐JustineMontrealQCCanada
| | - Sara J. Israels
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegMBCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - MacGregor Steele
- Section of Pediatric HematologyDepartment of PediatricsUniversity of Calgary and Alberta Children's HospitalCalgaryABCanada
| | - Stephanie Cloutier
- Centre de l’hémophilie de l'est du QuébecHôpital de l'Enfant‐JésusUniversité LavalQuébecQCCanada
| | - Robert J. Klaassen
- Division of Hematology OncologyChildren’s Hospital of Eastern Ontario Research InstituteOttawaONCanada
| | - Victoria E. Price
- Division of Pediatric Hematology/OncologyIWK Health CentreHalifaxNSCanada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders ProgramRoyal University HospitalSaskatoonSKCanada
| | - Nicole Laferriere
- Division of Hematology/OncologyThunder Bay Regional Cancer CareThunder BayONCanada
| | | | - John K. M. Wu
- Division of Hematology/Oncology/BMTDepartment of PediatricsUBC & BC Children’s HospitalVancouverBCCanada
| | - Paul Babyn
- Department of Medical ImagingUniversity of SaskatchewanSaskatoonSKCanada
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15
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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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16
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Tailored prophylaxis in children with severe hemophilia: A four-year Iranian study. Transfus Apher Sci 2021; 60:103212. [PMID: 34257016 DOI: 10.1016/j.transci.2021.103212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prophylaxis the current standard care for patients with severe hemophilia should be planned to optimize the replacement therapy and minimize bleeding. We report our single-center experience of tailored prophylaxis in children affected by hemophilia A (HA) and hemophilia B (HB). METHODS This study was conducted on 55 patients, under 15 years, with HA (PWHA, n: 46) and HB (PWHB, n: 9) between 2015 and 2019. According to the phenotype, three prophylaxis regimens: 25-50 unit/kg once, twice, or three-times a week for PWHA, and two: 30-50 unit/kg once or twice a week for PWHB were administered. Following the occurrence of > 3 joint bleeding, or > 4 soft tissue bleeding, or one spontaneous major bleeding in the last 3 months, the prophylaxis regimen is changed. Annualized bleeding rate (ABR), annualized joint bleeding rate (AJBR), target joints development, inhibitor development, and hemophilia joint health score (HJHS) also were assessed. RESULTS A mean ± SD of 2520 ± 1045 IU/kg/yr coagulation factor (F) VIII was used to reduce ABR and AJBR from 1.02 ± 1.11 and 0.8 ± 1.3 (in the first year of the study) to 0.27 ± 0.44 (P < 0.001) and 0.19 ± 0.38 (P = 0.004) (at the end of the study) in PWHA, respectively. Furthermore, in PWHB, in the first year of the study, with using 2168 ± 1216 IU/kg coagulation FIX, ABR and AJBR were 0.19 ± 0.39 and 0.06 ± 0.1. At the end of the study, ABR and AJBR were 0.02 ± 0.05 (p = 0.156) and 0.01 ± 0.03 (p = 0.361), respectively. During the study period, the mean number of the target joints and mean HJHS were 0.25 ± 0.57 and 7.6 ± 2.1 for PWHA and 0 and 6.3 ± 1.8 for PWHB, respectively. Finally, 5 PWHA (11 %) did not need dose-escalation in their prophylaxis regimen, whereas 31 (67 %) and 10 (21 %) PWHA needed two and three infusions a week, respectively. In PWHB, 7 (78 %) and 2 (22 %) were adjusted to receive a once and twice weekly regimen, respectively. CONCLUSION Our results suggest that tailored prophylaxis is an effective strategy to reduce the rate of bleeding and optimize the replacement therapy in children with hemophilia.
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17
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Kun H, Xu W, Zhou M, Li X, Xu Z, Fang Y, Li C, Chen Z, Wu R. Pharmacokinetics and complementary evaluation system-based guidance on prophylaxis of paediatric patients with haemophilia A in China with Kovaltry: protocol of the LEAP study. BMJ Open 2021; 11:e048432. [PMID: 34226228 PMCID: PMC8258559 DOI: 10.1136/bmjopen-2020-048432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Haemophilia A is a rare inherited bleeding disease caused by the deficiency of coagulation factor VIII (FVIII). The main treatment protocol is to administer regular exogenous FVIII concentrate infusions. With the discovery of variability in individualised pharmacokinetics (PK) and bleeding phenotype, the previous weight-based approach needs to be replaced by more advanced PK-tailored prophylaxis with an accurate evaluation system. In this study, we combine individualised PK profiles and a complementary evaluation system to guide prophylaxis in paediatric patients with haemophilia A. METHODS AND ANALYSIS This is a single-centre, prospective single-arm study. The aim of this study is to assess the effectiveness of a new strategy combining PK and a complementary evaluation system to treat haemophilia A in Chinese paediatric patients. Sixty paediatric patients with haemophilia will be recruited. After PK testing, they will receive a PK-guided stepup prophylaxis in the next 2 years. The dosing regimen will be determined according to individualised PK profiles and complementary evaluation findings. Related indicators at the end of the study will be compared with the values at treatment initiation to examine the effectiveness of this new strategy. The demographic data of the investigated patients will be summarised by descriptive statistics. Quantitative data will be described by summary statistics, including arithmetic median, range, mean and arithmetic SD. Analyses will use t-test to compare indicators such as bleeding rate and imaging score at both ends of the study as well as during follow-up. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of Beijing Children's Hospital (Number 2020-Z-095). The findings will be presented at international meetings such as World Federation of Hemophilia World Congress. Related manuscripts will be submitted to peer-review journals such as Blood and Hemophilia. TRIAL REGISTRATION NUMBER ChiCTR2000037821; Pre-results.
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Affiliation(s)
- Huang Kun
- Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiqun Xu
- Department of Hematology and Oncology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, Zhejiang, China
| | - Min Zhou
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaojing Li
- Department of Hematology, Chengdu Women & Children's New Century Hospital, Chengdu, China
| | - Zhongjin Xu
- Department of Hematology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yongjun Fang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University School of Medicine, Nanjing, China
| | - Changgang Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Runhui Wu
- Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
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18
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Goren R, Pullenayegum E, Blanchette VS, Dover S, Carcao M, Israels SJ, Chan A, Rivard GE, Steele M, Cloutier S, Klaassen RJ, Sinha R, Price VE, Laferriere N, Paradis E, Wu JK, Feldman BM. Patterns of joint damage in severe haemophilia A treated with prophylaxis. Haemophilia 2021; 27:666-673. [PMID: 34015166 DOI: 10.1111/hae.14345] [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: 07/29/2020] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objective of this study was to assess whether there are different patterns (classes) of joint health in young boys with severe haemophilia A (SHA) prescribed primary tailored prophylaxis. We also assessed whether age at first index joint bleed, blood group, FVIII gene abnormality variant, factor VIII trough level, first-year bleeding rate and adherence to the prescribed prophylaxis regimen significantly predicted joint damage trajectory, and thus class membership. METHODS Using data collected prospectively as part of the Canadian Hemophilia Primary Prophylaxis Study (CHPS), we implemented a latent class growth mixture model technique to determine how many joint damage classes existed within the cohort. We used a multinomial logistic regression to predict the odds of class membership based on the above predictors. We fitted a survival model to assess whether there were differences in the rate of dose escalation across the groups. RESULTS We identified three distinct classes of trajectory: persistently low, moderately increasing and rapidly increasing joint scores. By multinomial regression, we found that only age at first index joint bleed predicted rapidly increasing joint scores. The rapidly increasing joint score class group moved through dose escalation significantly faster than the other two groups. CONCLUSIONS Using tailored prophylaxis, boys with SHA follow one of three joint health trajectories. By using knowledge of disease trajectories, clinicians may be able to adjust treatment according to a subject's predicted long-term joint health and institute cost-effective programmes of prophylaxis targeted at the individual subject level.
