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Chowdary P, Nissen F, Burke T, Aizenas M, Czirok T, Dhillon H, O'Hara J. The humanistic and economic burden of problem joints for children and adults with moderate or severe haemophilia A: Analysis of the CHESS population studies. Haemophilia 2023; 29:753-760. [PMID: 36897517 DOI: 10.1111/hae.14766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Adequate prophylactic treatment and physical activity improve joint health and clinical outcomes for people with haemophilia A (HA). However, non-clinical joint-related burden of moderate (MHA) and severe (SHA) HA has not been well characterised. AIM To quantify the joint health-related humanistic and economic burden of MHA and SHA in Europe. METHODS A retrospective analysis of the cross-sectional CHESS population studies using a patient-centric measure of joint health (problem joints, PJs: chronic joint pain and/or limited range of movement due to compromised joint integrity with or without persistent bleeding) was conducted. Descriptive statistics summarised health-related quality of life (HRQoL), work productivity/activity impairment and costs by number of PJs (0, 1 or ≥2) and HA severity. RESULTS A total of 1171 patients were included from CHESS-II (n = 468) and CHESS-PAEDs (n = 703). In both studies, 41 and 59% of patients had MHA and SHA, respectively. Prevalence of ≥2 PJs was similar with MHA and SHA (CHESS-II: 23 and 26%; CHESS-PAEDs: 4 and 3%, respectively). HRQoL was worse with an increasing number of PJs (CHESS-II: .81 vs. .66 with 0 and ≥2 PJs, respectively, for MHA; .79 vs. .51 for SHA; CHESS-PAEDs: .64 vs. .26 and .72 vs. .14). Total costs increased with increasing PJs regardless of severity in CHESS-II (€2923 vs. €22,536 with 0 and ≥2 PJs, respectively, for MHA; €11,022 vs. €27,098 for SHA) and CHESS-PAEDs (€6222 vs. €11,043 for MHA; €4457 vs. €14,039 for SHA). CONCLUSION Presence of PJs was associated with a substantial humanistic and economic burden on patients with MHA or SHA across the lifespan.
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Affiliation(s)
- Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | | | - Tom Burke
- HCD Economics, Daresbury, UK.,University of Chester, Chester, UK
| | | | | | | | - Jamie O'Hara
- HCD Economics, Daresbury, UK.,University of Chester, Chester, UK
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Hmida J, Hilberg T, Ransmann P, Tomschi F, Klein C, Koob S, Franz A, Richter H, Oldenburg J, Strauss AC. Most subjectively affected joints in patients with haemophilia - what has changed after 20 years in Germany? Haemophilia 2022; 28:663-670. [PMID: 35420240 DOI: 10.1111/hae.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/21/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with haemophilia (PwH), most frequently affected joints are the ankle, knee and elbow. Due to improved factor therapy in the last decades, these previous findings have to be verified in Germany. AIM The aim of this study is to detect the most affected joint, evaluate the significance of the source of pain and determine the point prevalence of back pain in Germany today. PATIENTS AND METHODS In a retrospective study, data of n = 300 patients with severe moderate and mild haemophilia were evaluated regarding the most affected joint, the most common source of pain, and the point prevalence of back pain. An anamnesis questionnaire and the German Pain Questionnaire were used for this assessment. RESULTS The most affected joint in German PwH is still the ankle (41%), followed by the knee (27%) and the elbow (11%). The most common source of pain is also the ankle joint (32%). Back pain was also identified as one of the most common sources of pain, which is comparable to the elbow (elbow:15%; back:13%). The point prevalence in PwH for back pain was significantly higher compared to the general German population (P = .031). CONCLUSION Our data showed that the ankle is still the most affected joint and the most common source of pain in Germany. These results also showed the relevance of back pain as a pain source. The evaluations also demonstrated the high point prevalence of back pain in PwH. Future therapies should also focus on the spine because joint changes affect posture.
