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Castaman G, Borchiellini A, Santagostino E, Radossi P, Aksu S, Yilmaz M, Serban M, Uscatescu V, Truica C, Fasulo MR, Mancuso ME, Paladino E, Valpreda A, Guarnieri C, Macchia R, Scarpellini M, Mathew P, Morfini M. Non-Compartment and compartmental pharmacokinetics, efficacy, and safety of Kedrion FIX concentrate. Eur J Pharm Sci 2020; 153:105485. [PMID: 32712218 DOI: 10.1016/j.ejps.2020.105485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND An open-label phase II, multicenter clinical trial was conducted at 11 Haemophilia Centres in Italy, Romania, and Turkey, to evaluate the pharmacokinetics (PK), efficacy, and safety of high purity, plasma-derived, double virus inactivated and double nano-filtered factor IX (pd-FIX) concentrate (Kedrion FIX), EudraCT Number: 2005-006186-14. MATERIAL AND METHODS 16 previously treated patients (PTPs) with severe or moderately severe haemophilia B were enrolled in the study. At enrolment, 14 underwent the first PK assessment (PK I), and the second PK (PK II) assessment was performed after six months of treatment (5 on-demand and nine prophylaxis) at the end of the study. PK parameters were evaluated by Non-Compartmental Analysis (NCA), One-Compartment model (OCM), and Two-Compartment Model (TCM). Efficacy of Kedrion FIX in all 16 patients was evaluated by the number of bleeding events, and clinical response following the infusions. Periodic FIX inhibitor assays and thrombogenicity tests were scheduled throughout the study to assess the safety of the drug. RESULTS As compared to the published data on PK of pdFIX, Kedrion FIX displayed a longer half-life (22.37-55.73 hrs), reduced clearance, and regular volume of distribution at PK I by both NCA and OCM. The comparison of outcomes of PK II with those of PK I by OCM, also showed significant changes, particularly in patients on prophylaxis, who showed some improved parameters of PK. Due to two outlier values at the end of the trial, the NCA parameters of PK I were not compared to those of PK II. Breakthrough bleeds were successfully treated with 1 or 2 infusions. No significant adverse events were observed during the study. DISCUSSION During the six-month clinical study period, the use of Kedrion FIX resulted in a safe and effective pd-FIX concentrate with excellent PK characteristics.
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Affiliation(s)
- G Castaman
- Azienda Ospedaliero-Universitaria Careggi, Malattie Emorragiche e della Coagulazione, Largo Brambilla 3, 50134 Firenze, Italy
| | - A Borchiellini
- Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza, CRR Malattie emorragiche e Trombotiche dell'adulto Ematologia, Corso Bramante, Torino, Italy
| | - E Santagostino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Via Pace 9, 20122 Milano, Italy
| | - P Radossi
- Regional Hospital and Haemophilia Hospital, Castelfranco Veneto, Italy
| | - S Aksu
- Hacettepe University Medical Faculty, Department of Internal Medicine, Sihhiye/Ankara, Turkey
| | - M Yilmaz
- SANKO University, School of Medicine Sani Konukoglu Application and Research Hospital, Department of Hematology, Gaziantep, Turkey
| | - M Serban
- "Louis Turcanu" Children Clinical Emergency Hospital, 21 Nemoianu str., Timisoara, Romania
| | - V Uscatescu
- Clinical Institute Fundeni, Bucharest 2nd district, Romania
| | - C Truica
- "Dr. Constantin Opris" Country Emergency Hospital, Hematology Department, Baia Mare, Romania
| | - M R Fasulo
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Via Pace 9, Milano, Italy
| | - M E Mancuso
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Via Pace 9, Milano, Italy
| | - E Paladino
- Azienda Ospedaliero-Universitaria Careggi, Malattie Emorragiche e della Coagulazione Largo Brambilla 3, Firenze, Italy
| | - A Valpreda
- Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza, CRR Malattie emorragiche e Trombotiche dell'adulto Ematologia. Corso Bramante, Torino, Italy
| | - C Guarnieri
- Kedrion Biopharma, Global Medical Affairs, Castelvecchio Pascoli, Lucca, Italy
| | - R Macchia
- Kedrion Biopharma, Global Medical Affairs, Castelvecchio Pascoli, Lucca, Italy
| | - M Scarpellini
- Kedrion Biopharma, Global Medical Affairs, Castelvecchio Pascoli, Lucca, Italy
| | - P Mathew
- Prasad has a account Presbyterian Hospital, Albuquerque, NM, USA; Kedrion Biopharma, TA Lead Haematology, Global Medical Affairs, Fort Lee, NJ, USA
| | - M Morfini
- Italian Association of Haemophilia Centres (AICE), Milan, Italy.