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Affiliation(s)
- Rachel Goren
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victor S Blanchette
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Manuel Carcao
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Anthony Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, AB, Canada
| | - Stéphanie Cloutier
- Centre de l'hémophilie de l'est du Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada
| | - Robert J Klaassen
- Division of Pediatric Hematology/Oncology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders Program, Royal University Hospital, Saskatoon, SK, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | | | - John K Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - Brian M Feldman
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
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19
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Huang K, Zhen Y, Li G, Wu X, Wu R, Chen Z. Pharmacokinetic study of Kovaltry in thirty-five pediatric patients aged <12 years with severe hemophilia A. Haemophilia 2021; 27:e340-e346. [PMID: 33645868 DOI: 10.1111/hae.14276] [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: 12/16/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kovaltry (BAY81-8973) is an unmodified full-length factor VIII (FVIII) concentrate that enhances the pharmacokinetic (PK) profiles as compared to some other standard half-life time FVIII concentrates. However, the PK of Kovaltry in haemophiliac patients aged <12 years has not been reported previously. AIM To investigate the pharmacokinetics and clinical outcomes of Kovaltry in 35 paediatric patients aged <12 years. METHODS A total of 35 boys with severe haemophilia A were enrolled from August 2019 to May 2020 in Beijing Children's Hospital. After 72-hour washout, PK tests were performed post-infusion of 50 IU/kg Kovaltry in a five-timepoint assay. WinNonlin software was used to generate individual PK parameters. The dose, frequency and bleeding details were collected within the first 6 months after switching to Kovaltry from other FVIII concentrates. RESULTS Compared to the blood group O, patients with blood group non-O showed longer mean half-life (t1/2 ) (p < .01), lower mean clearance (CL) (p = .01) and similar in vivo recovery (IVR) (p = .51). Higher von Willebrand factor antigen (VWF:Ag) level was correlated to longer t1/2 (p < .0001) and lower CL (p < .01). IVR was correlated to body mass index (BMI) (p < .0001). Patients with trough level >3 IU/dL demonstrated lower annual bleeding rate (ABR) (p < .01), annual joint bleeding rate (AJBR) (p < .01) and annual spontaneous bleeding rate (ASBR) (p < .01). CONCLUSION This study firstly reported the PK profiles of Kovaltry in 35 paediatric patients <12 years old. The great inter-individual variability of PK parameters was also confirmed in these patients. VWF:Ag and blood group were major influencing factors of t1/2 and CL of Kovaltry, while BMI was a vital predictor for IVR. Patients with high trough FVIII level in routine prophylaxis had reduced bleeding rates.
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Affiliation(s)
- Kun Huang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - Yingzi Zhen
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - Gang Li
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - Xinyi Wu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - Runhui Wu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - Zhenping Chen
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
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20
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Bel F, Meunier S, Lienhart A, Revy A, Chamouard V. Evolution of clotting factor concentrates prescriptions and impact of recommendations of prophylaxis in children with haemophilia. Therapie 2020; 76:23-29. [PMID: 32711847 DOI: 10.1016/j.therap.2020.06.014] [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: 07/12/2019] [Revised: 04/09/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
Prophylaxis treatment is considered as the reference approach for children with severe haemophilia A or B. However, no consensus about the best prophylaxis protocol has yet been identified in term of dosage and timing of infusions. Guidelines were drawn up in France in the early 2000s by an expert group. The objective of this 16-year study (2001 to 2016) was to describe the clotting factor concentrates (CFCs) use in haemophiac outpatients. This is a retrospective monocentric study. Pharmaceutical and clinical data were captured using medical records. Main outcome measures are CFCs use and clinical data in paediatrics. Eighty haemophiliacs A or B under 12 years old with a factor level less than 2% were included (74% of HA), from pharmaceutical outpatient data. Global use of CFCs followed the evolution of the patients' number and regimen type introduced: increase of prophylaxis and decrease of on demand regimen. The average age at the prophylaxis introduction is significantly different according to the birth year. Prophylaxis introduction was made earlier with an increase of prophylactic regimen joined to an increase of CFCs use. The significant reduction of haemarthrosis in our cohort can be linked to a first infusion age and a prophylaxis introduction much earlier.
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Affiliation(s)
- Florianne Bel
- Pharmacie, groupement hospitalier Est, Hospices civils de Lyon, 61, boulevard Pinel, 69500 Bron, France
| | - Sandrine Meunier
- Centre régional de traitement de l'hémophilie, groupement hospitalier Est, Hospices civils de Lyon, 69500 Bron, France
| | - Anne Lienhart
- Centre régional de traitement de l'hémophilie, groupement hospitalier Est, Hospices civils de Lyon, 69500 Bron, France
| | - Alban Revy
- Pharmacie, groupement hospitalier Est, Hospices civils de Lyon, 61, boulevard Pinel, 69500 Bron, France
| | - Valérie Chamouard
- Pharmacie, groupement hospitalier Est, Hospices civils de Lyon, 61, boulevard Pinel, 69500 Bron, France; Centre régional de traitement de l'hémophilie, groupement hospitalier Est, Hospices civils de Lyon, 69500 Bron, France.
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21
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Na Songkla P, Seksarn P, Sosothikul D. Comparison of different prophylactic regimens for Thai children with moderate and severe haemophilia A. Haemophilia 2020; 26:e211-e213. [PMID: 32267988 DOI: 10.1111/hae.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Pokpong Na Songkla
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Panya Seksarn
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Darintr Sosothikul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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22
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Tolend M, Majeed H, Soliman M, Daruge P, Bordalo-Rodrigues M, Dertkigil SSJ, Gibikote S, Keshava SN, Stimec J, Dunn A, Li YJ, Blanchette V, Lundin B, Doria AS. Critical appraisal of the International Prophylaxis Study Group magnetic resonance image scale for evaluating haemophilic arthropathy. Haemophilia 2020; 26:565-574. [PMID: 32497355 DOI: 10.1111/hae.14032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022]
Abstract
A goal of the International Prophylaxis Study Group (IPSG) is to provide an accurate instrument to measure MRI-based disease severity of haemophilic arthropathy at various time points, so that longitudinal changes in disease severity can be identified to support decisions on treatment management. We review and discuss in this paper the evaluative purpose of the IPSG MRI scale in relation to its development and validation processes so far. We also critically appraise the validity, reliability and responsiveness of using the IPSG MRI scale in different clinical and research settings, and whenever applicable, compare these clinimetric properties of the IPSG MRI scale with those of its precursors, the compatible additive and progressive MRI scales.
