1
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Han JH, Dupervil B, Mahajerin A, Kulkarni R, Manco-Johnson M, Thornburg C. Clinical and treatment characteristics of infants and toddlers less than 2 years of age with hemophilia. Blood Adv 2024; 8:2707-2717. [PMID: 38547443 DOI: 10.1182/bloodadvances.2023012486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/20/2024] [Indexed: 05/31/2024] Open
Abstract
ABSTRACT Infants and toddlers (ITs) with hemophilia have unique bleeding features. Factor prophylaxis has been shown to decrease the risk of intracranial hemorrhage (ICH), which supports recommendations to begin at a young age. Clinical and demographic characteristics were analyzed for 883 ITs ≤2 years old with hemophilia A and B, seen at US Hemophilia Treatment Centers and enrolled in the Community Counts Registry, a surveillance program of the Centers for Disease Control and Prevention. ICH in the first 2 years of life was seen in 68 of 883 (7.7%) ITs, of whom 8 of 68 (11.8%) were on continuous prophylaxis at the time of ICH. ITs in this study usually started prophylaxis within the first year of life (mean, 10.3 months), with earlier ages of prophylaxis initiation in later birth cohorts in ITs with hemophilia A. Compared with those without a family history (FH) of hemophilia, known positive FH of hemophilia was associated with earlier age of diagnosis (P ≤ .0001) and decreased rates of vaginal delivery (P = .0006). The use of factor VIII mimetics and extended half-life clotting factor prophylaxis increased with later birth cohorts for ITs with hemophilia A and B. The study highlights that ICH rates in ITs with hemophilia remains substantial and underscores the need for further research to identify modifiable risk factors to prevent ICH by earlier diagnosis and initiating prophylaxis early, even within the first month of life.
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Affiliation(s)
- Jennifer H Han
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN
| | - Brandi Dupervil
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Roshni Kulkarni
- Center for Bleeding and Clotting Disorders, Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI
| | - Marilyn Manco-Johnson
- Hemophilia & Thrombosis Center, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Courtney Thornburg
- Hemophilia & Thrombosis Treatment Center, Rady Children's Hospital San Diego, San Diego, CA
- Department of Pediatrics, University of California Health Sciences, La Jolla, CA
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2
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Tartarin H, Morotti A, Van Etten ES, Hausman-Kedem M, Charidimou A, Jouvent E, Susen S, Cordonnier C, Pasi M, Boulouis G. Uncommon Causes of Nontraumatic Intracerebral Hemorrhage. Stroke 2024; 55:1416-1427. [PMID: 38572651 DOI: 10.1161/strokeaha.123.043917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Nontraumatic intracerebral hemorrhage is an important health issue. Although common causes such as hypertension and cerebral amyloid angiopathy predominantly affect the elderly, there exists a spectrum of uncommon etiologies that contribute to the overall incidence of intracerebral hemorrhage. The identification of these rare causes is essential for targeted clinical management, informed prognostication, and strategic secondary prevention where relevant. This topical review explores the uncommon intracerebral hemorrhage causes and provides practical clues for their clinical and imaging identification. By expanding the clinician's differential diagnosis, this review aims to bridge the gap between standard intracerebral hemorrhage classification systems and the nuanced reality of clinical practice.
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Affiliation(s)
- Hugo Tartarin
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy (A.M.)
| | - Ellis S Van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.S.V.E.)
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv Unisversity, Israel (M.H.-K.)
| | | | - Eric Jouvent
- Neurology Department, Lariboisière Hosp, APHP and Université Paris Cité, France (E.J.)
| | - Sophie Susen
- Hematology and Transfusion Department, Centre Hospitalier Universitaire de Lille, France (S.S.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, France (C.C.)
| | - Marco Pasi
- Stroke unit, CHU Tours, Centre Val de Loire, France (M.P.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
- INSERM 1253 iBrain, Tours, Centre Val de Loire, France (G.B.)
- CIC-IT 14.15, Tours, Centre Val de Loire, France (G.B.)
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3
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Meier N, Fuchs H, Galactionova K, Hermans C, Pletscher M, Schwenkglenks M. Cost-Effectiveness Analysis of Etranacogene Dezaparvovec Versus Extended Half-Life Prophylaxis for Moderate-to-Severe Haemophilia B in Germany. PHARMACOECONOMICS - OPEN 2024; 8:373-387. [PMID: 38520664 PMCID: PMC11058170 DOI: 10.1007/s41669-024-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Haemophilia B is a rare genetic disease that is caused by a deficiency of coagulation factor IX (FIX) in the blood and leads to internal and external bleeding. Under the current standard of care, haemophilia is treated either prophylactically or on-demand via intravenous infusions of FIX. These treatment strategies impose a high burden on patients and health care systems as haemophilia B requires lifelong treatment, and FIX is costly. Etranacogene dezaparvovec (ED) is a gene therapy for haemophilia B that has been recently approved by the United States Food and Drug Administration and has received a recommendation for conditional marketing authorization by the European Medicines Agency. We aimed to examine the cost-effectiveness of ED versus extended half-life FIX (EHL-FIX) prophylaxis for moderate-to-severe haemophilia B from a German health care payer perspective. METHODS A microsimulation model was implemented in R. The model used data from the ED phase 3 clinical trial publication and further secondary data sources to simulate and compare patients receiving ED or EHL-FIX prophylaxis over a lifetime horizon, with the potential for ED patients to switch treatment to EHL-FIX prophylaxis when the effectiveness of ED waned. Primary outcomes of this analysis included discounted total costs, discounted quality-adjusted life years (QALYs), incremental cost-effectiveness, and the incremental net monetary benefit. The annual discount rate for costs and effects was 3%. Uncertainty was examined via probabilistic analysis and additional univariate sensitivity analyses. RESULTS Probabilistic analysis indicated that patients treated with ED instead of EHL-FIX prophylaxis gained 0.50 QALYs and experienced cost savings of EUR 1,179,829 at a price of EUR 1,500,000 per ED treatment. ED was the dominant treatment strategy. At a willingness to pay of EUR 50,000/QALY, the incremental net monetary benefit amounted to EUR 1,204,840. DISCUSSION Depending on the price, ED can save costs and improve health outcomes of haemophilia patients compared with EHL-FIX prophylaxis, making it a potentially cost-effective alternative. These results are uncertain due to a lack of evidence regarding the long-term effectiveness of ED.
