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Dargaud Y, Negrier C, Rusen L, Windyga J, Georgiev P, Bichler J, Solomon C, Knaub S, Lissitchkov T, Klamroth R. Individual thrombin generation and spontaneous bleeding rate during personalized prophylaxis with Nuwiq®(human-cl rhFVIII) in previously treated patients with severe haemophilia A. Haemophilia 2018; 24:619-627. [DOI: 10.1111/hae.13493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Dargaud
- Hopital Cardiologique Louis Pradel; University of Lyon; Lyon France
| | - C. Negrier
- Hopital Cardiologique Louis Pradel; University of Lyon; Lyon France
| | | | - J. Windyga
- Department of Disorders of Haemostasis and Internal Medicine; Institute of Haematology and Transfusion Medicine; Warsaw Poland
| | - P. Georgiev
- Clinic of Haematology; University Multiprofile Hospital for Active Treatment “Sveti Georgi” and Medical University; Plovdiv Bulgaria
| | | | - C. Solomon
- Octapharma AG; Lachen Switzerland
- Department of Anesthesiology; Perioperative Care and General Intensive Care; Salzburg University Hospital; Paracelsus Medical University; Salzburg Austria
| | - S. Knaub
- Octapharma AG; Lachen Switzerland
| | - T. Lissitchkov
- Department of Clinical Haematology in Haemorrhagic Diathesis and Anaemia; Specialized Hospital for Active Treatment “Joan Pavel”; Sofia Bulgaria
| | - R. Klamroth
- Vivantes Klinikum im Friedrichshain; Berlin Germany
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Rusen L, Kavakli K, Korth-Bradley J, Huard F, Rendo P, Fuiman J, Baumann JA, Smith L, Alvey C, Rupon J. Clinical experience with moroctocog alfa (AF-CC) in younger paediatric patients with severe haemophilia A: Two open-label studies. Haemophilia 2018; 24:604-610. [PMID: 29582525 DOI: 10.1111/hae.13466] [Citation(s) in RCA: 5] [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: 02/14/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The pharmacokinetics (PK), efficacy and safety of moroctocog alfa (AF-CC) have been demonstrated in haemophilia A patients aged ≥6 years. AIM These studies aimed to further describe moroctocog alfa (AF-CC) experience in paediatric patients (<12 years) with severe haemophilia A (FVIII:C < 1%). METHODS Two prospective, open-label studies enrolled patients aged <12 years: one study with 37 previously treated patients (PTPs) and another with 23 previously untreated patients (PUPs). All patients initially received 50 IU/kg of moroctocog alfa (AF-CC) to evaluate either recovery alone, or with other PK parameters (6 to <12 years) before continuing treatment for 100 exposure days (EDs) or 24 months. RESULTS At baseline, mean (±SD) recovery ranged between 1.32 ± 0.65 (PUPs aged <2 years) and 2.13 ± 0.82 (PTPs aged 6 to <12 years). The mean (±SD) half-life was 9.12 ± 1.94 hours in PTPs aged 6 to <12 years. No new safety signals were detected in either study, 2 transient lower titre inhibitors occurred in PTPs while 8 inhibitors (3 low and 5 high titre) were detected in PUPs. Most bleeding episodes resolved with one infusion (94% [893/954]). The annualised bleeding rate (ABR) in the PTP study was 27.5 and 4.2 for patients reporting an on-demand and routine prophylaxis regimen at baseline, respectively. In the PUP study, the overall ABR was 5.9. CONCLUSION Moroctocog alfa (AF-CC) had expected PK findings (lower recovery in young children compared with older children) along with being safe and efficacious in a population of young severe haemophilia A patients.