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Affiliation(s)
- Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Fabian Tomschi
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Claudia Klein
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Alexander Franz
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | | | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Andreas C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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Reding MT, Pabinger I, Lalezari S, Santagostino E, Mancuso ME. Target joint resolution in patients with haemophilia A receiving long-term prophylaxis with BAY 94-9027. Haemophilia 2020; 26:e201-e204. [PMID: 32578323 PMCID: PMC7496507 DOI: 10.1111/hae.13982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Mark T Reding
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - Shadan Lalezari
- National Hemophilia Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Elena Santagostino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Maria Elisa Mancuso
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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Das S, Roy RN, Das DK, Chakraborty A, Mondal R. Health-related quality of life of hemophilics and its possible correlates: A perspective in health promotion and disability prevention. J Educ Health Promot 2019; 8:257. [PMID: 32002429 PMCID: PMC6967119 DOI: 10.4103/jehp.jehp_249_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical evaluations are not sufficient to adequately characterize the morbidity associated with hemophilia. Quality of life (QoL) of hemophilics and associated factors is not well explored in Indian research. The present study aimed to measure the QoL in hemophilics and its association with socio-demographic characteristics and other characteristics. MATERIALS AND METHODS A cross-sectional study was conducted during June-November 2018. Two hundred and one hemophilics (age ≥ 4 years) were interviewed with a pre-tested schedule for sociodemographic and other relevant variables. QoL was measured by Haemo-QoL questionnaire for different pediatric age groups and Haem-A-QoL questionnaire for adults and assigned health-related QoL scores. Score achieved in each dimension as well as total scores were transformed on scales ranging from 0 to 100, high values indicate high impairment of QoL. Hemophilic arthropathy was assessed using the World Federation of Hemophilia Joint Scores. One-way ANOVA, independent t-test, Kruskal-Wallis test, and Spearman correlation analyses were performed using SPSS version 16. RESULTS Mean Haemo-QoL scores for 4-7 years, 8-12 years, 13-16 years, and >16 years were 43.92 ± 8.09, 37.37 ± 8.62, 32.79 ± 6.66, and 45.92 ± 6.30, respectively. Significant difference was noted for QoL scores across different age groups, grades of severity, educational, occupational categories, socioeconomic status classes, marital status, and presence or absence of target joint. Total QoL scores, as well as scores in some of the dimensions, showed a significant positive correlation with the World Federation of Hemophilia joint scores by Spearman correlation analysis. CONCLUSIONS Improvement of the joint health status by regular physiotherapy is needed to improve the QoL of hemophilics.
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Affiliation(s)
- Soumyaneel Das
- Department of Community Medicine, Burdwan Medical College, Purba Bardhaman, West Bengal, India
| | - Rabindra Nath Roy
- Department of Community Medicine, Burdwan Medical College, Purba Bardhaman, West Bengal, India
| | - Dilip Kumar Das
- Department of Community Medicine, Burdwan Medical College, Purba Bardhaman, West Bengal, India
| | - Amitava Chakraborty
- Department of Community Medicine, Burdwan Medical College, Purba Bardhaman, West Bengal, India
| | - Raston Mondal
- Department of Community Medicine, Burdwan Medical College, Purba Bardhaman, West Bengal, India
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Negrier C, Young G, Abdul Karim F, Collins PW, Hanabusa H, Colberg T, Goldman B, Walsh CE. Recombinant long-acting glycoPEGylated factor IX (nonacog beta pegol) in haemophilia B: assessment of target joints in multinational phase 3 clinical trials. Haemophilia 2016; 22:507-13. [PMID: 26936227 DOI: 10.1111/hae.12902] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The paradigm(™) 2 and 4 phase 3 clinical trials investigated the safety and efficacy of nonacog beta pegol, a recombinant glycoPEGylated factor IX (FIX) with extended half-life, in previously treated haemophilia B patients. AIM These post hoc analyses investigated the bleeding patterns in target joints. METHODS Patients randomized to 40 or 10 IU kg(-1) once weekly prophylaxis who had at least one target joint were included. Baseline demographics and disease-specific data were collected. Bleeding patterns were assessed, and an International Society on Thrombosis and Haemostasis (ISTH) definition of target joints was used. RESULTS A total of 67% and 8% of patients in the 40 and 10 IU kg(-1) arm, respectively, did not experience target joint bleeds during the paradigm(™) 2 trial. Twenty-four target joints were recorded in each prophylaxis arm at baseline. During the paradigm(™) 2 trial, no bleeds were reported in 17 (71%) and 7 (29%) target joints in the 40 and 10 IU kg(-1) arms respectively. All target joint bleeds in the 40 IU kg(-1) once weekly prophylaxis arm were controlled with a single injection of 40 IU kg(-1) nonacog beta pegol. By the latest ISTH definition, 90% and 58% of target joints in the 40 and 10 IU kg(-1) arms, respectively, were no longer considered target joints at the end of the paradigm(™) 2 trial. At the end of the paradigm(™) 4 extension trial, all target joints in the 40 IU kg(-1) arm were no longer considered target joints. CONCLUSION Routine prophylaxis with 40 IU kg(-1) once weekly nonacog beta pegol has the potential for effective management of target joint bleeds in haemophilia B patients.