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Affiliation(s)
- Mirkamal Tolend
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Haris Majeed
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Magdy Soliman
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Paulo Daruge
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | | | | | - Sridhar Gibikote
- Department of Radiology, Christian Medical College, Vellore, India
| | | | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Amy Dunn
- Department of Hematology, Nationwide Children's Hospital, Columbus, OH
| | - Ying-Jia Li
- Department of Radiology, Nanfang Hospital Hospital, Guangzhou, China
| | - Victor Blanchette
- Department of Hematology & Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Björn Lundin
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
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23
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Dover S, Blanchette VS, Wrathall D, Pullenayegum E, Kazandjian D, Song B, Hawes SA, Cloutier S, Rivard GE, Klaassen RJ, Paradis E, Laferriere N, Stain AM, Chan AK, Israels SJ, Sinha R, Steele M, Wu JKM, Feldman BM. Hemophilia prophylaxis adherence and bleeding using a tailored, frequency-escalated approach: The Canadian Hemophilia Primary Prophylaxis Study. Res Pract Thromb Haemost 2020; 4:318-325. [PMID: 32110763 PMCID: PMC7040543 DOI: 10.1002/rth2.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Standard of care for persons with severe hemophilia A includes regular replacement of factor VIII (FVIII). Prophylaxis regimens using standard half-life (SHL) FVIII concentrates, while effective, are costly and require frequent intravenous infusions. AIM This study evaluated the adherence of 56 boys with severe hemophilia A to tailored, frequency-escalated prophylaxis with an SHL recombinant FVIII concentrate. METHODS We reviewed the factor infusion and bleeding logs of study subjects. Adherence to the prescribed regimen was calculated on a weekly basis, and bleeding rates were determined from self/proxy-reported bleeding logs. The primary outcome was adherence to the prescribed prophylaxis regimen. RESULTS The median (range of values [ROV]) weekly adherence to prophylaxis was 85.7% (37.4%-99.8%). The median (ROV) adherent weeks on steps 1 (weekly), 2 (twice weekly), and 3 (alternate-day) were 92.9% (50%-100%), 80.3 (32%-96%), and 72.6% (14%-98%); relative to step 1, subjects were less likely to be adherent on steps 2 and 3 (P < 0.00). On step 1, our cohort had higher adherence than previously reported rates. The median (ROV) adherence to the breakthrough bleeding protocol was 47.1% (0%-100%). At any given time, bleeding risk was reduced by 15% for each 10% increase in adherence during the preceding 12 weeks (hazard ratio, 0.85; 95% confidence interval, 0.81-0.90). CONCLUSION This cohort had high rates of adherence to the prescribed prophylaxis regimen. Initiating prophylaxis with once-weekly infusions facilitated adherence to the prophylaxis regimen in this cohort of boys with severe hemophilia A started on primary prophylaxis at a very young age.
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Affiliation(s)
- Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Darius Wrathall
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Eleanor Pullenayegum
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Institute of Health Policy, Management and Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Daniel Kazandjian
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Byron Song
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/OncologyIWK Health CentreHalifaxNSCanada
| | - Stéphanie Cloutier
- Centre de l'hémophilie de l'est du QuébecHôpital de l’Enfant‐JésusUniversité LavalQuébecQCCanada
| | - Geroges E. Rivard
- Division of Hematology/OncologyDepartment of PediatricsCHU Sainte‐JustineMontrealQCCanada
| | - Robert J. Klaassen
- Division of Pediatric Hematology/OncologyChildren’s Hospital of Eastern OntarioUniversity of OttawaOttawaONCanada
| | | | - Nicole Laferriere
- Division of Hematology/OncologyThunder Bay Regional Cancer CareThunder BayONCanada
| | - Ann Marie Stain
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children’s HospitalMcMaster UniversityHamiltonONCanada
| | - Sara J. Israels
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegMBCanada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders ProgramRoyal University HospitalSaskatoonSKCanada
| | - MacGregor Steele
- Section of Pediatric HematologyDepartment of PediatricsUniversity of Calgary and Alberta Children’s HospitalCalgaryABCanada
| | - John K. M. Wu
- Division of Hematology/Oncology/BMTDepartment of PediatricsUBC & BC Children’s HospitalVancouverBCCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsFaculty of MedicineUniversity of TorontoTorontoONCanada
- Institute of Health Policy, Management and Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
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24
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Songnuy R, Seksarn P, Sosothikul D. Prophylactic vs episodic treatment to prevent bleeds and preserve joint function in Thai children with moderate and severe haemophilia A. Haemophilia 2019; 26:e18-e20. [PMID: 31762139 DOI: 10.1111/hae.13894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Ratchaneekorn Songnuy
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, King Chulalonkorm Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Panya Seksarn
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, King Chulalonkorm Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Darintr Sosothikul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, King Chulalonkorm Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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25
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McEneny-King A, Yeung CH, Edginton AN, Iorio A, Croteau SE. Clinical application of Web Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo): Patterns of blood sampling and patient characteristics among clinician users. Haemophilia 2019; 26:56-63. [PMID: 31742831 DOI: 10.1111/hae.13882] [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: 08/20/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Use of population pharmacokinetics (PopPK) to facilitate PK-informed prophylaxis in clinical practice has gained momentum among haemophilia providers due to the accessibility of tools such as the Web Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo) and availability of extended half-life (EHL) factor concentrates. It is unknown how clinicians implement PopPK. AIM To investigate the evolution of PopPK use in clinical practice by comparing blood sampling strategies, patient features, and factor group between initial and recent periods of WAPPS-Hemo availability. METHODS PK data for haemophilia A and haemophilia B patients from two time periods were extracted from the WAPPS-Hemo database: early availability (10/2015-09/2016) and recent use (10/2017-09/2018). We compared patient characteristics (age, body weight, haemophilia type), product type and dose, and blood sampling times between the time frames. RESULTS Over 1900 eligible infusions were submitted to WAPPS-Hemo during the periods studied, with 85% representing FVIII concentrates. In the recent cohort, PK profiles were requested for younger patients (median age 18 vs 26 years), with increased proportional EHL FVIII use (29% vs 14% of infusions). High-use centres generally submitted fewer blood samples per infusion than non-high-use centres, although the number of samples collected by non-high-use centres decreased significantly over time. During both periods, blood sample timing was generally consistent with ISTH recommended windows. CONCLUSION The use of WAPPS-Hemo by haemophilia providers grew by over threefold between the time periods investigated. While sampling times have included key time points proposed first by Björkman since early WAPPS-Hemo usage, a trend towards minimizing sampling was observed.