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Affiliation(s)
- L Rusen
- Prof. Dr. C. T. Nicolau National Institute for Transfusional Haematology, Bucharest, Romania
| | - K Kavakli
- Department of Haematology, Ege University Children's Hospital, Izmir, Turkey
| | - J Korth-Bradley
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - F Huard
- Global Product Development, Pfizer Inc., Paris, France
| | - P Rendo
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - J Fuiman
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - J A Baumann
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - L Smith
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | - C Alvey
- Pfizer Inc., Groton, CT, USA
| | - J Rupon
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
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Manco-Johnson MJ, Lundin B, Funk S, Peterfy C, Raunig D, Werk M, Kempton CL, Reding MT, Goranov S, Gercheva L, Rusen L, Uscatescu V, Pierdominici M, Engelen S, Pocoski J, Walker D, Hong W. Effect of late prophylaxis in hemophilia on joint status: a randomized trial. J Thromb Haemost 2017; 15:2115-2124. [PMID: 28836341 DOI: 10.1111/jth.13811] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 10/31/2016] [Indexed: 11/29/2022]
Abstract
Essentials High-quality data are lacking on use of prophylaxis in adults with hemophilia and arthropathy. SPINART was a 3-year randomized clinical trial of late/tertiary prophylaxis vs on-demand therapy. Prophylaxis improved function, quality of life, activity and pain but not joint structure by MRI. Prophylaxis improves function but must start before joint bleeding onset to prevent arthropathy. SUMMARY Background Limited data exist on the impact of prophylaxis on adults with severe hemophilia A and pre-existing joint disease. Objectives To describe 3-year bleeding, joint health and structure, health-related quality-of-life (HRQoL) and other outcomes from the open-label, randomized, multinational SPINART study. Patients/Methods Males aged 12-50 years with severe hemophilia A, ≥ 150 factor VIII exposure days, no inhibitors and no prophylaxis for > 12 consecutive months in the past 5 years were randomized to sucrose-formulated recombinant FVIII prophylaxis or on-demand therapy (OD). Data collected included total and joint bleeding events (BEs), joint structure (magnetic resonance imaging [MRI]), joint health (Colorado Adult Joint Assessment Scale [CAJAS]), HRQoL, pain, healthcare resource utilization (HRU), activity, and treatment satisfaction. Results Following 3 years of prophylaxis, adults maintained excellent adherence, with a 94% reduction in BEs despite severe pre-existing arthropathy; 35.7% and 76.2% of prophylaxis participants were bleed-free or had fewer than two BEs per year, respectively. As compared with OD, prophylaxis was associated with improved CAJAS scores (least squares [LS] mean, - 0.31 [n = 42] versus + 0.63 [n = 42]) and HAEMO-QoL-A scores (LS mean, + 3.98 [n = 41] versus - 6.00 [n = 42]), less chronic pain (50% decrease), and approximately two-fold less HRU; activity, Euro QoL-5D-3L (EQ-5D-3L) scores and satisfaction scores also favored prophylaxis. However, MRI score changes were not different for prophylaxis versus OD (LS mean, + 0.79 [n = 41] versus + 0.96 [n = 38]). Conclusions Over a period of 3 years, prophylaxis versus OD in adults with severe hemophilia A and arthropathy led to decreased bleeding, pain, and HRU, better joint health, activity, satisfaction, and HRQoL, but no reduction in structural arthropathy progression, suggesting that pre-existing joint arthropathy may be irreversible.
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Affiliation(s)
| | - B Lundin
- Lund University and Skåne University Hospital, Lund, Sweden
| | - S Funk
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, FL, USA
| | - D Raunig
- ICON Medical Imaging, Warrington, PA, USA
| | - M Werk
- Martin-Luther-Krankenhaus, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - M T Reding
- University of Minnesota, Minneapolis, MN, USA
| | - S Goranov
- UMHAT Sveti Georgi and Medical University, Plovdiv, Bulgaria
| | | | - L Rusen
- S. C. SANADOR SRL, Bucharest, Romania
| | - V Uscatescu
- Institutul Clinic Fundeni, Bucharest, Romania
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Lissitchkov T, Rusen L, Georgiev P, Windyga J, Klamroth R, Gercheva L, Nemes L, Tiede A, Bichler J, Knaub S, Belyanskaya L, Walter O, Pasi KJ. PK-guided personalized prophylaxis with Nuwiq®(human-cl rhFVIII) in adults with severe haemophilia A. Haemophilia 2017; 23:697-704. [DOI: 10.1111/hae.13251] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- T. Lissitchkov
- Department of Clinical Haematology in Haemorrhagic Diathesis and Anaemia; Specialized Hospital for Active Treatment “Joan Pavel”; Sofia Bulgaria
