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Guérois C, Laurian Y, Rothschild C, Parquet-Gernez A, Duclos AM, Négrier C, Vicariot M, Fimbel B, Fressinaud E, Fiks-Sigaud M, Derlon A, Berthier AM, Gaillard S, Bertrand MA. Incidence of Factor VIII Inhibitor Development in Severe Hemophilia A Patients Treated only with One Brand of Highly Purified Plasma-Derived Concentrate. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653753] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe incidence of factor VIII inhibitor was studied in a cohort of 56 previously untreated patients with severe hemophilia A (factor VIII below 1 U/dl). They received only one brand of highly purified factor VIII concentrate (HPSD-VIII) prepared by conventional chromatography with a solvent-detergent step for viral inactivation. Followup since the first infusion of HPSD-VIII was from 1 to 76 months (mean = 29) and cumulative exposure days (CED) from 1 to over 100 (median = 26). Five patients (9%) developed an inhibitor after 6 to 19 CED, only one being a high responder (2%), showing a low incidence of inhibitor compared with previous studies using high purity plasma- derived or recombinant products.
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Ménart C, Trzeciak MC, Nurden P, Fressinaud E, Dreyfus M, Laurian Y, Négrier C, d’Oiron R. Use of Recombinant Factor VIIa in 3 Patients with Inherited Type I Glanzmann’s Thrombasthenia Undergoing Invasive Procedures. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613884] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe treatment of bleeds in Glanzmann’s thrombasthenia is a challenging issue, especially when repeated platelet transfusions have induced anti-glycoprotein (GP) IIb-IIIa or anti-HLA allo-immunisation. In an attempt to find an alternative treatment regimen, we used recombinant factor VIIa (rFVIIa, NovoSeven®, Novo Nordisk, Denmark) as first-line therapy in 3 patients with Glanzmann’s thrombasthenia and anti-GPIIb-IIIa iso-antibodies who were scheduled for invasive procedures. The administration of an initial bolus dose of rFVIIa (70–110 µg/kg) was immediately followed by continuous infusion at the rate of 9-30 µg/kg/h for 3–15 days. The treatment resulted in an excellent clinical efficacy and tolerance in 2 cases. In the third patient, whereas efficacy was excellent at the surgical site, pharyngonasal bleeds of traumatic origin persisted for 10 days, and a severe thromboembolic complication occurred 5 days after discontinuation of rFVIIa. Complementary studies are needed for patients with congenital platelet disorders in order to evaluate the safety and the potential therapeutic place of rFVIIa treatment.
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Laurian Y, Satre EP, Derlon AB, Chambost H, Moreau P, Goudemand J, Parquet A, Peynet J, Vicariot M, Beurrier P, Claeyssens S, Durin A, Faradji A, Fressinaud E, Gaillard S, Guérin V, Guérois C, Pernod G, Pouzol P, Schved JF, Gazengel C, Rothschild C. French Previously Untreated Patients with Severe Hemophilia A after Exposure to Recombinant Factor VIII : Incidence of Inhibitor and Evaluation of Immune Tolerance. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615358] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryFifty French previously untreated patients with severe hemophilia A (factor VIII <1%), treated with only one brand of recombinant factor VIII (rFVIII), were evaluated for inhibitor development, assessment of risk factors and outcome of immune tolerance regimen. The median period on study was 32 months (range 9-74) since the first injection of rFVIII. Fourteen patients (28%) developed an inhibitor, four of whom (8%) with a high titer (≥10 BU). All inhibitor patients but one continued to receive rFVIII either for on-demand treatment or for immune tolerance regimen (ITR). Among these patients, inhibitor was transient in 2 (4%), became undetectable in 6 and was still present in 6. The prevalence of inhibitor was 12%. Presence of intron 22 inversion was found to be a risk factor for inhibitor development. Immune tolerance was difficult to achieve in our series despite a follow-up period of 16 to 30 months: immune tolerance was complete in only one out of the 3 patients undergoing low dose ITR and in one out of the 5 patients with high dose ITR.
