101
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Chowdary P, Lethagen S, Friedrich U, Brand B, Hay C, Abdul Karim F, Klamroth R, Knoebl P, Laffan M, Mahlangu J, Miesbach W, Dalsgaard Nielsen J, Martín-Salces M, Angchaisuksiri P. Safety and pharmacokinetics of anti-TFPI antibody (concizumab) in healthy volunteers and patients with hemophilia: a randomized first human dose trial. J Thromb Haemost 2015; 13:743-54. [PMID: 25641556 DOI: 10.1111/jth.12864] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/24/2015] [Indexed: 08/31/2023]
Abstract
BACKGROUND Prophylaxis with either intravenous (i.v.) factor VIII (FVIII) or FIX is the gold standard of care for patients with severe hemophilia. A monoclonal antibody (concizumab) targeting tissue factor pathway inhibitor (TFPI) that can be administered subcutaneously (s.c.) has the potential to alter current concepts of prophylaxis in hemophilia. OBJECTIVES To evaluate the safety and describe the pharmacokinetics and pharmacodynamics of single-dose concizumab in healthy volunteers and patients with hemophilia A or B. METHODS In this first human dose, phase 1, multicenter, randomized, double-blind, placebo-controlled trial escalating single i.v. (0.5-9000 μg kg(-1) ) or s.c. (50-3000 μg kg(-1) ) doses of concizumab were administered to healthy volunteers (n = 28) and hemophilia patients (n = 24). RESULTS Concizumab had a favorable safety profile after single i.v. or s.c. administration. There were no serious adverse events and no anti-concizumab antibodies. No clinically relevant changes in platelets, prothrombin time, activated partial thromboplastin time, fibrinogen, or antithrombin were found. A dose-dependent procoagulant effect of concizumab was seen as increased levels of D-dimers and prothrombin fragment 1 + 2. Nonlinear pharmacokinetics of concizumab was observed due to target-mediated clearance. A maximum mean AUC0-∞ of 33 960 h μg mL(-1) and a maximum mean concentration of 247 μg mL(-1) was measured at the highest dose. CONCLUSIONS Concizumab showed a favorable safety profile after i.v. or s.c. administration and nonlinear pharmacokinetics was observed due to target-mediated clearance. A concentration-dependent procoagulant effect of concizumab was observed, supporting further study into the potential use of s.c. concizumab for hemophilia treatment.
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Affiliation(s)
- P Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK
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102
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Jiménez-Yuste V, Lejniece S, Klamroth R, Suzuki T, Santagostino E, Karim FA, Saugstrup T, Møss J. The pharmacokinetics of a B-domain truncated recombinant factor VIII, turoctocog alfa (NovoEight®), in patients with hemophilia A. J Thromb Haemost 2015; 13:370-9. [PMID: 25495795 DOI: 10.1111/jth.12816] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 06/24/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Turoctocog alfa (NovoEight(®)) is a human recombinant coagulation factor VIII (rFVIII) for the treatment of patients with hemophilia A. OBJECTIVES To evaluate the pharmacokinetics of turoctocog alfa in all age groups across clinical trials. PATIENTS/METHODS Data from previously treated patients with severe hemophilia A (FVIII activity level of ≤ 1%) with no history of FVIII inhibitors, in a non-bleeding state, were included. The pharmacokinetics were assessed following a wash-out period and a subsequent single intravenous 50 IU kg(-1) dose of turoctocog alfa. Blood was sampled during a 48-h period postdose. Standard pharmacokinetic (PK) parameters were estimated on the basis of plasma FVIII activity vs. time (PK profiles) with non-compartmental methods. Furthermore, a population PK analysis was conducted. RESULTS Data from 76 patients (aged 1-60 years) enrolled globally across six clinical trials were included, totaling 105 turoctocog alfa PK profiles. Single-dose PK results 3-6 months after the first dose of turoctocog alfa were comparable with the results obtained after the first dose. Similar PK characteristics were shown for different lots and strengths of the drug product. Overall, area under the plasma concentration (activity) curve from administration to infinity (AUC) and t1(/2) tended to increase with increasing age, with lower AUC and shorter t(1/2) being seen in children than in adolescents and adults. The PK profiles of turoctocog alfa and other commercially available plasma-derived FVIII and rFVIII products were similar in all age groups. CONCLUSIONS The PK characteristics of turoctocog alfa have been thoroughly studied, and shown to be consistent over time, reproducible between different lots and strengths of drug product, and similar to those observed for other FVIII products.