| | | | - P. Georgiev
- Clinic of Haematology; University Multiprofile Hospital for Active Treatment “Sveti Georgi” and Medical University; Plovdiv Bulgaria
| | - J. Windyga
- Department of Disorders of Haemostasis and Internal Medicine; Institute of Haematology and Transfusion Medicine; Warsaw Poland
| | - R. Klamroth
- Department for Internal Medicine, Vascular Medicine and Haemostaseology; Vivantes Klinikum im Friedrichshain; Berlin Germany
| | - L. Gercheva
- Clinic of Clinical Haematology; Multiple Hospital for Active Treatment “Sveta Marina”; Varna Bulgaria
| | - L. Nemes
- Medical Centre; Hungarian Defence Forces; National Haemophilia Centre; Budapest Hungary
| | - A. Tiede
- Clinic for Haematology, Haemostaseology, Oncology and Stem Cell Transplantation; Hannover Medical School; Hannover Germany
| | | | - S. Knaub
- Octapharma AG; Lachen Switzerland
| | | | | | - K. J. Pasi
- The Royal London Hospital; Barts and the London School of Medicine and Dentistry; London UK
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Ljung R, Kenet G, Mancuso ME, Kaleva V, Rusen L, Tseneklidou‐Stoeter D, Michaels LA, Shah A, Hong W, Maas Enriquez M, Kaleva V, Stoyanova‐Deleva A, Blanchette V, Dower N, Clausen N, Kardos M, Kiss C, Zombori M, Nolan B, Kenet G, Santagostino E, Zanon E, Luciani M, Kovalova Z, Rageliene L, Dobaczewski G, Klukowska A, Mlynarkski W, Serban M, Rusen L, Uscatescu V, Kerlin B, Ahuja S, Gruppo R, Singleton T. BAY
81‐8973 safety and efficacy for prophylaxis and treatment of bleeds in previously treated children with severe haemophilia A: results of the
LEOPOLD
Kids Trial. Haemophilia 2015; 22:354-60. [DOI: 10.1111/hae.12866] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/13/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Affiliation(s)
- R. Ljung
- Department of Clinical Sciences Lund‐Pediatrics Malmö Centre for Thrombosis and Haemostasis Skåne University Hospital Lund University Malmö Sweden
| | - G. Kenet
- Chaim Sheba Medical Center The Israeli National Hemophilia Center The Sackler Medical School Tel Aviv University Tel‐Hashomer Israel
| | - M. E. Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - V. Kaleva
- MHAT Sveta Marina Clinic of Pediatric Hematology and Oncology Varna Bulgaria
| | - L. Rusen
- SC Sanador SRL Bucharest Romania
| | | | | | - A. Shah
- Bayer HealthCare Pharmaceuticals Whippany NJ USA
| | - W. Hong
- Bayer HealthCare Pharmaceuticals Whippany NJ USA
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Kavakli K, Yang R, Rusen L, Beckmann H, Tseneklidou-Stoeter D, Maas Enriquez M. Prophylaxis vs. on-demand treatment with BAY 81-8973, a full-length plasma protein-free recombinant factor VIII product: results from a randomized trial (LEOPOLD II). J Thromb Haemost 2015; 13:360-9. [PMID: 25546368 PMCID: PMC4671268 DOI: 10.1111/jth.12828] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND BAY 81-8973 is a new full-length human recombinant factor VIII product manufactured with technologies to improve consistency in glycosylation and expression to optimize clinical performance. OBJECTIVES To demonstrate superiority of prophylaxis vs. on demand therapy with BAY 81-8973 in patients with severe hemophilia A. PATIENTS/METHODS In this multinational,randomized, open-label crossover study (LEOPOLD II;ClinicalTrials.gov identifier: NCT01233258), males aged 12–65 years with severe hemophilia A were randomized to twice-weekly prophylaxis (20-30 IU kg(-1)), 3-times-weekly prophylaxis (30-40 IU kg(-1)), or on-demand treatment with BAY 81-8973. Potency labeling for BAY 81-8973 was based on the chromogenic substrate assay or adjusted to the one-stage assay. Primary efficacy endpoint was annualized number of all bleeds (ABR). Adverse events (AEs)and immunogenicity were also assessed. RESULTS Eighty patients (on demand, n = 21; twice-weekly prophylaxis, n = 28; 3-times-weekly prophylaxis, n = 31) were treated and analyzed. Mean ± SD ABR was significantly lower with prophylaxis (twice-weekly, 5.7 ± 7.2; 3-times-weekly, 4.3 ± 6.5; combined, 4.9 ± 6.8) vs. on-demand treatment (57.7 ± 24.6; P < 0.0001, ANOVA). Median ABR was reduced by 97% with prophylaxis (twice-weekly, 4.0;3-times-weekly, 2.0; combined, 2.0) vs. on-demand treatment (60.0). Median ABR was higher with twice-weekly vs. 3-times-weekly prophylaxis during the first 6-month treatment period (4.1 vs. 2.0) but was comparable in the second 6-month period (1.1 vs. 2.0). Few patients reported treatment-related AEs (4%); no treatment-related serious AEs or inhibitors were reported. CONCLUSIONS Twice weekly or 3-times-weekly prophylaxis with BAY 81-8973 reduced median ABR by 97% compared with on-demand therapy, confirming the superiority of prophylaxis. Treatment with BAY 81-8973 was well tolerated.