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Affiliation(s)
- Niklaus Meier
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
| | - Hendrik Fuchs
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katya Galactionova
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Mark Pletscher
- Institute of Health Economics and Health Policy, Bern University of Applied Sciences, Bern, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
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4
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Hu J, Chandler M, Manuel CM, Caicedo J, Denne M, Ewenstein B, Mokdad AG, Xing S, Recht M. Risk of Intracranial Hemorrhage in Persons with Hemophilia A in the United States: Real-World Retrospective Cohort Study Using the ATHNdataset. J Blood Med 2024; 15:191-205. [PMID: 38699197 PMCID: PMC11063465 DOI: 10.2147/jbm.s443380] [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: 11/15/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Intracranial hemorrhage (ICH), a serious complication in persons with hemophilia A (PWHA), causes high rates of mortality and morbidity. Identified ICH risk factors from patient data spanning 1998-2008 require reassessment in light of changes in the current treatment landscape. Aim and methods PWHA identified in the ATHNdataset were evaluated retrospectively to assess incidence of ICH and determine the association between ICH risk and key characteristics using time-to-event analyses (Cox proportional-hazards models, survival curves, and sensitivity analyses). Results Over a median follow-up time of 10.7 patient-years, 135 of 7837 PWHA over 2 years of age in the ATHNdataset (1.7%) experienced an ICH. Stratification by prophylaxis status and inhibitor status resulted in an incidence rate (IR) ratio (IRR) (IR+/IR-) of 0.63 (95% confidence interval [CI], 0.43-0.94; P=0.020) and 1.76 (95% CI, 0.97-3.20; P=0.059), respectively. Characteristics associated with greater risk of developing ICH include being aged 2-12 years; being covered by Medicaid; having had HIV, hepatitis C, or hypertension; and never having received factor VIII or prophylactic treatment. In multivariable analysis with interaction, the estimated hazard ratio for PWHA never receiving prophylaxis was 7.67 (95% CI, 2.24-26.30), which shrunk to 2.03 (95% CI, 1.30-9.12) in bootstrapping analysis and 3.09 in the highest-penalty ridge-regression analysis but was still significant. Inhibitor status was found not to be statistically associated with ICH in all analyses. Conclusion These results align with previous studies demonstrating that prophylaxis confers a protective effect against ICH. Previously, inhibitor positivity had been shown to increase risk for ICH; however, this study did not corroborate those findings.
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Affiliation(s)
- Jianzhong Hu
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Martin Chandler
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | | | - Jorge Caicedo
- Rare Diseases and Hematology, Takeda Pharmaceuticals, U.S.A., Inc, Lexington, MA, USA
| | - Michael Denne
- Rare Diseases and Hematology, Takeda Pharmaceuticals, U.S.A., Inc, Lexington, MA, USA
| | - Bruce Ewenstein
- Rare Diseases and Hematology, Takeda Pharmaceuticals, U.S.A., Inc, Lexington, MA, USA
| | - Ali G Mokdad
- Rare Diseases and Hematology, Takeda Pharmaceuticals, U.S.A., Inc, Lexington, MA, USA
| | - Shan Xing
- US Value and Evidence Generation, Takeda Pharmaceuticals, U.S.A., Inc, Lexington, MA, USA
| | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
- Yale Center for Bleeding and Clotting Disorders, Yale University School of Medicine, New Haven, CT, USA
- National Bleeding Disorders Foundation, New York, NY, USA
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5
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Abshire TC. A treatment bridge for infants with hemophilia. Blood 2024; 143:1317-1318. [PMID: 38573607 DOI: 10.1182/blood.2023023576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Thomas C Abshire
- Versiti Blood Research Institute and Medical College of Wisconsin
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6
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Pipe SW, Collins P, Dhalluin C, Kenet G, Schmitt C, Buri M, Jiménez-Yuste V, Peyvandi F, Young G, Oldenburg J, Mancuso ME, Kavakli K, Kiialainen A, Deb S, Niggli M, Chang T, Lehle M, Fijnvandraat K. Emicizumab prophylaxis in infants with hemophilia A (HAVEN 7): primary analysis of a phase 3b open-label trial. Blood 2024; 143:1355-1364. [PMID: 38127586 PMCID: PMC11033591 DOI: 10.1182/blood.2023021832] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT Subcutaneous emicizumab enables prophylaxis for people with hemophilia A (HA) from birth, potentially reducing risk of bleeding and intracranial hemorrhage (ICH). HAVEN 7 (NCT04431726) is the first clinical trial of emicizumab dedicated to infants, designed to investigate the efficacy, safety, pharmacokinetics, and pharmacodynamics of emicizumab in those aged ≤12 months with severe HA without factor VIII (FVIII) inhibitors. Participants in this phase 3b trial received emicizumab 3 mg/kg maintenance dose every 2 weeks for 52 weeks and are continuing emicizumab during the 7-year long-term follow-up. Efficacy end points included annualized bleed rate (ABR): treated, all, treated spontaneous, and treated joint bleeds. Safety end points included adverse events (AEs), thromboembolic events (TEs), thrombotic microangiopathies (TMAs), and immunogenicity (anti-emicizumab antibodies [ADAs] and FVIII inhibitors). At primary analysis, 55 male participants had received emicizumab (median treatment duration: 100.3; range, 52-118 weeks). Median age at informed consent was 4.0 months (range, 9 days to 11 months 30 days). Model-based ABR for treated bleeds was 0.4 (95% confidence interval, 0.30-0.63), with 54.5% of participants (n = 30) having zero treated bleeds. No ICH occurred. All 42 treated bleeds in 25 participants (45.5%) were traumatic. Nine participants (16.4%) had ≥1 emicizumab-related AE (all grade 1 injection-site reactions). No AE led to treatment changes. No deaths, TEs, or TMAs occurred. No participant tested positive for ADAs. Two participants were confirmed positive for FVIII inhibitors. This primary analysis of HAVEN 7 indicates that emicizumab is efficacious and well tolerated in infants with severe HA without FVIII inhibitors.
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Affiliation(s)
| | - Peter Collins
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - Gili Kenet
- Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Muriel Buri
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Flora Peyvandi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Guy Young
- Children’s Hospital Los Angeles, Los Angeles, CA
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Maria Elisa Mancuso
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Humanitas University, Pieve Emanuele, Milan, Italy
| | - Kaan Kavakli
- Ege University Children’s Hospital Department of Hematology, Bornova, İzmir, Turkey
| | | | - Sonia Deb
- Genentech, Inc, South San Francisco, CA
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7
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Gupta N, Dutta A, Ahmed B, Ross CR, S C, Dolan G, John MJ, Radhakrishnan N, Aggarwal S, Seth T, Kaul V, Shah V. Expert Opinions on the Management of Hemophilia A in India: The Role of Emicizumab. Cureus 2024; 16:e58941. [PMID: 38725780 PMCID: PMC11081140 DOI: 10.7759/cureus.58941] [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] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
Hemophilia A (HA) is a genetic disorder of hemostasis associated with a deficiency or reduced activity of clotting factor VIII (FVIII). This disorder remains unacceptably underdiagnosed in India. Early diagnosis and appropriate management of HA can substantially prevent morbidity and mortality. Currently, HA is managed with regular replacement therapy using standard or extended half-life FVIII concentrates or non-factor drug products. The challenges associated with FVIII concentrates include plateauing of drug effect, issues with its administration and adherence to treatment, breakthrough bleeds, and the development of inhibiting antibodies against administered clotting factors. Emicizumab is a bispecific antibody, launched in India in April 2019, for managing patients with HA. To investigate the role of emicizumab in Indian patients with HA, opinions were sought from 13 eminent hematologists and experts from India on the effectiveness of emicizumab in preventing all bleeds, spontaneous bleeds, perioperative bleeds, and intracranial hemorrhage; resolving target joints; and reducing the rate of hospitalizations and fatality associated with HA in children and adults, with or without inhibitors. The benefits of emicizumab over traditional FVIII concentrates include the subcutaneous route of delivery, less frequent dosing, and a lack of inhibitor development, in addition to providing sustained hemostasis without in-depth monitoring. It is a safe and effective management option for all HA patients, especially for patients with certain archetypes, such as those with inhibitors, those with high annualized bleed rates, those living far away from hemophilia care centers, pediatric patients and infants with intravenous access challenges, and those with a history of life-threatening bleeding events.