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Affiliation(s)
- V Jiménez-Yuste
- Hemophilia Center, La Paz University Hospital, Autonoma University, Madrid, Spain
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103
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Mannucci PM, Shi Q, Bonanad S, Klamroth R. Novel investigations on the protective role of the FVIII/VWF complex in inhibitor development. Haemophilia 2015; 20 Suppl 6:2-16. [PMID: 24975700 DOI: 10.1111/hae.12465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Development of inhibitory antibodies to infused factor VIII (FVIII) concentrates is the most serious unresolved complication of haemophilia A treatment. Systematic reviews suggest a twofold higher incidence of inhibitors with recombinant (rFVIII) vs. plasma-derived (pdFVIII) FVIII products, but study methodologies vary widely. The lower immunogenicity of pdFVIII concentrates is believed to derive from the presence of von Willebrand factor (VWF) which acts as protector and chaperone for FVIII. Several novel investigations reinforce the protective role of the VWF/FVIII complex in inhibitor development. At the basic science level, numerous in vitro and in vivo experiments have demonstrated that VWF-containing pdFVIII concentrates (pdFVIII/VWF) provide better protection against inhibitor neutralization than rFVIII products. Conformational aspects of the binding between VWF and FVIII are thought to prevent the 'attack' on FVIII by inhibitory antibodies. VWF/FVIII binding is 100% in pdFVIII products but only 80% in recombinant products and this 'free' FVIII may be a target for inhibitory antibodies. At the clinical level, newer strategies to prevent inhibitor development in previously untreated patients with severe haemophilia are under investigation. The concept of early prophylaxis (before the onset of a bleed) is convincing from a theoretical point of view but requires further evaluation. The Study on Inhibitors in Plasma-Product Exposed Toddlers is specifically addressing the issue of relative immunogenicity between classes of FVIII product (recombinant vs. plasma-derived). Currently nearing its target enrolment of 300 patients, this international randomized controlled trial is expected to provide some definitive answers about this ever-present clinical dilemma.
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Affiliation(s)
- P M Mannucci
- Scientific Direction, IRCCS Ca' Granda Foundation Maggiore Hospital, Milan, Italy
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104
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Seuser A, Boehm P, Ochs S, Trunz-Carlisi E, Halimeh S, Klamroth R. How fit are children and adolescents with haemophilia in Germany? Results of a prospective study assessing the sport-specific motor performance by means of modern test procedures of sports science. Haemophilia 2015; 21:523-9. [DOI: 10.1111/hae.12636] [Citation(s) in RCA: 9] [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: 12/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Seuser
- Private Practise for Prevention, Rehabilitation and Orthopedics; Bonn Germany
| | - P. Boehm
- Institute for Prevention and Aftercare; Cologne Germany
| | - S. Ochs
- Institute for Prevention and Aftercare; Cologne Germany
| | | | - S. Halimeh
- Coagulation Center Rhine-Ruhr; Duisburg Germany
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105
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Kessler C, Oldenburg J, Ettingshausen CE, Tiede A, Khair K, Négrier C, Klamroth R. Spotlight on the human factor: building a foundation for the future of haemophilia A management. Haemophilia 2014; 21 Suppl 1:1-12. [DOI: 10.1111/hae.12582] [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] [Indexed: 01/11/2023]
Affiliation(s)
- C. Kessler
- Division of Hematology and Oncology; The Vincent Lombardi Comprehensive Cancer Center; Georgetown University Medical Center; Washington, DC USA
| | - J. Oldenburg
- The Institute of Experimental Haematology and Transfusion Medicine and the Haemophilia Centre at the University Clinic; Bonn Germany
| | | | - A. Tiede
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School; Hannover Germany
| | - K. Khair
- Great Ormond Street Hospital for Children NHS Trust; London UK
| | - C. Négrier
- Hematology Division; Director Hemophilia Comprehensive Care Center; Hôpital Edouard Herriot Pavillon E; Université Lyon; Lyon France
| | - R. Klamroth
- The Haemophilia Treatment Centre; Vivantes Klinikum im Friedrichshain; Berlin Germany
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106
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Schutgens REG, Klamroth R, Pabinger I, Dolan G. Management of atrial fibrillation in people with haemophilia - a consensus view by the ADVANCE Working Group. Haemophilia 2014; 20:e417-20. [DOI: 10.1111/hae.12525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R. E. G. Schutgens