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Affiliation(s)
| | - Cindy Ht Yeung
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Clinical Epidemiology of Congenital Bleeding Disorders, McMaster University, Hamilton, ON, Canada
| | - Stacy E Croteau
- Boston Hemophilia Center, Boston Children's Hospital, Boston, MA, USA
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26
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Lalezari S, Reding MT, Pabinger I, Holme PA, Negrier C, Chalasani P, Shin HJ, Wang M, Tseneklidou-Stoeter D, Maas Enriquez M. BAY 94-9027 prophylaxis is efficacious and well tolerated for up to >5 years with extended dosing intervals: PROTECT VIII extension interim results. Haemophilia 2019; 25:1011-1019. [PMID: 31621991 PMCID: PMC6900134 DOI: 10.1111/hae.13853] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Introduction BAY 94‐9027 is an extended‒half‐life, site‐specifically PEGylated, B‐domain‒deleted recombinant factor VIII (FVIII). The PROTECT VIII main study demonstrated efficacy of bleed control using extended‐interval prophylaxis with BAY 94‐9027 for 36 weeks. Aim To report long‐term efficacy and safety of prophylaxis with BAY 94‐9027 in a descriptive analysis of the ongoing PROTECT VIII extension with a total treatment time of up to >5 years. Methods Previously treated males aged 12‐65 years with severe haemophilia A who completed the PROTECT VIII main study were eligible for the open‐label extension. Patients received on‐demand treatment or prophylaxis (30‒40 IU/kg twice weekly, 45‒60 IU/kg every 5 days, or 60 IU/kg every 7 days) and could switch regimens as needed. Results Patients (N = 121; on demand, n = 14; prophylaxis, n = 107) accumulated a median (range) of 3.9 years (297‒1965 days) and 223 (23‒563) total exposure days by 31 January 2018. During the extension, median (quartile [Q]1; Q3) annualized bleeding rates (ABRs) for total bleeds were 1.6 (0.3; 4.6) for patients receiving prophylaxis and 34.1 (20.3; 36.6) for patients receiving on‐demand treatment. ABRs for twice‐weekly (n = 23), every‐5‐days (n = 33), every‐7‐days (n = 23) and variable frequency (n = 28) treatments were 1.7, 1.2, 0.7 and 3.1, respectively. Of prophylaxis patients, 20.6% were bleed‐free throughout the extension (median time, 3.2 years), and 51.0% were bleed‐free during the last 6 months. No patients developed FVIII inhibitors. Conclusions BAY 94‐9027 prophylaxis was efficacious and well tolerated with dosing intervals up to every 7 days for a median (range) of 3.9 years (0.8‐5.4 years).
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Affiliation(s)
- Shadan Lalezari
- Israel National Hemophilia Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Mark T Reding
- Center for Bleeding and Clotting Disorders, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Pal Andre Holme
- Department of Haematology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claude Negrier
- Hemophilia Comprehensive Care Center and Hematology Department, Louis Pradel University Hospital, Lyon, France
| | | | - Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
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27
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Hashem F, Bladen M, Carroll L, Dodd C, Drechsler WI, Lowery D, Patel V, Pellatt-Higgins T, Saloniki E, Stephensen D. Protocol for a feasibility randomised controlled trial of a musculoskeletal exercise intervention versus usual care for children with haemophilia. BMJ Open 2019; 9:e029474. [PMID: 31375620 PMCID: PMC6688743 DOI: 10.1136/bmjopen-2019-029474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Haemophilia is a rare, inherited disorder in which blood does not clot normally, resulting in bleeding into joints and muscles. Long-term consequence is disabling joint pain, stiffness, muscle weakness, atrophy and reduced mobility. The purpose of this proposed feasibility of a randomised controlled trial (RCT) is to test the feasibility of an age-appropriate physiotherapy intervention designed to improve muscle strength, posture and the way boys use their joints during walking and everyday activities. METHODS AND ANALYSIS A small-scale two-centre RCT of a 12-week muscle strengthening exercise intervention versus usual care for young children with haemophilia will be conducted. Primary outcomes will be safety and adherence to the exercise intervention. Secondary outcomes will include recruitment, retention and adverse event rates, clinical data, muscle strength, joint biomechanics and foot loading patterns during walking, 6 min timed walk, timed-up-and-down-stairs, EQ-5D-Y, participants' perceptions of the study, training requirements and relevant costs. Recruitment, follow-up, safety and adherence rates will be described as percentages. Participant diary and interview data will be analysed using a framework analysis. Demographic and disease variable distributions will be analysed for descriptive purposes and covariant analysis. Estimates of differences between treatment arms (adjusted for baseline) and 75% and 95% CIs will be calculated. ETHICS AND DISSEMINATION The study has ethical approval from the London-Fulham Research Ethics Committee (17/LO/2043) as well as Health Research Authority approval. As well as informing the design of the definitive trial, results of this study will be presented at local, national and international physiotherapy and haemophilia meetings as well as manuscripts submitted to peer-reviewed journals. We will also share the main findings of the study to all participants and the Haemophilia Society.
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Affiliation(s)
- Ferhana Hashem
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | - Charlene Dodd
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Wendy I Drechsler
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - David Lowery
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Vishal Patel
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - T Pellatt-Higgins
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Eirini Saloniki
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Haemophilia Centre, Barts Health NHS Trust, London, UK
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28
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Low Dose Prophylaxis in Hemophilia Care. Indian J Hematol Blood Transfus 2019; 36:16-25. [PMID: 32158085 DOI: 10.1007/s12288-019-01147-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/10/2019] [Indexed: 01/25/2023] Open
Abstract
Hemophilia is an inherited bleeding disorder which causes impaired blood clotting. The severity of disease depends on the type of Hemophilia, level of clotting factor concentrate (CFC), phenotypic heterogeneity and the development of inhibitors. The currently accepted standard of care of this disease is prophylaxis therapy (PT) with CFC. Prophylaxis therapy for Hemophilia is given in developed countries for the last few decades. On the contrary, episodic therapy (ET) is still the mode of treatment in middle and low income countries. ET is documented to have several potential risks such as increased bleeding rate, disability due to haemarthrosis, poor quality of life and increased chances of mortality. Several studies conducted in developed countries have confirmed the clinical efficacy of PT in Hemophilia treatment. Currently, there exist several challenges for implementation of this effective treatment in resource poor nations. Low dose prophylaxis (LDP) has been developed as a solution to minimize these challenges and to provide better care for subjects with Hemophilia from low resource countries. The impact of LDP was evaluated by several recent studies and the reported clinical outcomes seem to suggest an optimistic future for this line of therapy. Several themes related to Hemophilia care like inhibitor development, tolerance, pharmacokinetics of CFCs and cost-benefit analysis of different prophylaxis regimens are currently understood poorly. These distinct elements are highly relevant to assess the actual benefits of LDP regimen in a global scale.
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29
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Wiley RE, Khoury CP, Snihur AWK, Williams M, Page D, Graham N, Laudenbach L, Milne-Wren C, Stoffman JM. From the voices of people with haemophilia A and their caregivers: Challenges with current treatment, their impact on quality of life and desired improvements in future therapies. Haemophilia 2019; 25:433-440. [PMID: 31016823 PMCID: PMC6850753 DOI: 10.1111/hae.13754] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/25/2022]
Abstract
Introduction Haemophilia A is a chronic disease requiring frequent intravenous infusions of recombinant factor VIII. Previous studies have shown that challenges associated with current treatments may have significant impacts on quality of life (QoL) that are as important as the health outcomes conferred by the therapy. Emerging therapeutic innovations offer the potential to mitigate treatment‐related challenges, and it is therefore important to develop a better understanding of patient and caregiver experiences with existing haemophilia A treatments in order to characterize the full value of new treatments. Aim To gather firsthand perspectives from people with haemophilia A (PWHA) and caregivers on the challenges with current treatment, their impact on QoL and desired improvements in future therapies. Methods Qualitative insights were gathered from 20 non‐inhibitor PWHA or caregivers of PWHA across Canada through one‐on‐one interviews; insights were further explored through focus group sessions to uncover overarching themes and prioritize issues with current treatments. Results PWHA and caregivers identified several challenges, including administration of intravenous infusions, coordination of treatment schedules and ensuring adequate medication and supplies. Participants described how these challenges impact psychosocial well‐being, physical health, personal/social life and work. Alternate modes of administration and longer‐lasting treatment effects were identified as desired improvements over current treatments. Conclusion This study emphasizes the impact that existing haemophilia A treatments have on psychological well‐being, employment opportunities and adherence to treatment regimens. These considerations may help to inform decision‐making for policymakers and health systems around the true value of new therapies entering the haemophilia market.