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Affiliation(s)
- Naresh Gupta
- Medicine and Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
- Haematology & Haemophilia, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, IND
| | - Anupam Dutta
- General Medicine, Assam Medical College and Hospital, Dibrugarh, IND
| | - Bilal Ahmed
- Pathology, Transfusion Medicine & Hemophilia, Government Medical College, Srinagar, IND
| | - Cecil R Ross
- Hematology, St. John's Medical College and Hospital, Bangalore, IND
| | - Chandrakala S
- Clinical Haematology, King Edward Memorial Hospital, Mumbai, IND
| | - Gerard Dolan
- Haematology, St. Thomas' Haemophilia Comprehensive Care Centre, Bournemouth, GBR
| | - M J John
- Clinical Hematology, Hemato-Oncology & Bone Marrow Transplant, Christian Medical College & Hospital, Ludhiana, IND
| | - Nita Radhakrishnan
- Hematology and Oncology, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, IND
| | | | - Tulika Seth
- Hematology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Varun Kaul
- Pediatrics, Guru Gobind Singh Medical College & Hospital, Faridkot, IND
| | - Vijay Shah
- Pediatrics, Nirmal Hospital Pvt. Ltd., Surat, IND
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8
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Clark K, Patrick BM, Torian SC. Acute treatment of intracranial hemorrhage complicated by hemophilia a and emicizumab therapy. Am J Emerg Med 2024; 76:272.e1-272.e2. [PMID: 38123423 DOI: 10.1016/j.ajem.2023.11.051] [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: 11/03/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
Among patients with hemophilia A with or without FVIII inhibitors, emicizumab prophylaxis has demonstrated significantly reduced bleeding events. However, emicizumab interferes with clotting-based assays used for monitoring FVIII activity, resulting in falsely elevated FVIII activity. This lack of accurate monitoring can complicate the dosing of intravenous therapeutic FVIII clotting factor concentrates in the treatment of critical bleeding events. This case report aims to inform providers who frequently treat hemophilia-associated hemorrhages about emicizumab's effect on clotting-based assays essential for monitoring factor replacement.
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Affiliation(s)
- Kacie Clark
- Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA
| | - Brett M Patrick
- Department of Emergency Medicine, The University of Tennessee Health Science Center College of Medicine, 910 Madison Avenue, Memphis, TN 38104, USA
| | - Sterling C Torian
- Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA.
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9
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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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10
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Wang J, Chen J. Infection with COVID-19 is a risk factor for poor prognosis in patients with intracranial hemorrhage: A prospective observational cohort study. Medicine (Baltimore) 2023; 102:e35716. [PMID: 37960736 PMCID: PMC10637543 DOI: 10.1097/md.0000000000035716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 11/15/2023] Open
Abstract
This research aimed to explore the COVID-19 infection in the prognosis of patients with intracerebral hemorrhage (ICH), as well as analyzed the risk factors of the poor prognosis. This present prospective observational cohort study enrolled 136 patients with ICH who were admitted in our hospital during May 2020 to July 2022. The diagnosis of COVID-19 was confirmed by reverse transcriptase polymerase chain reaction. All patients were collected demographic and clinical data and were followed up for 3 months, and we used the modified Rankin scale (mRS) to assess the prognosis of ICH patients, mRS score ≥ 3 indicated a bad prognosis and mRS score ≤ 2 indicated a good prognosis. All data used SPSS 18.0 for statistical analyses. The mRS score after 3 months of patients in COVID-19 group were also remarkably elevated than that in the patients in control group (P < .05). The levels of fasting plasma glucose (FPG), D-dimer (D-D) were remarkably enhanced in the ICH patients in COVID-19 group compared to the control group (P < .05). The national institutes of health stroke scale scores, hematoma volume, the serum levels of white blood cell, FPG, D-D and the proportion of patients with diabetes were significantly higher while the Glasgow coma scale scores were significantly lower in bad prognosis group (P < .05). In addition, we found a significantly higher rate of COVID-19 infections in ICH patients with poor prognosis (P < .05). Infection of COVID-19, FPG, white blood cell, national institutes of health stroke scale, Glasgow coma scale and hematoma volume were the risk factors for poor prognosis in patients with ICH. This study showed that the proportion of patients with diabetes, the mRS score after 3 months and the levels of FPG, D-D were remarkably elevated in the ICH patients in COVID-19 group compared to the control group. This study may provide the effective preventive and treatment measures for the burden of ICH on families and society.
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Affiliation(s)
- Jia Wang
- Department of Critical Care Medicine, People’s Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Jin Chen
- Department of Critical Care Medicine, People’s Hospital of Dongxihu District, Wuhan, Hubei, China
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11
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Guan T, Ai D, Zhao N, Liu G, Yao W, Chen Z, Li Z, Zhou Y, Wu R. Treatment-related outcome from patient report outcome (PRO) of children with severe and moderate hemophilia A in China: An analysis report of registration data from patient organization "hemophilia home care center". Haemophilia 2023; 29:1467-1474. [PMID: 37718575 DOI: 10.1111/hae.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To assess current treatment-related outcomes for children with severe and moderate haemophilia A (cHA) in China. METHODS This cross-section Patient Report Outcome (PRO) report collected PRO data of severe and moderate cHAs registered in the 'Hemophilia Home Care Center' database (http://web.bjxueyou.cn) between January 2021 and November 2022. Data included records of bleeding, activities, and concentrates consumption. All patients had a confirmed diagnosis of moderate or severe haemophilia A (FVIII: C ≤ 5%) and were < 18 years old. RESULTS Among 1038 analysable cases, 9.6% of children with inhibitors had a higher rate of intracranial haemorrhage, dropout school rate, and higher FVIII consumption than children without inhibitors. Among 100 children with inhibitors, 36 patients were treated without immune tolerance induction (ITI), 14 patients with irregular treatment and 50 patients received ITI. Children with ITI had a lower ABR (2.4 (0,6.6) vs. 13.4 (9.5, 26.6), p<.001) and AJBR (0 (0, 3.1) vs. 8.9 (1.6, 19.3), p < .001) compared to those without ITI. Among 938 children without inhibitors, 28.5% received on-demand treatment and 71.5% received prophylaxis. Of 528 children with 1343.8 (1050.4, 2922.9)IU/kg/year median FVIII consumption, 43.0% received low-dose, 43.2% received intermediate-dose, and 13.8% received high-dose regimen; these children with prophylaxis had a lower ABR (3.1 (0, 10.7) vs. 12.8 (2.4, 45.5), p < .001), AJBR (0.5 (0, 3.9) vs. 3.0 (0, 12.0), p < .001) and disability rate (9.0% vs.18.5%, p = .032) compared to children who received on-demand treatment. CONCLUSION The high rate of drop-out of school and disability still present a huge gap to meet the needs in China. It is necessary to improve the level of medical accessibility and medicine affordability and strengthen the patient/parent's education in China.