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Fiks-Sigaud M, Bendelac L, Parquet A, Verroust F, Torchet M, Berthier A, Fressinaud E, Guerois C, Aillaud M, Boneu B, Derlon A, Subtil E, Bertrand M, Borg J, Laurian Y. Comparison of Anti-Human and Anti-Porcine Factor VIII Inhibitor Levels in 63 Patients with Severe Haemophilia A. Vox Sang 2017. [DOI: 10.1159/000462354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Laurian Y, Blanc A, Delaney SR, Allain JP. All Exposed Hemophiliacs Have Markers of HCV. Vox Sang 2017. [DOI: 10.1159/000462166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Salvado C, Mekinian A, Gerin M, Boukari L, Morin AS, Laurian Y, Stirnemann J, Fain O. Hémophilie acquise associée à une maladie de Biermer. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghnaya H, Eymard F, Morin A, Boukari L, Ora J, Stirnemann J, Laurian Y, Fain O. Hémophilie acquise du sujet âgé : efficacité du rituximab. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Desmarres C, Laurian Y. From top to toe. An alternative approach to physiotherapy for hemophiliacs. SCANDINAVIAN JOURNAL OF HAEMATOLOGY. SUPPLEMENTUM 2009; 40:469-70. [PMID: 6591405 DOI: 10.1111/j.1600-0609.1984.tb02603.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Bibi-Triki T, Aras N, Braun T, Lautridou C, Boukari L, Morin A, Maquarre E, Stirnemann J, Brichler S, Laurian Y, Fain O. Plasmocytose sanguine et médullaire au cours de la dengue : une observation. Rev Med Interne 2009; 30:274-6. [DOI: 10.1016/j.revmed.2008.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 05/05/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
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Mazoyer E, Fain O, Dhote R, Laurian Y. Is rituximab effective in acquired von Willebrand syndrome? Br J Haematol 2009; 144:967-8. [DOI: 10.1111/j.1365-2141.2008.07538.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Toledano A, Lachassinne E, Roumegoux C, Laurian Y, Benabadji Z, Chiadmi F, Cisternino S, Schlatter J, Fontan JE. Treatment of Congenital Afibrinogenemia in a Premature Neonate. Ann Pharmacother 2008; 42:1145-6. [DOI: 10.1345/aph.1l132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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d'Audigier C, Pasmant E, Bournier O, Laurian Y, Guillin MC, Bezeaud A. A natural variant with a point mutation resulting in a homozygous Arg to His substitution at position 388 in prothrombin. Haematologica 2008; 93:799-800. [DOI: 10.3324/haematol.12520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Calvez T, Laurian Y, Goudemand J. Inhibitor incidence with recombinant vs. plasma-derived FVIII in previously untreated patients with severe hemophilia A: homogeneous results from four published observational studies. J Thromb Haemost 2008; 6:390-2. [PMID: 18036187 DOI: 10.1111/j.1538-7836.2008.02852.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Calvez T, Laurian Y, Goudemand J. Inhibitor incidence with recombinant vs. plasma-derived FVIII in previously untreated patients with severe hemophilia A: homogeneous results from four published observational studies. J Thromb Haemost 2007; 6:390-2. [PMID: 18036187 DOI: 10.1111/j.1538-7836.2007.02852.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Calvez T, Laurian Y, Goudemand J. Associations between type of product and inhibitors in previously untreated patients (PUPs) with severe hemophilia: switches and particular products can disturb analysis. Blood 2007; 110:1073-4; author reply 1074-5. [PMID: 17644742 DOI: 10.1182/blood-2007-03-079723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Goudemand J, Laurian Y, Calvez T. Risk of inhibitors in haemophilia and the type of factor replacement. Curr Opin Hematol 2007; 13:316-22. [PMID: 16888435 DOI: 10.1097/01.moh.0000239702.40297.ec] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Inhibitors in haemophilia are a serious complication that may render usual replacement therapy ineffective. The risk is greatest in previously untreated children with severe haemophilia A. The role of replacement factor VIII in this group is an important issue. RECENT FINDINGS Until now, few clinical studies have correctly taken into account the variety of cofactors involved in inhibitor development: genetic (familial antecedents, ethnicity, F8 and immune response genotypes), and environmental cofactors (age at first infusion, prophylaxis and intensity of treatment). This is a prerequisite to correctly evaluating the putative role of the type of factor replacement. Prospective cohort studies are therefore urgently needed. Depending on the expected inhibitor risk in the reference group, the intensity of the relationship between risk factor and endpoint, the duration of patient follow up, and the design of the study (balanced or unbalanced groups), cohorts including 200-500 previously untreated children should be sufficient to demonstrate an increased intensity of risk of about 2 or more with one product compared with another. SUMMARY Aside from clinical studies, fundamental research is essential to test the multiple hypotheses that could explain a difference in inhibitor risk between the currently available factor VIII concentrates in order to develop less immunogenic factor VIII.