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Affiliation(s)
| | | | | | | | - David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Nicole Graham
- Health Sciences North Children's Treatment Centre, Sudbury, Ontario, Canada
| | | | - Cindy Milne-Wren
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Jayson M Stoffman
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Strategies for Individualized Dosing of Clotting Factor Concentrates and Desmopressin in Hemophilia A and B. Ther Drug Monit 2019; 41:192-212. [DOI: 10.1097/ftd.0000000000000625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gouw SC, Timmer MA, Srivastava A, de Kleijn P, Hilliard P, Peters M, Blanchette V, Fischer K. Measurement of joint health in persons with haemophilia: A systematic review of the measurement properties of haemophilia-specific instruments. Haemophilia 2019; 25:e1-e10. [PMID: 30427100 PMCID: PMC7379965 DOI: 10.1111/hae.13631] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/20/2018] [Accepted: 05/04/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Accurate assessment of joint health in persons with haemophilia is crucial. Several haemophilia-specific measurement tools are available, but an overview of the measurement properties is lacking. AIM To provide an overview of the measurement properties of haemophilia-specific measurement tools to assess clinical joint health. METHODS MEDLINE and EMBASE were searched for reports on reliability, validity or responsiveness of the World Federation of Haemophilia Orthopedic Joint Score (WFH), Colorado Physical Examination Score (CPE), joint examination score by Petrini (PJS) and Hemophilia Joint Health Score (HJHS). Methodological quality of the studies was assessed using an adapted COSMIN checklist. RESULTS The search yielded 2905 unique hits, and 98 papers were included. The methodological quality of the included studies was limited. The HJHS was studied most extensively, which yielded limited evidence for good internal consistency and structural validity, moderate evidence for hypothesis testing in adults and conflicting evidence for hypothesis testing in children. Reliability, measurement error and responsiveness were rated unknown due to low COSMIN scores. For the CPE and PJS, we found limited to moderate evidence for good responsiveness and conflicting evidence for hypothesis testing. CONCLUSION Only patchy evidence is available on the quality of measurement properties of all haemophilia-specific joint health scores. Although significant gaps in the evidence for all instruments remain, measurement properties of the HJHS were most extensively studied and show no drawbacks for use in clinical practice. This review forms the basis for further research aimed at the assessment of measurement properties of measurement tools to assess joint health.
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Affiliation(s)
- Samantha C. Gouw
- Department of Pediatric HematologyAcademic Medical CenterAmsterdamThe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterAmsterdamThe Netherlands
| | - Merel A. Timmer
- Van Creveldkliniek, Department of HematologyUniversity Medical CenterUtrechtThe Netherlands
| | - Alok Srivastava
- Department of HematologyChristian Medical CollegeVelloreIndia
| | - Piet de Kleijn
- Van Creveldkliniek, Department of HematologyUniversity Medical CenterUtrechtThe Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Pamela Hilliard
- Department of RehabilitationHospital for Sick ChildrenTorontoOntarioCanada
| | - Marjolein Peters
- Department of Pediatric HematologyAcademic Medical CenterAmsterdamThe Netherlands
| | - Victor Blanchette
- Department of Paediatrics, Division of Hematology/Oncology, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Kathelijn Fischer
- Van Creveldkliniek, Department of HematologyUniversity Medical CenterUtrechtThe Netherlands
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Attempting to remedy sub-optimal medication adherence in haemophilia: The rationale for repeated ultrasound visualisations of the patient's joint status. Blood Rev 2018; 33:106-116. [PMID: 30146094 DOI: 10.1016/j.blre.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 07/14/2018] [Accepted: 08/17/2018] [Indexed: 01/01/2023]
Abstract
Haemophilia is marked by joint bleeding (haemarthrosis) leading to cartilage damage (arthropathy). Lifelong prophylaxis-initiated after the first bleeding episode-leads to a dramatic decrease in arthropathy in haemophilia patients. However, adherence to continuous intravenous administrations of factor VIII (FVIII) or FIX products is challenging, and patients potentially suffer from breakthrough bleedings while on prophylaxis. Newer FVIII/FIX products with enhanced convenience attributes and/or easier infusion procedures are intended to improve adherence. However, pharmacokinetic data should be harmonised with information from individual attitudes and treatment needs, to tailor intravenous dosing and scheduling in patients who receive extended half-life products. Nor is there sound evidence as to how subcutaneous non-FVIII/FIX replacement approaches (concizumab; emicizumab; fitusiran) or single intravenous injections of adeno-associated viral vectors (when employing gene therapy) will revolutionize adherence in haemophilia. In rheumatoid arthritis, repeated ultrasound examination of a patient's major joints is a valuable tool to educate patients and parents to understand the disease and provide an objective framework for clinicians to acknowledge patient's adherence. Joint ultrasound examination in haemophilia significantly correlates with cartilage damage, effusion, and synovial hypertrophy evaluated by magnetic resonance imaging. Furthermore, in patients with haemophilia undergoing prophylaxis with an extended half-life product for a ≈ 2.8 year period, a significant continued improvement in joint health is detected at the physical examination. This provides the rationale for studies on repeated ultrasound examinations of joint status to attempt to remedy sub-optimal medication adherence and help identify which approach is most suited on which occasion and for which patient.
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Stoffman J, Andersson NG, Branchford B, Batt K, D'Oiron R, Escuriola Ettingshausen C, Hart DP, Jiménez Yuste V, Kavakli K, Mancuso ME, Nogami K, Ramírez C, Wu R. Common themes and challenges in hemophilia care: a multinational perspective. ACTA ACUST UNITED AC 2018; 24:39-48. [PMID: 30073913 DOI: 10.1080/10245332.2018.1505225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges. METHODS The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care. RESULTS The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice. DISCUSSION Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting. ABBREVIATIONS AHCDC: Association of Hemophilia Clinic Directors of Canada; AICE: Italian Association of Hemophilia Centres; ATHN: American Thrombosis and Hemostasis Network; EAHAD: European Association for Haemophilia and Allied Disorders; EHC: European Hemophilia Consortium; FIX: Coagulation Factor IX; FVIII: Coagulation Factor VIII; HAL: Haemophilia Activity List; HJHS: Haemophilia Joint Health Score; HTC: Hemophilia Treatment Centre; HTCCNC: Hemophilia Treatment Centre Collaborative Network of China; MASAC: Medical and Scientific Advisory Council; MDT: Multidisciplinary team; NHD: National Haemophilia Database; NHF: National Hemophilia Foundation; PK: Pharmacokinetics; POCUS: Point of care ultrasound; PWH: People with haemophilia; SHIELD: Supporting Hemophilia through International Education, Learning and Development; WFH: World Federation of Hemophilia.