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Affiliation(s)
- Tao Guan
- Beijing Hemophilia Home Care Centre, Beijing, China
| | - Di Ai
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Nan Zhao
- Beijing Hemophilia Home Care Centre, Beijing, China
| | - Guoqing Liu
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Wanru Yao
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Paediatric Research Institute, Beijing Childrenute Laborat, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Zhenping Li
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Yaohan Zhou
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Runhui Wu
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
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12
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Bhatti MQ, Gonzalez-Fernandez E, Bhatia K, Divani AA, Di Napoli M, Hinduja A, Datta YH. Neurological Complications Associated with Hereditary Bleeding Disorders. Curr Neurol Neurosci Rep 2023; 23:751-767. [PMID: 37864642 DOI: 10.1007/s11910-023-01313-y] [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] [Accepted: 09/15/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Hereditary bleeding disorders may have a wide variety of clinical presentations ranging from mild mucosal and joint bleeding to severe central nervous system (CNS) bleeding, of which intracranial hemorrhage (ICH) is the most dreaded complication. In this review, we will discuss the pathophysiology of specific hereditary bleeding disorders, namely, hemophilia A, hemophilia B, and von Willebrand disease (vWD); their clinical manifestations with a particular emphasis on neurological complications; a brief overview of management strategies pertaining to neurological complications; and a review of literature guiding treatment strategies. RECENT FINDINGS ICH is the most significant cause of morbidity and mortality in patients with hemophilia. Adequate control of bleeding with the administration of specific factors or blood products, identification of risk factors for bleeding, and maintaining optimal coagulant activity are essential for appropriately managing CNS bleeding complications in these patients. The administration of specific recombinant factors is tailored to a patient's pharmacokinetics and steady-state levels. During acute bleeding episodes, initial factor activity should be maintained between 80 and 100%. Availability of monoclonal antibody Emicizumab has revolutionized prophylactic therapies in patients with hemophilia. Management of ICH in patients with vWD involves using plasma-derived factor concentrates, recombinant von Willebrand factor, and supportive antifibrinolytic agents individualized to the type and severity of vWD. Hemophilia and vWD are the most common hereditary bleeding disorders that can predispose patients to life-threatening CNS complications-intracranial bleeds, intraspinal bleeding, and peripheral nerve syndromes. Early care coordination with a hematologist can help develop an effective prophylactic regimen to avoid life-threatening bleeding complications in these patients. Further research is needed to evaluate using emicizumab as an on-demand treatment option for acute bleeding episodes in patients with hemophilia.
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Affiliation(s)
| | | | - Kunal Bhatia
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Sulmona, L'Aquila, Italy
| | - Archana Hinduja
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yvonne H Datta
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
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13
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Chopra P, Singh M, Singh A, Masi A, Yurkofsky J, Zaita B, Kaur G. Perioperative Management of Spontaneous Intracranial Hemorrhage in a Patient With Hemophilia A in a Resource Limited Country. Cureus 2023; 15:e43485. [PMID: 37711951 PMCID: PMC10499499 DOI: 10.7759/cureus.43485] [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] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
Intracranial hemorrhage (ICH) is a serious complication of hemophilia A with high morbidity and mortality. The management of such cases is complicated by nonspecific and often delayed presentation, increased frequency of rebleeding, low awareness regarding clotting factor replacement, and debate regarding the efficacy of surgical interventions. We report a case of an 18-year-old male patient with hemophilia A, who first presented to the emergency department in India in a comatose state. Neuroimaging revealed subdural hematoma with midline shift and uncal herniation. The patient was successfully managed with perioperative cryoprecipitate and factor VIII replacement, tiered intracranial pressure lowering strategies, and early decompressive craniectomy with clot evacuation. In India, there are no standardized guidelines for screening and routine care for hereditary diseases like hemophilia. In a resource-deficient country, management was complicated by the limited availability of factor VIII in the emergent setting, as well as the inability to obtain serial factor levels in the postoperative period. We hope that this article helps to guide the management of ICH and hemophilia in resource-limited countries.
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Affiliation(s)
- Puneet Chopra
- Critical Care, Satguru Partap Singh (SPS) Hospital, Ludhiana, IND
| | - Manraj Singh
- Basic Biomedical Sciences, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Athena Masi
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
| | - Judith Yurkofsky
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
| | - Brittany Zaita
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
| | - Gurjinder Kaur
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
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14
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Abstract
PURPOSE OF REVIEW The purpose of this review is to review recent findings regarding stroke epidemiology, etiologies, and treatment in children and young adults. RECENT FINDINGS Incidence in young adults is increasing, and incidence, recurrence, and survival is worse in patients with cryptogenic stroke and in developing countries. Careful consideration of patent foramen ovale closure is now recommended in young adults with cryptogenic stroke. Thrombectomy has recently been extended to carefully selected children with acute ischemic stroke, and two recent publications strongly suggest that it can be beneficial for children. Sickle cell is also an important global contributor to stroke burden, but hydroxyurea can be a cost effective medication for stroke prevention in children. Recent advances in genetic testing and treatments may improve outcomes for patients with monogenic causes of stroke, such as deficiency of adenosine deaminase 2, hemophilia, and Fabry's disease. SUMMARY Stroke in children and young adults is a morbid disease responsible for enormous indirect societal costs and a high burden of years with disability per affected patient. Recent advances have improved access to care for children with large vessel occlusion and adults with rare causes of stroke. Future research may bring effective treatments for other monogenic causes of stroke as well as increasing access to hyperacute therapies for young stroke patients.