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Affiliation(s)
- K Kavakli
- Ege University Children’s Hospital, Izmir, Turkey.
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Urasinski T, Stasyshyn O, Andreeva T, Rusen L, Perina FG, Oh MS, Chapman M, Pavlova BG, Valenta-Singer B, Abbuehl BE. Recombinant factor IX (BAX326) in previously treated paediatric patients with haemophilia B: a prospective clinical trial. Haemophilia 2014; 21:196-203. [PMID: 25495591 DOI: 10.1111/hae.12548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
A newly developed recombinant factor IX (BAX326(1) ) was investigated for prophylactic use in paediatric patients aged <12 years with severe (FIX level <1%) or moderately severe (FIX level 1-2%) haemophilia B. The aim of this prospective clinical trial was to assess the safety, haemostatic efficacy and pharmacokinetic profile of BAX326 in previously treated paediatric patients. BAX326 was administered as prophylaxis twice a week for a period of 6 months, and on demand for treatment of bleeds. Safety was assessed by the occurrence of related AEs, thrombotic events and immunologic assessments. Efficacy was evaluated by annualized bleeding rate (ABR), and by treatment response rating (excellent, good, fair, none). PK was assessed over 72 h. None of the 23 treated paediatric subjects had treatment-related SAEs or AEs. There were no thrombotic events, inhibitory or specific binding antibodies against FIX, rFurin or CHO protein. Twenty-six bleeds (19 non-joint vs. 7 joint bleeds) occurred (mean ABR 2.7 ± 3.14, median 2.0), of which 23 were injury-related. Twenty subjects (87%) did not experience any bleeds of spontaneous aetiology. Haemostatic efficacy of BAX326 was excellent or good for >96% of bleeds (100% of minor, 88.9% of moderate and 100% of major bleeds); the majority (88.5%) resolved after 1-2 infusions. Longer T1/2 and lower IR were observed in younger children (<6 years) compared to those aged 6 to 12 years. BAX326 administered as prophylactic treatment as well as for controlling bleeds is efficacious and safe in paediatric patients aged <12 years with haemophilia B.
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Affiliation(s)
- T Urasinski
- Department of Paediatrics, Paediatric Haematology and Oncology, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Solano Trujillo MH, Stasyshyn O, Rusen L, Serban M, Lamas JL, Perina FG, Urasinski T, Oh M, Knowlton WB, Valenta-Singer B, Pavlova BG, Abbuehl B. Safe switching from a pdFIX (Immunine®) to a rFIX (Bax326). Haemophilia 2014; 20:674-81. [DOI: 10.1111/hae.12444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - O. Stasyshyn
- Institute of Blood Pathology and Transfusion Medicine of Academy of Medical Sciences of Ukraine; Lviv Ukraine
| | - L. Rusen
- S.C. Sanador SRL; Bucharest Romania
| | - M. Serban
- Louis Turcanu Emergency Clinical Children′s Hospital; Timisoara Romania
| | | | - F. G. Perina
- Regional Clinical Hospital Ekaterinburg; Ekaterinburg Russia
| | - T. Urasinski
- Department of Paediatrics, Paediatric Hematology and Oncology; Pomeranian Medical University; Szczecin Poland
| | - M. Oh
- Baxter Healthcare Corporation; Westlake Village CA USA
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Valentino LA, Rusen L, Elezovic I, Smith LM, Korth-Bradley JM, Rendo P. Multicentre, randomized, open-label study of on-demand treatment with two prophylaxis regimens of recombinant coagulation factor IX in haemophilia B subjects. Haemophilia 2014; 20:398-406. [PMID: 24418368 DOI: 10.1111/hae.12344] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 11/30/2022]
Abstract
Few randomized studies have reported on the use of factor IX (FIX) for secondary prophylaxis in haemophilia B patients. This study aimed to evaluate the efficacy and safety of two secondary prophylaxis regimens of recombinant coagulation FIX, nonacog alfa, compared with on-demand therapy. Male subjects aged 6-65 years with severe or moderately severe haemophilia B (FIX:C ≤ 2, n = 50) and ≥12 bleeding episodes (including ≥6 haemarthroses episodes) within 12 months of study participation were enrolled in this multicentre, randomized, open-label, four-period crossover trial. The primary measure was the annualized bleeding rate (ABR) of two prophylactic regimens vs. on-demand therapy. In the intent-to-treat group, mean ABR values were 35.1, 2.6 and 4.6 for the first on-demand period, the 50 IU kg(-1) twice-weekly period, and the 100 IU kg(-1) once-weekly period respectively. Differences in ABR between the first on-demand period and both prophylaxis regimens were significant (P < 0.0001); no significant differences were observed between prophylaxis regimens (P = 0.22). Seven serious adverse events occurred in five subjects, none related to study drug. Results demonstrated that secondary prophylaxis therapy with nonacog alfa 50 IU kg(-1) twice weekly or 100 IU kg(-1) once weekly reduced ABR by 89.4% relative to on-demand treatment. Both prophylaxis regimens demonstrated favourable safety profiles in subjects with haemophilia B.