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Affiliation(s)
- J Stoffman
- a Department of Pediatrics and Child Health , University of Manitoba , Winnipeg , Canada
| | - N G Andersson
- b Department for Thrombosis and Haemostasis Hematology , Skåne University Hospital , Scania , Sweden
| | - B Branchford
- c School of Medicine Research Complex 1 , University of Colorado , Aurora , CO , USA
| | - K Batt
- d Wake Forest Baptist University Medical Center, 1 Medical Center Blvd , Winston-Salem , NC , USA
| | - R D'Oiron
- e Centre de Traitement de l'Hémophilie et Maladies Hémorragiques Constitutionnelles Rares , Hôpitaux Universitaires Paris Sud - Hôpital Bicêtre , Le Kremlin-Bicêtre Cedex , France
| | | | - D P Hart
- g The Royal London Hospital Haemophilia Centre , Barts and The London School of Medicine & Dentistry , London , UK
| | - V Jiménez Yuste
- h Hospital Universitario La Paz - Hematology , Madrid , Spain
| | - K Kavakli
- i Department of Hematology , Ege University Children's Hospital , Izmir , Turkey
| | - M E Mancuso
- j Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre , University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan , Milan , Italy
| | - K Nogami
- k Department Pediatrics , Nara Medical University , Kashihara, Nara , Japan
| | - C Ramírez
- l Clinica Colsanitas , Fundación Universitaria Sanitas , Bogota , Colombia
| | - R Wu
- m Hemophilia Work Group, Hematology-Oncology Center , Beijing Children's Hospital affiliated to Capital Medical University , Beijing , People's Republic of China
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Sachdeva A, Gunasekaran V, Ramya HN, Dass J, Kotwal J, Seth T, Das S, Garg K, Kalra M, S. SR, Prakash A. Consensus Statement of the Indian Academy of Pediatrics in Diagnosis and Management of Hemophilia. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1302-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Carcao M, Lambert T, Leissinger C, Escuriola-Ettingshausen C, Santagostino E, Aledort L. Prophylaxis re-visited: The potential impact of novel factor and non-factor therapies on prophylaxis. Haemophilia 2018; 24:845-848. [DOI: 10.1111/hae.13558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- M. Carcao
- Division of Haematology/Oncology; Department of Paediatrics; Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - T. Lambert
- Haemophilia Care Centre; Bicêtre APHP University Hospital; Le Kremlin-Bicêtre France
| | - C. Leissinger
- Tulane University School of Medicine; New Orleans LA USA
| | | | - E. Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; University of Milan; Milan Italy
| | - L. Aledort
- Icahn School of Medicine; New York NY USA
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Castaman G, Linari S. Prophylactic versus on-demand treatments for hemophilia: advantages and drawbacks. Expert Rev Hematol 2018; 11:567-576. [PMID: 29886751 DOI: 10.1080/17474086.2018.1486704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Early long-term prophylaxis is the standard of care to prevent joint bleeding and chronic arthropathy in patients with severe hemophilia. Areas covered: Despite the obvious prophylaxis advantages upon the clinical outcomes, there are still several drawbacks to be addressed for the optimal patients' compliance. Frequency of treatment due to short half-life of conventional FVIII and FIX concentrates, difficult venous access, adherence to the prescribed therapy and costs may represent significant critical issues. The development of inhibitors also makes replacement therapy ineffective, preventing patients from receiving long-term prophylaxis. This paper will review these drawbacks and the tools to overcome these limitations, mainly thanks to the use of extended half-life products and the development of novel non-conventional therapeutic approaches. Expert commentary: The use of extended half-life products may help in reducing the burden of the frequent intravenous administration and in better tailoring an individualized prophylaxis. The development of novel therapeutic approaches, like the bi-specific antibody mimicking the coagulation function of FVIII or inhibition of anticoagulant proteins may facilitate prophylaxis treatment not only in patients with inhibitors, but also in severe hemophilia patients without inhibitors. Exciting opportunities are emerging for improving prophylaxis in hemophilia.
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Affiliation(s)
- Giancarlo Castaman
- a Center for Bleeding Disorders and Coagulation, Department of Oncology , Careggi University Hospital , Florence , Italy
| | - Silvia Linari
- a Center for Bleeding Disorders and Coagulation, Department of Oncology , Careggi University Hospital , Florence , Italy
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Feldman BM, Rivard GE, Babyn P, Wu JKM, Steele M, Poon MC, Card RT, Israels SJ, Laferriere N, Gill K, Chan AK, Carcao M, Klaassen RJ, Cloutier S, Price VE, Dover S, Blanchette VS. Tailored frequency-escalated primary prophylaxis for severe haemophilia A: results of the 16-year Canadian Hemophilia Prophylaxis Study longitudinal cohort. LANCET HAEMATOLOGY 2018; 5:e252-e260. [PMID: 29731369 DOI: 10.1016/s2352-3026(18)30048-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe haemophilia A has high morbidity, and treatment, while effective, is very expensive. We report the 16-year follow-up of the Canadian Hemophilia Prophylaxis Study, which examined the effectiveness of tailored frequency-escalated primary prophylaxis with a focus on health outcomes within the domains of body structures and functions, and activities and participation (according to the WHO International Classification of Functioning, Disability and Health [WHO-ICF] framework) and a view to reducing consumption of costly clotting factor, which accounts for more than 90% of the cost of care of severe haemophilia. METHODS In this longitudinal study, boys with severe haemophilia A from 12 Canadian centres were enrolled at age 1·0-2·5 years. They were treated with standard half-life recombinant factor VIII (SHL-rFVIII), beginning as once-weekly prophylaxis with 50 IU/kg and escalating in frequency (with accompanying dose adjustments) in response to breakthrough bleeding as determined by the protocol. The primary endpoint for this analysis was joint health, as measured by the modified Colorado Child Physical Examination Scores (CCPES) at study end. All analyses were done by intention to treat. The trial is complete, and is registered with ClinicalTrials.gov, number NCT01085344. FINDINGS Between June 26, 1997, and Jan 30, 2007, 56 boys were enrolled. They were followed for a median of 10·2 years (to a maximum of 16·1 years). Median rFVIII usage was about 3600 IU/kg per year. The median end-of-study CCPES physical examination score was 1 (IQR 1-3; range 0-12) for the left ankle and 1 (1-2; 0-12) for the right ankle, with all other joints having a median score of 0. No treatment-related safety events occurred over the duration of the study, including central venous catheter infections. The median annualised index joint bleeding rate was 0·95 per year (IQR 0·44-1·35; range 0·00-13·43), but 17 (30%) patients had protocol-defined unacceptable breakthrough bleeding at some point during the study. INTERPRETATION Tailored frequency-escalated prophylaxis leads to very little arthropathy and very good health outcomes within the WHO-ICF domains, and only uses a moderate amount of expensive clotting factor as compared with standard prophylaxis protocols. Some sequelae of bleeding were observed in our cohort, and future studies should consider a more stringent protocol of escalation. FUNDING This study was initially funded by grants from the Medical Research Council of Canada/Pharmaceutical Manufacturers Association of Canada Partnership Fund and the Bayer/Canadian Blood Services/Hema-Quebec Partnership Fund. Subsequent renewals were funded by Bayer.