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Affiliation(s)
- Stuart Fraser
- Division of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas McGovern Medical School
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center Houston, Houston, Texas
| | - Lisa Pabst
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Fiona Smith
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas and Houston Methodist Sugar Land Hospital, Sugar Land, Texas
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15
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Dahra A, Mehdi Z, Gupta M, Patle V, Sharan S. Congenital Bleeding Disorders: Managing Central Nervous System Bleeding in an Adult Hemophiliac. Cureus 2023; 15:e36906. [PMID: 37128522 PMCID: PMC10148606 DOI: 10.7759/cureus.36906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Congenital bleeding disorders remain a challenge to healthcare in the developing world. Despite the initiation of gene therapy almost five decades ago, the natural history of hemophilia remains the same. The cost of concentrated plasma factors, the development of a high titer of inhibitors in severe hemophilia A (HA), and the associated enhanced propensity of ICH make advancements in disease management questionable. Severe cases of hemophilia die young due to spontaneous central nervous system bleeds due to the lack of standard guidelines for plasma concentrate replacement and the limited availability of products due to the associated economic burden. Monoclonal antibodies, although a promising option as a standardized prophylactic treatment, remain underutilized due to availability and accessibility issues. Here, we report the case of a 28-year-old male with HA who presented to the emergency with a progressively worsening headache, nausea, and elevated blood pressure. He had an intracerebral hemorrhage (ICH) successfully managed with decongestants and factor VIII supplementation.
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16
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Ay C, Kovacevic KD, Kraemmer D, Schoergenhofer C, Gelbenegger G, Firbas C, Quehenberger P, Jilma-Stohlawetz P, Gilbert JC, Zhu S, Beliveau M, Koenig F, Iorio A, Jilma B, Derhaschnig U, Pabinger I. The von Willebrand factor-binding aptamer rondaptivon pegol as a treatment for severe and nonsevere hemophilia A. Blood 2023; 141:1147-1158. [PMID: 36108308 PMCID: PMC10651782 DOI: 10.1182/blood.2022016571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
Factor VIII (FVIII) circulates in a noncovalent complex with von Willebrand Factor (VWF), the latter determining FVIII half-life. The VWF-binding aptamer rondaptivon pegol (BT200) increases plasma levels of VWF/FVIII in healthy volunteers. This trial assessed its safety, pharmacokinetics, and pharmacodynamics in hemophilia A. Nineteen adult patients (ages 20-62 years, 4 women) with hemophilia A (8 mild, 2 moderate, and 9 severe) received subcutaneous injections of rondaptivon pegol. After an initial fixed dose of 3 mg on days 0 and 4, patients received weekly doses of 2 to 9 mg until day 28. Severe hemophilia A patients underwent sparse-sampling population pharmacokinetics individual profiling after the final dose of rondaptivon pegol. Adverse events, pharmacokinetics, and pharmacodynamics were assessed. FVIII activity and VWF levels were measured. All patients tolerated rondaptivon pegol well. The geometric mean half-life of rondaptivon pegol was 5.4 days and rondaptivon pegol significantly increased VWF levels. In severe hemophilia A, 6 doses of rondaptivon pegol increased the half-lives of 5 different FVIII products from a median of 10.4 hours to 31.1 hours (range, 20.8-56.0 hours). Median FVIII increased from 22% to 48% in mild hemophilia A and from 3% to 7.5% in moderate hemophilia A. Rondaptivon pegol is a first-in-class prohemostatic molecule that extended the half-life of substituted FVIII approximately 3-fold and increased endogenous FVIII levels approximately 2-fold in hemophilia patients. This trial was registered at www.clinicaltrials.gov as #NCT04677803.
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Affiliation(s)
- Cihan Ay
- Clinical Division of Hematology and Hemastaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Daniel Kraemmer
- Clinical Division of Hematology and Hemastaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Peter Quehenberger
- Clinical Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Jilma-Stohlawetz
- Clinical Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Shuhao Zhu
- Guardian Therapeutics, Lexington, Massachusetts
| | | | - Franz Koenig
- CEMSIS, Medical University of Vienna, Vienna, Austria
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ulla Derhaschnig
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Hematology and Hemastaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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17
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Tran DQ, Benson CC, Boice JA, Chitlur M, Dunn AL, Escobar MA, Gupta K, Johnsen JM, Jorgenson J, Martin SD, Martin S, Meeks SL, Narvaez AA, Quon DV, Reding MT, Reiss UM, Savage B, Schafer K, Steiner B, Thornburg C, Volland LM, von Drygalski A. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities to transform the care of people with hemophilia. Expert Rev Hematol 2023; 16:19-37. [PMID: 36920859 PMCID: PMC10020869 DOI: 10.1080/17474086.2023.2171981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Decades of research have transformed hemophilia from severely limiting children's lives to a manageable disorder compatible with a full, active life, for many in high-income countries. The direction of future research will determine whether exciting developments truly advance health equity for all people with hemophilia (PWH). National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive inclusive all-stakeholder consultations to identify the priorities of people with inherited bleeding disorders and those who care for them. RESEARCH DESIGN AND METHODS Working group (WG) 1 of the NHF State of the Science Research Summit distilled the community-identified priorities for hemophilia A and B into concrete research questions and scored their feasibility, impact, and risk. RESULTS WG1 defined 63 top priority research questions concerning arthropathy/pain/bone health, inhibitors, diagnostics, gene therapy, the pediatric to adult transition of care, disparities faced by the community, and cardiovascular disease. This research has the potential to empower PWH to thrive despite lifelong comorbidities and achieve new standards of wellbeing, including psychosocial. CONCLUSIONS Collaborative research and care delivery will be key to capitalizing on current and horizon treatments and harnessing technical advances to improve diagnostics and testing, to advance health equity for all PWH.