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Windyga J, Lissitchkov T, Stasyshyn O, Mamonov V, Rusen L, Lamas JL, Oh MS, Chapman M, Fritsch S, Pavlova BG, Wong WY, Abbuehl BE. Pharmacokinetics, efficacy and safety of BAX326, a novel recombinant factor IX: a prospective, controlled, multicentre phase I/III study in previously treated patients with severe (FIX level <1%) or moderately severe (FIX level ≤2%) haemophilia B. Haemophilia 2013; 20:15-24. [DOI: 10.1111/hae.12228] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2013] [Indexed: 12/31/2022]
Affiliation(s)
- J. Windyga
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - T. Lissitchkov
- Specialized Hematological Hospital “Joan Pavel”; Sofia Bulgaria
| | - O. Stasyshyn
- State Institution “Institute of Blood Pathology and Transfusion Medicine of the Academy of Medical Sciences of Ukraine”; Lviv Ukraine
| | - V. Mamonov
- Hematological Research Center; Moscow Russia
| | - L. Rusen
- Prof. Dr. C. T. Nicolau National Institute for Transfusional Hematology; Bucharest Romania
| | | | - M.-S. Oh
- Global Clinical Research and Development; Baxter BioScience; Westlake Village CA USA
| | - M. Chapman
- Global Clinical Research and Development; Baxter BioScience; Vienna Austria
| | - S. Fritsch
- Global Clinical Research and Development; Baxter BioScience; Vienna Austria
| | - B. G. Pavlova
- Global Clinical Research and Development; Baxter BioScience; Vienna Austria
| | - W.-Y. Wong
- Global Clinical Research and Development; Baxter BioScience; Westlake Village CA USA
| | - B. E. Abbuehl
- Global Clinical Research and Development; Baxter BioScience; Vienna Austria
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Manco-Johnson MJ, Kempton CL, Reding MT, Lissitchkov T, Goranov S, Gercheva L, Rusen L, Ghinea M, Uscatescu V, Rescia V, Hong W. Randomized, controlled, parallel-group trial of routine prophylaxis vs. on-demand treatment with sucrose-formulated recombinant factor VIII in adults with severe hemophilia A (SPINART). J Thromb Haemost 2013; 11:1119-27. [PMID: 23528101 DOI: 10.1111/jth.12202] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [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: 11/30/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The benefits of routine prophylaxis vs. on-demand treatment with factor VIII products have not been evaluated in controlled clinical trials in older patients with hemophilia A. OBJECTIVES To report results from a preplanned analysis of data from the first year of the 3-year SPINART study, which compares routine prophylaxis with on-demand treatment with sucrose-formulated recombinant FVIII (rFVIII-FS). PATIENTS/METHODS SPINART is an open-label, randomized, controlled, parallel-group, multinational trial. Males aged 12-50 years with severe hemophilia A, ≥ 150 days of exposure to FVIII, no FVIII inhibitors, no prophylaxis for > 12 consecutive months in the past 5 years and 6-24 bleeding episodes in the preceding 6 months were randomized 1 : 1 to rFVIII-FS prophylaxis (25 IU kg(-1) , three times weekly) or on-demand treatment. The primary efficacy endpoint, number of total bleeding episodes in the intent-to-treat population, was analyzed after the last patient had completed 1 year of follow-up. A negative binomial model was used for the primary endpoint analysis; analysis of variance was used for confirmatory analysis of annualized bleeding rates. RESULTS Eighty-four patients were enrolled and analyzed (n = 42 per group; mean age, 30.6 years; median treatment duration, 1.7 years). The median number of total bleeding episodes and total bleeding episodes per year were significantly lower with prophylaxis than with on-demand treatment (total, 0 vs. 54.5; total per year, 0 vs. 27.9; both P < 0.0001). No treatment-related adverse events occurred, and no patients developed FVIII inhibitors. CONCLUSIONS Routine prophylaxis with rFVIII-FS leads to a significant reduction in bleeding as compared with on-demand treatment. Adverse events were consistent with the established rFVIII-FS safety profile.