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Affiliation(s)
- Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - John K M Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Man-Chiu Poon
- Department of Medicine, Division of Hematology and Hematologic Malignancies, Foothills Hospital, Calgary, AB, Canada
| | - Robert T Card
- Department of Hematology, Division of Oncology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | - Kulwant Gill
- Hemophilia Program, Laurentian Hospital, Sudbury, ON, Canada
| | - Anthony K Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Manuel Carcao
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Klaassen
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stephanie Cloutier
- Centre de l'hémophilie de l'est du Québec de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, QC, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Dargaud Y, Delavenne X, Hart D, Meunier S, Mismetti P. Individualized PK-based prophylaxis in severe haemophilia. Haemophilia 2018. [DOI: 10.1111/hae.13397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Dargaud
- Unité d'Hémostase Clinique; Hôpital Cardiologique Louis Pradel; CRTH de Lyon; CHU de Lyon France
| | - X. Delavenne
- INSERM, UMR 1059; Pôle Biologie-Pathologie; Hôpital Nord; CHU de Saint-Etienne France
| | - D.P. Hart
- The Royal London Haemophilia Centre; Barts and The London School of Medicine; Blizard Institute; QMUL; London UK
| | - S. Meunier
- Unité d'Hémostase Clinique; Hôpital Cardiologique Louis Pradel; CRTH de Lyon; CHU de Lyon France
| | - P. Mismetti
- INSERM, UMR 1059; Pôle Biologie-Pathologie; Hôpital Nord; CHU de Saint-Etienne France
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Stephensen D, Classey S, Harbidge H, Patel V, Taylor S, Wells A. Physiotherapist inter-rater reliability of the Haemophilia Early Arthropathy Detection with Ultrasound protocol. Haemophilia 2018; 24:471-476. [DOI: 10.1111/hae.13440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D. Stephensen
- Kent Haemophilia Centre; East Kent Hospitals NHS Trust Canterbury; Canterbury UK
- Haemophilia Centre; Royal London Hospital; Barts Health NHS Trust; London UK
| | - S. Classey
- Haemophilia Centre; St Thomas’ Hospital; Guys & St Thomas’ NHS Trust; London UK
| | - H. Harbidge
- Bristol Haemophilia Centre; Bristol Children's Hospital; University Hospitals Bristol NHS Trust; Bristol UK
| | - V. Patel
- Haemophilia Centre; Royal London Hospital; Barts Health NHS Trust; London UK
| | - S. Taylor
- Oxford Haemophilia Centre; Churchill Hospital; Oxford University Hospitals NHS Trust; Oxford UK
| | - A. Wells
- Basingstoke Haemophilia Centre; Hampshire Hospitals NHS Foundation Trust; Basingstoke UK
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Roman E, Larson PJ, Manno CS. Transfusion Therapy for Coagulation Factor Deficiencies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Fischer K, Carcao M, Santagostino E, Manco-Johnson MJ, Mathew P, Ljung R. Practical considerations in choosing a factor VIII prophylaxis regimen: Role of clinical phenotype and trough levels. Thromb Haemost 2017; 115:913-20. [DOI: 10.1160/th15-08-0664] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/28/2015] [Indexed: 11/05/2022]
Abstract
SummaryCurrent therapy for haemophilia A is guided by severity of the disease, which in turn is best reflected in patients' endogenous factor VIII activity levels. For patients with severe haemophilia (particularly children), prophylaxis with continuous routine factor replacement has become standard of care in developed countries and is gradually becoming the standard of care in developing countries. The question arises then: what is an appropriate prophylaxis regimen to prevent bleeding events and arthropathy, while also maximizing patient quality of life and taking into consideration the costs of prophylaxis? Should all patients be treated with one standard, fixed prophylaxis regimen, or should prophylaxis be individualised for each patient? If so, what factors need to be considered in choosing the appropriate dose and frequency of factor administration? If prophylaxis is tailored to the individual patient, then patient-related factors (bleeding phenotype, activity profiles, age, joint status) and product-specific factors (half-life of the replacement factor in the individual patient) will determine the choice of regimen, whether it be a fixed-regimen prophylaxis or prophylaxis that is tailored to patient activity and bleeding risk. Regardless of the choice of prophylaxis regimen, for any regimen to be effective, adherence to therapy is key to optimising outcomes.
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Cheng X, Li P, Chen Z, Zhang N, Zhen Y, Zhao L, Wang X, Wu R. Break-through bleeding in relation to pharmacokinetics of Factor VIII in paediatric patients with severe haemophilia A. Haemophilia 2017; 24:120-125. [PMID: 29194866 DOI: 10.1111/hae.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION As the pharmacokinetics (PK) of factor VIII (FVIII) is individualized in children with haemophilia A (HA), PK parameters may be indicators of patients' bleeding phenotype and instruction for their personalized replacement program. AIM The aim of this study was to investigate the possible relationship between PK/FVIII level and bleeding frequency in Chinese paediatric patients with severe (HA). METHODS A total of 24 patients were enrolled in Beijing Children's Hospital from February to October 2015, all of whom were given 50 IU/kg of FVIII concentrates after a 72-hours washout period. Samples' activities (FVIII:C) were tested at 5 time points, using WinNonlin software for PK testing, and then the individual half-life(t1/2 ) and the time (h) of FVIII concentrations <1 IU/dL within a week during prophylaxis were calculated. Baseline and the annual bleeding rate (ABR), annual joint bleeding rate (AJBR) were recorded and analyzed. RESULTS The mean t1/2 of FVIII was 10.20 ± 2.72 hours and the mean time of FVIII <1 IU/dL in 1 week was 44.7 hours (-38.56 to 102.33 hours). A significant relationship between t1/2 of FVIII and ABR0 /AJBR0 (baseline bleeding) was found (R2 = 0.75 and 0.62, P < .001). Besides, baseline and the annual bleeding rate during prophylactic treatment of haemophilia had a positive correlation with the time (hours) of FVIII <1 IU/dL in 1 week (R2 = 0.67 and 0.52, P < .001). CONCLUSION t1/2 was an important indicator to prevent bleeding in severe HA; the frequency of bleeding will be reduced with the increased of t1/2 of FVIII. The data also demonstrates that increasing the time with a FVIII<1 IU/dL is associated with an increased rate of bleeding during prophylaxis.
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Affiliation(s)
- X Cheng
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - P Li
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Z Chen
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - N Zhang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Y Zhen
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - L Zhao
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - R Wu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Antovic J, Mikovic D, Elezovic I, Holmström M, Wilkens M, Elfvinge P, Hourani Soutari N, Antovic A. Two global haemostatic assays as additional tools to monitor treatment in cases of haemophilia A. Thromb Haemost 2017; 108:21-31. [DOI: 10.1160/th11-11-0811] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/23/2012] [Indexed: 11/05/2022]
Abstract
SummaryHaemophilia A patients with similar levels of factor VIII (FVIII) may have different bleeding phenotypes and responses to treatment with FVIII concentrate. Therefore, a test which determines overall haemostasis may be appropriate for treatment monitoring in some patients. We studied two global haemostatic methods: endogenous thrombin potential (ETP) and overall haemostatic potential (OHP) before and after injection of FVIII concentrate in patients with haemophilia A treated prophylactically and on-demand. A significant correlation between FVIII and both ETP and OHP was observed, while ETP and OHP differed between patients with severe and mild clinical phenotypes. Both ETP and OHP differed significantly between severe, moderate and mild haemophilia A and controls. ETP and OHP increased after intravenous injection of FVIII concentrate in both groups of patients, but in spite of higher pre-treatment values of both ETP and OHP in patients treated prophylactically, and much higher post-treatment FVIII levels in comparison with the values in patients treated on-demand, no difference after treatment was observed for either ETP or OHP. ETP and OHP may be additional alternatives for monitoring (and even for individual tailoring) treatment in patients with haemophilia A.