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Affiliation(s)
- C Negrier
- Hôpital Louis Pradel, University Claude Bernard Lyon 1, Bron, France
| | - G Young
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - F Abdul Karim
- Haemophilia Centre, National Blood Centre, Kuala Lumpur, Malaysia
| | - P W Collins
- Arthur Bloom Haemophilia Centre, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - H Hanabusa
- Department of Haematology, Ogikubo Hospital, Tokyo, Japan
| | - T Colberg
- Haemophilia Medical & Science, Novo Nordisk A/S, Soeborg, Denmark
| | - B Goldman
- Haemophilia Biostatistics, Novo Nordisk A/S, Soeborg, Denmark
| | - C E Walsh
- Division of Hematology and Medical Oncology, Mount Sinai Medical Center, New York, NY, USA
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Abstract
Hemophilia is a hematological disorder characterized by a partial or complete deficiency of clotting factor VIII or IX. Its bleeding complications primarily affect the musculoskeletal system. Hemarthrosis is a major hemophilia-related complication, responsible for a particularly debilitating chronic arthropathy, in the long term. In addition to clotting factor concentrates, usually prescribed by the hematologist, managing acute hemarthrosis and chronic arthropathy requires a close collaboration between the orthopedic surgeon and physiotherapist. This collaboration, comprising a coagulation and musculoskeletal specialist, is key to effectively preventing hemarthrosis, managing acute joint bleeding episodes, assessing joint function, and actively treating chronic arthropathy. This paper reviews, from a practical point of view, the pathophysiology, clinical manifestations, and treatment of hemarthrosis and chronic hemophilia-induced arthropathy for hematologists, orthopedic surgeons, and physiotherapists.
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Affiliation(s)
- Sébastien Lobet
- Hemostasis-Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium ; Division of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Cedric Hermans
- Hemostasis-Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Catherine Lambert
- Hemostasis-Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Reininger AJ, Chehadeh HE. The principles of PK-tailored prophylaxis. Hamostaseologie 2013; 33 Suppl 1:S32-S35. [PMID: 24169861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/15/2013] [Indexed: 06/02/2023] Open
Abstract
While prophylaxis with factor VIII (FVIII) is considered the first choice therapy for patients with severe haemophilia A the optimal prophylaxis regimen is still under scientific debate. A recent study demonstrated efficacy and safety of a PK-tailored prophylaxis regimen with rFVIII (ADVATE) aimed to maintain FVIII trough levels of ≥1% (19). The annual bleed rate (ABR) could be significantly reduced compared to the previous on-demand treatment period (p < 0.0001) and bodily pain, a health-related quality of life dimension of the SF-36v1 questionnaire also significantly improved (p = 0.0007). Thus PK-tailored prophylaxis with ADVATE might offer a valid alternative to standard prophylaxis. Open issues to be considered for implementation of PK-tailored prophylaxis are: What FVIII trough level is needed to prevent any bleed? Do patients with target joints need higher FVIII trough levels to stay bleed-free? Are there user-friendly tools available to calculate individualized PK-driven prophylaxis doses and frequency without the need for a full 9-sample PK curve? Current knowledge on these aspects as well as some considerations about the future of PK-tailored prophylaxis is discussed.
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Affiliation(s)
- A J Reininger
- Prof. Dr. med. Armin J. Reininger, Baxter Innovations GmbH, Industriestr. 67, 1220 Vienna, Austria, Tel. +43/1/201 00-247 34 94 Fax +43/1/201 00-530, E-mail:
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