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Guillet B, Lambert T, d'Oiron R, Proulle V, Plantier JL, Rafowicz A, Peynet J, Costa JM, Bendelac L, Laurian Y, Lavergne JM. Detection of 95 novel mutations in coagulation factor VIII gene F8 responsible for hemophilia A: results from a single institution. Hum Mutat 2006; 27:676-85. [PMID: 16786531 DOI: 10.1002/humu.20345] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hemophilia A (HA) is an X-linked hereditary bleeding disorder defined by a qualitative and/or quantitative factor VIII (FVIII) deficiency. The molecular diagnosis of HA is challenging because of the high number of different causative mutations that are distributed throughout the large F8 gene. The putative role of the novel mutations, especially missense mutations, may be difficult to interpret as causing HA. We identified 95 novel mutations out of 180 different mutations responsible for HA in 515 patients from 406 unrelated families followed up at a single hemophilia treatment center of the Bicêtre university hospital (Assistance Publique-Hôpitaux de Paris [AP-HP], Le Kremlin-Bicêtre). These 95 novel mutations comprised 55 missense mutations, 12 nonsense mutations, 11 splice site mutations, and 17 small insertions/deletions. We therefore developed a mutation analysis based on a body of proof that combines the familial segregation of the mutation, the resulting biological and clinical HA phenotype, and the molecular consequences of the amino acid (AA) substitution. For the latter, we studied the putative biochemical modifications: its conservation status with cross-species FVIII and homologous proteins, its putative location in known FVIII functional regions, and its spatial position in the available FVIII 3D structures. The usefulness of such a strategy in interpreting the causality of novel F8 mutations is emphasized.
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Calvez T, Laurian Y. Protective effect of prophylaxis on inhibitor development in children with haemophilia A: more convincing studies are required. Br J Haematol 2006; 132:798-800; author reply 800-1. [PMID: 16487187 DOI: 10.1111/j.1365-2141.2006.05989.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poon MC, Zotz R, Di Minno G, Abrams ZS, Knudsen JB, Laurian Y. Glanzmann’s Thrombasthenia Treatment: A Prospective Observational Registry on the Use of Recombinant Human Activated Factor VII and Other Hemostatic Agents. Semin Hematol 2006; 43:S33-6. [PMID: 16427383 DOI: 10.1053/j.seminhematol.2005.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glanzmann's thrombasthenia (GT) is a rare congenital bleeding disorder caused by deficiency or dysfunction of platelet surface glycoprotein (GP) IIb/IIIa receptor. Platelet transfusion is the standard treatment for bleeding that remains non-responsive to conservative measures, and for surgical coverage. Platelet transfusions, however, may result in the development of antibodies to GPIIb/IIIa and/or human leukocyte antigen (HLA), rendering further transfusions ineffective. Recombinant human activated factor VII (rFVIIa; NovoSeven/Niastase [Canada], Novo Nordisk, Bagsvaerd, Denmark) has documented efficacy in GT patients, and is approved in the European Union for the treatment of GT patients with platelet antibodies and platelet refractoriness. However, there are insufficient data to determine the optimal rFVIIa regimen (eg, for major surgery) or to allow thorough safety evaluation (eg, thrombotic risk). A post-marketing, prospective, observational, multinational registry has been developed to collect data on the efficacy and safety of rFVIIa in the treatment and prevention of bleeding in GT patients with platelet antibodies or platelet refractoriness. Patients treated with other hemostatic agents or rFVIIa to avoid the development of antibodies against GPIIb/IIIa will also be reported. Standardized data will be collected using a customized internet-based (www.glanzmann-reg.org) data collection tool. Data collection will begin in 2005 and continue for up to 6 years. Patients of all ages from any country are eligible for inclusion.