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Wu R, Luke KH. The benefit of low dose prophylaxis in the treatment of hemophilia: a focus on China. Expert Rev Hematol 2017; 10:995-1004. [DOI: 10.1080/17474086.2017.1386096] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Runhui Wu
- Hemophilia Work Group, Hematology-Oncology Center, Beijing Children’s Hospital affiliated to Capital Medical University, Beijing, China
| | - Koon Hung Luke
- University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Canada
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Mannucci PM, Iacobelli M. Progress in the contemporary management of hemophilia: The new issue of patient aging. Eur J Intern Med 2017; 43:16-21. [PMID: 28532688 DOI: 10.1016/j.ejim.2017.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 01/09/2023]
Abstract
The management of inherited coagulation disorders such as hemophilia A and B has witnessed dramatic progresses since the last few decades of the last century. Accordingly, persons with hemophilia (PWH) now enjoy a life expectancy at birth not different from that of males in the general population, at least in high income countries. Nowadays, a substantial proportion of PWH are aging, like their peers in the general population. This outstanding progress is accompanied by problems that are in part similar to those of any old person (multiple concomitant diseases and the resulting intake of multiple drugs other than those specific for hemophilia treatment). In addition, older PWH suffer from the consequences of the comorbidities that developed when their treatment was at the same time poorly available and unsafe. Typical hemophilia comorbidities affect the musculoskeletal system following joint and muscle bleeds, but also the liver and kidney are often impaired due to previous bloodborne infections such as viral hepatitis and HIV. Thus, the comorbidities of hemophilia superimposed on the multimorbidity and polypharmacy associated with aging create peculiar problems in the current management of these patients, that demand the coordinated holistic intervention of internists, geriatricians and clinical pharmacologists in addition to the care traditionally provided by pediatricians and hematologists.
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47
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Fischer K, Ljung R. Primary prophylaxis in haemophilia care: Guideline update 2016. Blood Cells Mol Dis 2017; 67:81-85. [DOI: 10.1016/j.bcmd.2017.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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48
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Osooli M, Steen Carlsson K, Astermark J, Berntorp E. Surgery and survival in birth cohorts with severe haemophilia and differences in access to replacement therapy: The Malmö experience. Haemophilia 2017; 23:e403-e408. [PMID: 28758324 DOI: 10.1111/hae.13302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons with severe haemophilia require lifelong replacement therapy, prophylaxis, to prevent bleeding. Data describing long-term outcomes of prophylactic treatment are scarce. The aim of this study was to investigate joint surgery and survival among persons with severe haemophilia with special attention to access to prophylaxis in the early years of life. METHODS Eligible participants had severe haemophilia A or B and were treated at the Malmö centre from the 1960s onward. Time from birth until joint surgery was analysed for participants negative for factor inhibitor and alive in 2000. We compared survival among the entire cohort with severe haemophilia treated at the Malmö centre with the general male population of Sweden and a sample of persons with severe haemophilia from the United Kingdom (UK). RESULTS Overall, 167 participants were included, 106 (63.5%) of whom had complete data on joint surgery. Among those born before 1970, 1970-1979 and ≥1980 approximately 37%, 21% and 0% had their first joint surgery by age 30, respectively. There were no second joint surgeries reported in cohorts born ≥1970. Persons with severe haemophilia and negative for HIV treated in Malmö have attained approximately similar survival to that of the general male population in Sweden and live slightly longer than persons with severe haemophilia from the UK. DISCUSSION AND CONCLUSION Prophylaxis in Sweden, although costly, has markedly improved survival and joint outcomes for persons with severe haemophilia. This study highlights the importance of early start of replacement therapy to prevent or postpone serious joint damage.
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Affiliation(s)
- M Osooli
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - K Steen Carlsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Swedish Institute for Health Economics, Lund, Sweden
| | - J Astermark
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - E Berntorp
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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Andersson NG, Auerswald G, Barnes C, Carcao M, Dunn AL, Fijnvandraat K, Hoffmann M, Kavakli K, Kenet G, Kobelt R, Kurnik K, Liesner R, Mäkipernaa A, Manco-Johnson MJ, Mancuso ME, Molinari AC, Nolan B, Perez Garrido R, Petrini P, Platokouki HE, Shapiro AD, Wu R, Ljung R. Intracranial haemorrhage in children and adolescents with severe haemophilia A or B - the impact of prophylactic treatment. Br J Haematol 2017; 179:298-307. [DOI: 10.1111/bjh.14844] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/31/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Nadine G. Andersson
- Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
| | - Günter Auerswald
- Klinikum Bremen-Mitte; Professor Hess Children's Hospital; Bremen Germany
| | - Chris Barnes
- Haematology; Royal Children's Hospital; Melbourne Vic. Australia
| | - Manuel Carcao
- Division of Haematology/Oncology; Hospital for Sick Children; Toronto ON Canada
| | - Amy L. Dunn
- Division of Hematology, Oncology and Bone Marrow Transplant; Nationwide Children's Hospital and Ohio State University School of Medicine; Columbus OH USA
| | - Karin Fijnvandraat
- Department of Paediatric Haematology; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Marianne Hoffmann
- Department of Pediatrics and Adolescent Medicine; University Hospital Rigshospitalet; Copenhagen Denmark
| | - Kaan Kavakli
- Department of Haematology; Ege University Children's Hospital; Izmir Turkey
| | - Gili Kenet
- National Haemophilia Centre; Tel Hashomer and the Sackler Medical School; Tel Aviv University; Tel Aviv Israel
| | - Rainer Kobelt
- Hämophiliezentrum; Wabern and Children's Hospital of the University of Bern; Bern Switzerland
| | - Karin Kurnik
- Dr. von Hauner Children's Hospital; University of Munich; Munich Germany
| | - Ri Liesner
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - Anne Mäkipernaa
- Children's Hospital and Haematology; Cancer Center; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | | | - Maria E. Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; Fondazione IRCCS Ca' Granda; Milan Italy
| | - Angelo C. Molinari
- Dipartimento di Ematologia ed Oncologia; Unità Trombosi ed Emostasi; Ospedale Pediatrico Giannina Gaslini; Genoa Italy
| | | | | | - Pia Petrini
- Department of Paediatrics; Clinic of Coagulation Disorders; Karolinska Hospital; Stockholm Sweden
| | | | - Amy D. Shapiro
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - Runhui Wu
- Hematology-Oncology Center; Beijing Children's Hospital; Capital Medical University; National Center for Children's Health; Beijing China
| | - Rolf Ljung
- Department of Clinical Sciences Lund; Lund University; Lund Sweden
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50
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van den Berg HM. From treatment to prevention of bleeds: what more evidence do we need? Haemophilia 2017; 23:494-496. [DOI: 10.1111/hae.13256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 01/04/2023]
Affiliation(s)
- H. M. van den Berg
- Julius Centre for Health Sciences and Primary Care; University Hospital Utrecht; Utrecht Netherlands
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