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Affiliation(s)
- Duc Q. Tran
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University, Atlanta, Georgia, USA
| | - Craig C. Benson
- Sanofi ¬ Rare and Rare Blood Disorders Development, Cambridge, Massachusetts, USA
| | | | - Meera Chitlur
- Division of Hematology/Oncology, Central Michigan University College of Medicine, Detroit, Michigan, USA
| | - Amy L. Dunn
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Miguel A. Escobar
- Division of Hematology, UTHealth Houston McGovern Medical School, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
| | - Kalpna Gupta
- Center for Bleeding and Clotting Disorders, Division Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, California, USA
| | - Jill M. Johnsen
- Bloodworks Northwest, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | | | | | - Suzanne Martin
- Bleeding Disorders Association of South Carolina, Greenville, South Carolina, USA
| | - Shannon L. Meeks
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, USA
| | - Alfredo A Narvaez
- Louisiana Center for Bleeding & Clotting Disorders, Tulane University, New Orleans, Louisiana, USA
| | - Doris V. Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Hospital of Los Angeles, California, USA
| | - Mark T. Reding
- Center for Bleeding and Clotting Disorders, Division Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ulrike M. Reiss
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Brittany Savage
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Kim Schafer
- Davis Hemostasis and Thrombosis Center, University of California Davis, Sacramento, California, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | - Courtney Thornburg
- Rady Children’s Hospital-San Diego, San Diego, California, USA
- UC San Diego, La Jolla, California, USA
| | | | - Annette von Drygalski
- Hemophilia & Thrombosis Treatment Center, University of California San Diego, California, USA
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18
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Ter-Zakarian A, Al Banaa K, Barnes R, von Drygalski A. Hypertension in haemophilia: A meta-analysis. Haemophilia 2023; 29:352-356. [PMID: 36413602 DOI: 10.1111/hae.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/14/2022] [Accepted: 10/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Anna Ter-Zakarian
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Kadhim Al Banaa
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Richard Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
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19
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Shapiro AD, Hardesty BM, Peyvandi F, Iorio A. Prevalence of selected bleeding and thrombotic events in persons with hemophilia versus the general population: A scoping review. Res Pract Thromb Haemost 2023; 7:100007. [PMID: 36891522 PMCID: PMC9986102 DOI: 10.1016/j.rpth.2022.100007] [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: 05/05/2022] [Revised: 10/12/2022] [Accepted: 11/06/2022] [Indexed: 01/13/2023] Open
Abstract
Life expectancy for persons with hemophilia has increased over recent decades due to advances in treatment practice and patient care. Those with hemophilia are now more likely to be affected by conditions associated with aging, such as myocardial infarction, hemorrhagic/ischemic stroke, deep vein thrombosis, pulmonary embolism, and intracranial hemorrhage. Here, we describe the results of a literature search designed to summarize current data on the prevalence of the above selected bleeding and thrombotic events in persons with hemophilia vs the general population. A total of 912 articles published between 2005 and 2022 were identified in a search of BIOSIS Previews, Embase, and MEDLINE databases conducted in July 2022. Case studies, conference abstracts, review articles, studies focusing on hemophilia treatments or surgical outcomes, and studies examining patients with inhibitors only were excluded. After screening, 83 relevant publications were identified. The prevalence of bleeding events was consistently higher in hemophilia populations vs reference populations (hemorrhagic stroke, 1.4%-5.31% vs 0.2%-0.97%; intracranial hemorrhage, 1.1%-10.8% vs 0.04%-0.4%). Serious bleeding events showed a high rate of mortality with standardized mortality ratios for intracranial hemorrhage ranging from 3.5 to 14.88. Although 9 studies reported lower prevalence of arterial thrombosis (myocardial infarction/stroke) in hemophilia vs general populations, 5 studies reported higher or comparable prevalence in hemophilia. Prospective studies are therefore needed to understand the prevalence of bleeding and thrombotic events in hemophilia populations, particularly with the observed increases in life expectancy and availability of novel treatments.
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Affiliation(s)
- Amy D Shapiro
- Indiana Haemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | | | - Flora Peyvandi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - 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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20
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Astermark J, Blatný J, Königs C, Hermans C, Jiménez-Yuste V, Hart DP. Considerations for shared decision management in previously untreated patients with hemophilia A or B. Ther Adv Hematol 2023; 14:20406207231165857. [PMID: 37113810 PMCID: PMC10126613 DOI: 10.1177/20406207231165857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/04/2023] [Indexed: 04/29/2023] Open
Abstract
Recent advances in therapeutics are now providing a wide range of options for adults and children living with hemophilia. Although therapeutic choices are also increasing for the youngest individuals with severe disease, challenges remain about early management decisions, as supporting data are currently limited. Parents and healthcare professionals are tasked with helping children achieve an inclusive quality of life and maintain good joint health into adulthood. Primary prophylaxis is the gold standard to optimize outcomes and is recommended to start before 2 years of age. A range of topics need to be discussed with parents to aid their understanding of the decisions they can make and how these will affect the management of their child/children. For those with a family history of hemophilia, prenatal considerations include the possibility of genetic counseling, prenatal investigations, and planning for delivery, together with monitoring of the mother and neonate, as well as diagnosis of the newborn and treatment of any birth-associated bleeding. Subsequent considerations, which are also applicable to families where infant bleeding has resulted in a new diagnosis of sporadic hemophilia, involve explaining bleed recognition and treatment options, practical aspects of initiating/continuing prophylaxis, dealing with bleeds, and ongoing aspects of treatment, including possible inhibitor development. Over time, optimizing treatment efficacy, in which individualizing therapy around activities can play a role, and long-term considerations, including retaining joint health and tolerance maintenance, become increasingly important. The evolving treatment landscape is creating a need for continually updated guidance. Multidisciplinary teams and peers from patient organizations can help provide relevant information. Easily accessible, multidisciplinary comprehensive care remains a foundation to care. Equipping parents early with the knowledge to facilitate truly informed decision-making will help achieve the best possible longer-term health equity and quality of life for the child and family living with hemophilia. Plain language summary Points to be taken into account to help families make decisions to best care for children born with hemophilia Medical advances are providing a range of treatment options for adults and children with hemophilia. There is, however, relatively limited information about managing newborns with the condition. Doctors and nurses can help parents to understand the choices for infants born with hemophilia. We describe the various points doctors and nurses should ideally discuss with families to enable informed decision-making. We focus on infants who require early treatment to prevent spontaneous or traumatic bleeding (prophylaxis), which is recommended to start before 2 years of age. Families with a history of hemophilia may benefit from discussions before pregnancy, including how an affected child would be treated to protect against bleeds. When mothers are pregnant, doctors can explain investigations that can provide information about their unborn child, plan for the birth, and monitor mother and baby to minimize bleed risks at delivery. Testing will confirm whether the baby is affected by hemophilia. Not all infants with hemophilia will be born to families with a history of the condition. Identification of hemophilia for the first time in a family (which is 'sporadic hemophilia') occurs in previously undiagnosed infants who have bleeds requiring medical advice and possibly hospital treatment. Before any mothers and babies with hemophilia are discharged from hospital, doctors and nurses will explain to parents how to recognize bleeding and available treatment options can be discussed. Over time, ongoing discussions will help parents to make informed treatment decisions:• When and how to start, then continue, prophylaxis.• How to deal with bleeds (reinforcing previous discussions about bleed recognition and treatment) and other ongoing aspects of treatment. ○ For instance, children may develop neutralizing antibodies (inhibitors) to treatment they are receiving, requiring a change to the planned approach.• Ensuring treatment remains effective as their child grows, considering the varied needs and activities of their child.