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Fasulo MR, Biguzzi E, Abbattista M, Stufano F, Pagliari MT, Mancini I, Gorski MM, Cannavò A, Corgiolu M, Peyvandi F, Rosendaal FR. The ISTH Bleeding Assessment Tool and the risk of future bleeding. J Thromb Haemost 2018; 16:125-130. [PMID: 29064634 DOI: 10.1111/jth.13883] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Indexed: 11/28/2022]
Abstract
Essentials ISTH Bleeding Assessment Tool (ISTH-BAT) is used to assist the diagnosis of bleeding disorders. We examined whether the ISTH-BAT is capable of predicting the risk of future bleeding. 136 subjects were administered the ISTH-BAT and followed for up to four years. The ISTH-BAT score failed to predict the risk of future bleeding. SUMMARY Background The ISTH Bleeding Assessment Tool (ISTH-BAT) is a diagnostic tool used in subjects with suspected inherited bleeding disorders. Aim To evaluate whether the ISTH-BAT, applied at first work-up in a tertiary-care center, predicts the risk of subsequent bleeding events. Methods This was an observational cohort study including all consecutive subjects, of either sex and any age, referred between 2011 and 2015 because of a suspected bleeding disorder. The analysis was restricted to those with an ISTH-BAT score of ≥ 3. Incidence rates (IRs) of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) events were calculated as the number of events over accrued person-years. The main analysis was performed with Cox regression analysis, assessing an ISTH-BAT score of ≤ 5 versus a score of > 5, as well as the score as a continuous variable, and various covariates (sex, age, and presence/absence of a final diagnosis). Results One hundred and thirty-six subjects had a median ISTH-BAT score of 4 (range 3-18). Eleven subjects (8.1%) had a bleeding event during follow-up (one MB event; 10 CRNMB events). The overall IR of bleeding events per 100 person-years was 3.7 (95% confidence interval [CI] 1.8-6.6). No difference was observed between subjects with an ISTH-BAT score of ≤ 5 and those with a score of > 5 (hazard ratio [HR] 1.2, 95% CI 0.3-4.6). The results were similar when the ISTH-BAT score was considered as a continuous variable (HR 1.1, 95% CI 0.9-1.4). The IR of bleeding was increased in individuals with a diagnosis of a hemostatic defect (IR of 7.5 per 100 person-years; HR 3.0, 95% CI 0.8-11.8). Conclusions The ISTH-BAT does not identify patients at increased risk of future bleeding events.
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Affiliation(s)
- M R Fasulo
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - E Biguzzi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - M Abbattista
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - F Stufano
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - M T Pagliari
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - I Mancini
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - M M Gorski
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - A Cannavò
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - M Corgiolu
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
| | - F Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Mancuso ME, Chantarangkul V, Clerici M, Fasulo MR, Padovan L, Scalambrino E, Peyvandi F, Tripodi A, Santagostino E. Low thrombin generation during major orthopaedic surgery fails to predict the bleeding risk in inhibitor patients treated with bypassing agents. Haemophilia 2016; 22:e292-300. [DOI: 10.1111/hae.12939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 12/15/2022]
Affiliation(s)
- M. E. Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - V. Chantarangkul
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - M. Clerici
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - M. R. Fasulo
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - L. Padovan
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - E. Scalambrino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - F. Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
- Department of Pathophysiology and Transplantation; University of Milan; Milan Italy
| | - A. Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - E. Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
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Mancuso ME, Chantarangkul V, Clerici M, Fasulo MR, Padovan L, Scalambrino E, Peyvandi F, Tripodi A, Santagostino E. The thrombin generation assay distinguishes inhibitor from non-inhibitor patients with severe haemophilia A. Haemophilia 2016; 22:e286-91. [PMID: 27166132 DOI: 10.1111/hae.12927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with haemophilia A (HA) have impaired thrombin generation (TG) capacity and TG assay (TGA) values are linearly related to plasma factor VIII (FVIII) levels. AIM This study carried out in patients with unmeasurable FVIII (<1 IU dL(-1) ) was aimed at unravelling any difference in TG capacity in patients with or without inhibitors. METHODS Blood samples were collected from patients in a non-bleeding state, after a 5-day wash-out period from last treatment. RESULTS TGA was performed in 102 patients with severe HA (15% with high-responding inhibitors; 51% with null F8 mutations, that as expected were more prevalent in inhibitor than in non-inhibitor patients). TG capacity was significantly lower in inhibitor than non-inhibitor patients and in those with null mutations than in those with non-null mutations. When the TG capacity was evaluated only in patients with null mutations with and without inhibitors it was lower in the presence of inhibitors. CONCLUSIONS This study shows a greater TG impairment in inhibitor patients irrespective of FVIII levels, inhibitor titre and F8 mutation type, suggesting a role for the TGA in unravelling functional interferences of anti-FVIII inhibitors on coagulation system activation.
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Affiliation(s)
- M E Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - V Chantarangkul
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M Clerici
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M R Fasulo
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Padovan
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Scalambrino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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