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Goudemand J, Rothschild C, Demiguel V, Vinciguerrat C, Lambert T, Chambost H, Borel-Derlon A, Claeyssens S, Laurian Y, Calvez T. Influence of the type of factor VIII concentrate on the incidence of factor VIII inhibitors in previously untreated patients with severe hemophilia A. Blood 2006; 107:46-51. [PMID: 16166584 DOI: 10.1182/blood-2005-04-1371] [Citation(s) in RCA: 239] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Inhibitor development is the major treatment complication in children with severe hemophilia A. It is not clear whether the risk of inhibitors is higher with recombinant factor VIII or with plasma-derived factor VIII. We used multivariate analysis to compare 2 cohorts of previously untreated patients (PUPs) with severe hemophilia A: 62 patients treated with the same brand of high-purity plasma-derived FVIII (pFVIII) containing von Willebrand factor (VWF) and 86 patients treated with full-length recombinant FVIII (rFVIII). In addition to the usual end points (all inhibitors, high inhibitors), we also examined a third end point (high inhibitors and/or immune tolerance induction). The risk of inhibitor development was higher in patients treated with rFVIII than in patients treated with pFVIII, regardless of other risk factors (F8 genotype; nonwhite origin; history of inhibitors in patients with a family history of hemophilia; age at first FVIII infusion). The adjusted relative risk (RRa) for inhibitor development with rFVIII versus pFVIII was 2.4 (all inhibitors), 2.6 (high inhibitors), and 3.2 (high inhibitors and/or immune tolerance induction), respectively, depending on the end point (above). The pathophysiology of this large effect must be understood in order to improve the characteristics of recombinant products and to reduce the incidence of inhibitors to FVIII.
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Laurian Y, Tisseron-Maury B, Bibi Triki T, Kaplan C, Gaudelus J. Red blood cell transfusion in patients with type 1 Glanzmann's thrombasthenia. J Thromb Haemost 2005; 3:2346-7. [PMID: 16194208 DOI: 10.1111/j.1538-7836.2005.01579.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Regnault V, Briquel ME, Nguyen P, Laurian Y, Béguin S, Hemker HC, Lecompte T. Thrombinography can differentiate bleeding from nonbleeding patients with prolonged APTT. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb05474.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laurian Y. Treatment of bleeding in patients with platelet disorders: is there a place for recombinant factor VIIa? PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2003; 32 Suppl 1:37-40. [PMID: 12214146 DOI: 10.1159/000057300] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The mechanism of action of recombinant factor VIIa (rFVIIa), i.e. increased thrombin generation on the membrane of activated platelets, as well as the results from in vitro and ex vivo models of thrombocytopenia or inherited thrombocytopathia may support some potential of rFVIIa in thrombocytopenia/thrombocytopathia. rFVIIa was reported as effective to stop or to decrease bleeding in few patients with severe thrombocytopenia resistant to platelet transfusions; however data are still scarce and clinical studies are really needed to define efficacy/safety ratio as well as optimal treatment regimen in this potential indication. Some data in patients with Glanzmann thrombasthenia (GT) may support the use of rFVIIa outside its primary indication in the cases in which there is no real treatment alternative (GT patients with antibodies to GP IIb-IIIa or with platelet refractoriness).
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