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Affiliation(s)
| | - Jan Blatný
- Department of Pediatric Hematology, University
Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Christoph Königs
- Clinical and Molecular Hemostasis, Department
of Pediatrics, University Hospital Frankfurt, Goethe University, Frankfurt,
Germany
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of
Hematology, Cliniques Universitaires Saint-Luc, Université catholique de
Louvain (UCLouvain), Brussels, Belgium
| | - Victor Jiménez-Yuste
- Hematology Department, Hospital Universitario
La Paz, Autónoma University, Madrid, Spain
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21
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Barnes RFW, Pandey B, Sun HL, Jackson S, Kruse-Jarres R, Quon DV, von Drygalski A. Diabetes, hepatitis C and human immunodeficiency virus influence hypertension risk differently in cohorts of haemophilia patients, veterans and the general population. Haemophilia 2022; 28:e228-e236. [PMID: 35877992 DOI: 10.1111/hae.14637] [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: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/09/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The reasons for the high prevalence of hypertension in persons with haemophilia (PWH) are poorly understood. AIM To examine the roles of diabetes, Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) in the etiology of hypertension for PWH. METHODS Retrospective cross-sectional design. Adult PWH (n = 691) were divided into two groups: (A) free of diabetes, HCV and HIV; (B) with diabetes and/or HCV positivity and/or HIV positivity. Each group was matched by race and age with random samples from the general population of the US (National Health and Nutrition Examination Surveys, NHANES) and outpatients at the Veterans Affairs Medical Center (VAMC) in San Diego. Generalized additive models (GAMs) were fitted for graphical analysis of hypertension risk over the lifespan. RESULTS In Group A, PWH had the highest prevalence of hypertension compared to NHANES and VAMC, especially in young adults. In Group B, diabetes increased the risk of hypertension for all three cohorts (PWH, NHANES and VAMC), especially for PWH. In PWH, hypertension risk was also increased by HIV, in NHANES by HCV, and in VAMC by HCV and HIV. CONCLUSION Diabetes conferred the greatest risk of hypertension for all three cohorts. However, curves of hypertension in relation to age revealed that diabetes, HCV and HIV modulated hypertension risk differently in PWH. PWH experienced a disproportionally high risk increase with diabetes. Therefore, haemophilia care should include screening for hypertension and diabetes at a young age.
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Affiliation(s)
- Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Braj Pandey
- Department of Medicine, University of California San Diego, San Diego, California, USA.,Department of Primary Care, Veterans Affairs Medical Center, San Diego, California, USA
| | | | | | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopaedic Institute for Children, Los Angeles, California, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California, USA
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22
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GÖK V, ÜNAL E. Comprehensive approach to hemophilia. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1108174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hemophilia A, B are X-linked recessive bleeding disorder that typically results from a deficiency of clotting factor VIII (FVIII) and factor IX (FIX). The severity of the disease is determined according to the FVIII and FIX levels. Hemophilia A and B have similar symptoms and are both characterized by bleeding, particularly in large joints such as ankles, knees, elbows. Recurrent bleeding in joints eventually causes progressive hemophilic arthropathy. Life-threatening hemorrhages may occur rarely. Treatment of hemophilia has improved significantly in recent years with clotting factor concentrates. The average life expectancy was
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23
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Ter-Zakarian A, Barnes RFW, Kruse-Jarres R, Quon DV, Jackson S, Sun HL, Drygalski AV. Blood pressure in persons with haemophilia with a focus on haemophilia-specific risk factors. Haemophilia 2022; 28:977-985. [PMID: 35768896 DOI: 10.1111/hae.14614] [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: 03/11/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Persons with haemophilia (PWH) have a higher prevalence of hypertension compared to the general population, which cannot be explained entirely by the usual cardiovascular risk factors. Neutralizing antibodies (inhibitors) against clotting factors might have some relation to cardiovascular disease in PWH. However, whether inhibitors facilitate hypertension is unknown. AIM We investigated the relationship between hypertension/blood pressure and inhibitors in PWH. Additional goals were to determine the relationships with haemophilia type, race, and viral status. METHODS Records were extracted retrospectively for PWH (age ≥18 years) between 2003 and 2014 from four Hemophilia Treatment Centers in North America and included demographics, weight, height, haemophilia type/severity, HCV and HIV infection status, hypertension, use of anti-hypertensive medications, and inhibitor status. We fitted semiparametric generalized additive models (GAMs) to describe adjusted curves of blood pressure (BP) against age. RESULTS Among 691 PWH, 534 had haemophilia A and 157 had haemophilia B, with a median age of 39 years (range 18 to 79). Forty-four PWH (6.5%) had a history of inhibitors, without evidence for a higher prevalence of hypertension or higher BP. A higher prevalence of hypertension and higher BP were noted for haemophilia A (vs. haemophilia B), coinfection with HCV/HIV (vs. uninfected), or moderate haemophilia (vs. severe haemophilia). CONCLUSION While there was no signal to suggest that a history of inhibitors is associated with hypertension, differences based on haemophilia type, severity, and viral infection status were identified, encouraging prospective investigations to better delineate haemophilia-specific risk factors for hypertension.
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Affiliation(s)
- Anna Ter-Zakarian
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders and University of Washington, Seattle, Washington, USA
| | - Doris V Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles, California, USA
| | - Shannon Jackson
- Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, California, USA
| | - Haowei Linda Sun
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
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24
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Cnossen MH, van Moort I, Reitsma SH, de Maat MPM, Schutgens REG, Urbanus RT, Lingsma HF, Mathot RAA, Gouw SC, Meijer K, Bredenoord AL, van der Graaf R, Fijnvandraat K, Meijer AB, van den Akker E, Bierings R, Eikenboom JCJ, van den Biggelaar M, de Haas M, Voorberg J, Leebeek FWG. SYMPHONY consortium: Orchestrating personalized treatment for patients with bleeding disorders. J Thromb Haemost 2022; 20:S1538-7836(22)02096-7. [PMID: 35652368 PMCID: PMC9545335 DOI: 10.1111/jth.15778] [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: 02/03/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment choices for individual patients with an inborn bleeding disorder are increasingly challenging due to increasing options and rising costs for society. We have initiated an integrated interdisciplinary national research programme. OBJECTIVES The SYMPHONY consortium strives to orchestrate personalized treatment in patients with an inborn bleeding disorder, by unravelling the mechanisms behind inter-individual variations of bleeding phenotype. PATIENTS The SYMPHONY consortium will investigate patients with an inborn bleeding disorder, both diagnosed and not yet diagnosed. RESULTS Research questions are categorized under the themes: 1) Diagnosis; 2) Treatment; and 3) Fundamental research and consist of workpackages addressing specific domains. Importantly, collaborations between patients and talented researchers from different areas of expertise promise to augment the impact of the SYMPHONY consortium, leading to unique interactions and intellectual property. CONCLUSIONS SYMPHONY will perform research on all aspects of care, treatment individualization in patients with inborn bleeding disorders as well as diagnostic innovations and results of molecular genetics and cellular model technology with regard to the hemostatic process. We believe that these research investments will lead to health care innovations with long-term clinical and societal impact. This consortium has been made possible by a governmental, competitive grant from the Netherlands Organization for Scientific Research (NWO) within the framework of the NWA-ORC Call grant agreement NWA.1160.18.038.