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Affiliation(s)
- M J Manco-Johnson
- Department of Pediatrics, Hemophilia and Thrombosis Center, University of Colorado, Aurora, CO 80045, USA.
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Konkle BA, Ebbesen LS, Erhardtsen E, Bianco RP, Lissitchkov T, Rusen L, Serban MA. Randomized, prospective clinical trial of recombinant factor VIIa for secondary prophylaxis in hemophilia patients with inhibitors. J Thromb Haemost 2007; 5:1904-13. [PMID: 17723130 DOI: 10.1111/j.1538-7836.2007.02663.x] [Citation(s) in RCA: 256] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hemophilic patients with factor VIII (FVIII) and FIX inhibitors suffer from frequent bleeding episodes and reduced quality of life. OBJECTIVES To evaluate whether secondary prophylaxis with activated recombinant factor VII (rFVIIa) can safely and effectively reduce bleeding frequency as compared to conventional on-demand therapy. METHODS Thirty-eight male patients entered a 3-month preprophylaxis period to confirm high baseline bleeding frequency (mean > or = 4 bleeds per month). Twenty-two patients were randomized 1:1 to receive daily rFVIIa prophylaxis with either 90 or 270 microg kg(-1) for 3 months, followed by a 3-month postprophylaxis period. RESULTS Bleeding frequency was reduced by 45% and 59% during prophylaxis with 90 and 270 microg kg(-1), respectively (P < 0.0001); however, there was no significant difference detected between doses. The majority of this reduction was maintained during the postprophylaxis period. Although all types of bleed were similarly reduced, the effect was most pronounced for spontaneous joint bleeds. Patients reported significantly fewer hospital admissions and days absent from work/school during prophylaxis as compared to the preprophylaxis period. No thromboembolic events were reported during prophylaxis. CONCLUSION Clinically relevant reductions in bleeding frequency during prophylaxis as compared to conventional on-demand therapy were achieved without raising safety concerns. These results provide evidence for the concept of secondary rFVIIa prophylaxis in inhibitor patients with frequent bleeds.
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Affiliation(s)
- B A Konkle
- Penn Comprehensive Hemophilia Program, University of Pennsylvania, PA 19104, USA.
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Lee J, Dash C, Chernova T, Baglin T, Collins P, Serban M, Hay C, Matysiak M, Mitchell V, Plyusch O, Rusen L, Stasyshyn O. USE OF A HIGH PURITY FACTOR IX (FIX) CONCENTRATE IN SURGERY. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rusen L, Lambert C, Hermans C. ACUTE CORONARY STENT THROMBOSIS IN A PATIENT WITH SEVERE HAEMOPHILIA ON DUAL ANTIPLATELET THERAPY. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01890.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Rusen L, Anàstàsoaie F, Marinescu DC. P12-3 Transfusion des plaquettes dans les hôpitaux de Bucarest. Besoins et réactions transfusionnelles. Transfus Clin Biol 1998. [DOI: 10.1016/s1246-7820(98)80214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andronescu-Ghika S, Rusen L. Un point de vue concernant le traitement des hémophiles avec du plasma frais congelé. Transfus Clin Biol 1998. [DOI: 10.1016/s1246-7820(98)80393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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