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Affiliation(s)
- Marjon H. Cnossen
- Department of Pediatric Hematology and OncologyErasmus University Medical Center, Erasmus MC Sophia Children’s HospitalRotterdamthe Netherlands
| | - Iris van Moort
- Department of HematologyErasmus University Medical Center, Erasmus MC RotterdamRotterdamthe Netherlands
| | - Simone H. Reitsma
- Department of Pediatric Hematology and OncologyErasmus University Medical Center, Erasmus MC Sophia Children’s HospitalRotterdamthe Netherlands
| | - Moniek P. M. de Maat
- Department of HematologyErasmus University Medical Center, Erasmus MC RotterdamRotterdamthe Netherlands
| | - Roger E. G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Rolf T. Urbanus
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Hester F. Lingsma
- Department of Public HealthErasmus University Medical Center, Erasmus MC RotterdamRotterdamthe Netherlands
| | - Ron A. A. Mathot
- Department of Hospital Pharmacy‐Clinical PharmacologyAmsterdam University Medical CentersAmsterdamthe Netherlands
| | - Samantha C. Gouw
- Department of Pediatric HematologyEmma Children’s Hospital, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Karina Meijer
- Department of HematologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | | | - Rieke van der Graaf
- Julius Center for Health Sciences and Primary CareDepartment of Medical HumanitiesUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric HematologyEmma Children’s Hospital, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Sanquin Research, Department of Molecular HematologyAmsterdamthe Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Alexander B. Meijer
- Sanquin Research, Department of Molecular HematologyAmsterdamthe Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Emile van den Akker
- Sanquin Research, Department of HematopoiesisAmsterdamthe Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Ruben Bierings
- Department of HematologyErasmus University Medical Center, Erasmus MC RotterdamRotterdamthe Netherlands
| | - Jeroen C. J. Eikenboom
- Department of Internal Medicine, Division of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Maartje van den Biggelaar
- Sanquin Research, Department of Molecular HematologyAmsterdamthe Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Masja de Haas
- Sanquin Diagnostic Services and Center for Clinical Transfusion ResearchAmsterdamthe Netherlands
- Department of HematologyLeiden University Medical CenterLeidenthe Netherlands
| | - Jan Voorberg
- Sanquin Research, Department of Molecular HematologyAmsterdamthe Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Frank W. G. Leebeek
- Department of HematologyErasmus University Medical Center, Erasmus MC RotterdamRotterdamthe Netherlands
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25
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Zanon E, Pasca S, Demartis F, Tagliaferri A, Santoro C, Cantori I, Molinari AC, Biasoli C, Coppola A, Luciani M, Sottilotta G, Ricca I, Pollio B, Borchiellini A, Tosetto A, Peyvandi F, Frigo AC, Simioni P. Intracranial Haemorrhage in Haemophilia Patients Is Still an Open Issue: The Final Results of the Italian EMO.REC Registry. J Clin Med 2022; 11:jcm11071969. [PMID: 35407576 PMCID: PMC8999820 DOI: 10.3390/jcm11071969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Intracranial hemorrhage (ICH) is a highly serious event in patients with haemophilia (PWH) which leads to disability and in some cases to death. ICH occurs among all ages but is particularly frequent in newborns. Aim: The primary aim was to assess the incidence and mortality due to ICH in an Italian population of PWH. Secondary aims were to evaluate the risk factors for ICH, the role of prophylaxis, and the clinical management of patients presenting ICH. Methods: A retrospective-prospective registry was established in the network of the Italian Association of Haemophilia Centers to collect all ICHs in PWH from 2009 to 2019 reporting clinical features, treatments, and outcomes. Results: Forty-six ICHs were collected from 13 Centers. The ICHs occurred in 15 children (10 < 2 years), and in 31 adults, 45.2% of them with mild hemophilia. Overall, 60.9% patients had severe haemophilia (15/15 children). Overall ICH incidence (×1000 person/year) was 0.360 (0.270−0.480 95% CI), higher in children <2 years, 1.995 (1.110−3.442 95% CI). Only 7/46 patients, all with severe haemophilia, had received a prophylactic regimen before the ICH, none with mild. Inhibitors were present in 10.9% of patients. In adult PWHs 17/31 suffered from hypertension; 85.7% of the mild subjects and 29.4% of the moderate/severe ones (p < 0.05). ICH was spontaneous in the 69.6% with lower rate in children (46.7%). Surgery was required in 21/46 patients for cerebral hematoma evacuation. Treatment with coagulation factor concentrates for at least three weeks was needed in 76.7% of cases. ICH was fatal in 30.4% of the cases. Of the survivors, 50.0% became permanently disabled. Only one-third of adult patients received long term prophylaxis after the acute treatment. Conclusion: The results from our Registry confirm the still high incidence of ICH in infants <2 years and in adults, particularly in mild PWHs presenting hypertension and its unfavorable outcomes. The majority of PWHs were treated on-demand before ICH occurred, suggesting the important role of prophylaxis in preventing such life-threatening bleeding.
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Affiliation(s)
- Ezio Zanon
- Haemophilia Center-General Medicine, Padua University Hospital, 35128 Padua, Italy;
- Correspondence: ; Tel.: +39-049-8212-2666
| | - Samantha Pasca
- Department of Biomedical Sciences, Padua University Hospital, 35128 Padua, Italy;
| | - Francesco Demartis
- Centre for Bleeding Disorders, Careggi University Hospital of Florence, 50134 Florence, Italy;
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, 43126 Parma, Italy; (A.T.); (A.C.)
| | - Cristina Santoro
- Hematology Division, Umberto I University Hospital of Rome, 00185 Rome, Italy;
| | - Isabella Cantori
- Haemophilia Center, Department of Transfusion Medicine, Hospital of Macerata, 62100 Macerata, Italy;
| | - Angelo Claudio Molinari
- Regional Reference Centre for Hemorrhagic Diseases, Thrombosis and Hemostasis Unit, Gaslini Children Hospital of Genoa, 16147 Genova, Italy;
| | - Chiara Biasoli
- Haemophilia Center, Transfusion Medicine, Department of Clinical Pathology, Hospital of Cesena, 47521 Cesena, Italy;
| | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, 43126 Parma, Italy; (A.T.); (A.C.)
| | - Matteo Luciani
- Haemostasis and Thrombosis Center, Onco-Hematology Department, Bambin Gesù Children Hospital of Rome, 00165 Roma, Italy;
| | - Gianluca Sottilotta
- Haemophilia Center, Department of Onco-Hematology and Radioterapy, Hospital of Reggio Calabria, 89124 Reggio Calabria, Italy;
| | - Irene Ricca
- Transfusion Medicine, Department of Diagnostic, Regina Margherita Children Hospital of Turin, 10126 Turin, Italy; (I.R.); (B.P.)
| | - Berardino Pollio
- Transfusion Medicine, Department of Diagnostic, Regina Margherita Children Hospital of Turin, 10126 Turin, Italy; (I.R.); (B.P.)
| | | | - Alberto Tosetto
- Hemorrhagic and Thrombotic Diseases Unit, S. Bortolo Hospital of Vicenza, 36100 Vicenza, Italy;
| | - Flora Peyvandi
- Hemophilia and Thrombosis Center, University Hospital of Milan, 20132 Milan, Italy;
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health Padua University Hospital, 35122 Padova, Italy;
| | - Paolo Simioni
- Haemophilia Center-General Medicine, Padua University Hospital, 35128 Padua, Italy;
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26
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Can we do something about ICH in hemophilia? Blood 2021; 138:2750-2751. [PMID: 34967868 DOI: 10.1182/blood.2021013536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022] Open
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