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - I. Pabinger
- Medical University of Vienna; Vienna Austria
| | - G. Dolan
- Nottingham University Hospitals; Nottingham UK
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107
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Klamroth R. Abklärung einer erworbenen Blutungsneigung. Internist (Berl) 2014; 55:514-20. [DOI: 10.1007/s00108-013-3421-6] [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: 10/25/2022]
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108
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Klamroth R, Gröner A, Simon TL. Pathogen inactivation and removal methods for plasma-derived clotting factor concentrates. Transfusion 2014; 54:1406-17. [PMID: 24117799 PMCID: PMC7169823 DOI: 10.1111/trf.12423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/26/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
Pathogen safety is crucial for plasma-derived clotting factor concentrates used in the treatment of bleeding disorders. Plasma, the starting material for these products, is collected by plasmapheresis (source plasma) or derived from whole blood donations (recovered plasma). The primary measures regarding pathogen safety are selection of healthy donors donating in centers with appropriate epidemiologic data for the main blood-transmissible viruses, screening donations for the absence of relevant infectious blood-borne viruses, and release of plasma pools for further processing only if they are nonreactive for serologic markers and nucleic acids for these viruses. Despite this testing, pathogen inactivation and/or removal during the manufacturing process of plasma-derived clotting factor concentrates is required to ensure prevention of transmission of infectious agents. Historically, hepatitis viruses and human immunodeficiency virus have posed the greatest threat to patients receiving plasma-derived therapy for treatment of hemophilia or von Willebrand disease. Over the past 30 years, dedicated virus inactivation and removal steps have been integrated into factor concentrate production processes, essentially eliminating transmission of these viruses. Manufacturing steps used in the purification of factor concentrates have also proved to be successful in reducing potential prion infectivity. In this review, current techniques for inactivation and removal of pathogens from factor concentrates are discussed. Ideally, production processes should involve a combination of complementary steps for pathogen inactivation and/or removal to ensure product safety. Finally, potential batch-to-batch contamination is avoided by stringent cleaning and sanitization methods as part of the manufacturing process.
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Affiliation(s)
- Robert Klamroth
- Center for Vascular MedicineVivantes Klinikum im FriedrichshainBerlinGermany
| | - Albrecht Gröner
- Preclinical Research and Development, Pathogen SafetyCSL BehringMarburgGermany
| | - Toby L. Simon
- Plasma Research and Development/CSL PlasmaCSL BehringKing of PrussiaPennsylvania
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109
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Schutgens REG, Klamroth R, Pabinger I, Malerba M, Dolan G. Atrial fibrillation in patients with haemophilia: a cross-sectional evaluation in Europe. Haemophilia 2014; 20:682-6. [DOI: 10.1111/hae.12445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 01/04/2023]
Affiliation(s)
| | | | - I. Pabinger
- Medical University of Vienna; Vienna Austria
| | - M. Malerba
- Ospedale Maggiore Policlinico; Milan Italy
| | - G. Dolan
- Nottingham University Hospitals; Nottingham UK
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110
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Schindewolf M, Steindl J, Beyer-Westendorf J, Schellong S, Dohmen PM, Brachmann J, Madlener K, Pötzsch B, Klamroth R, Hankowitz J, Banik N, Eberle S, Kropff S, Müller MM, Lindhoff-Last E. Frequent off-label use of fondaparinux in patients with suspected acute heparin-induced thrombocytopenia (HIT)--findings from the GerHIT multi-centre registry study. Thromb Res 2014; 134:29-35. [PMID: 24703295 DOI: 10.1016/j.thromres.2014.03.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 02/19/2014] [Revised: 03/05/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In life-threatening immune heparin-induced thrombocytopenia (HIT), treatment with an approved non-heparin anticoagulant is essential. However, off-label use with fondaparinux has been reported in the literature. The study aim was to collect data on "real-life" management of patients with suspected acute HIT regarding diagnostic and therapeutic strategies. PATIENTS AND METHODS In a national multi-centre registry study, patients with a 4T's HIT-probability score of ≥ 4 points and treatment with at least one dose of (A)rgatroban, (L)epirudin, (D)anaparoid, or (F)ondaparinux were retrospectively evaluated. RESULTS Of 195 patients, the 4T's scores were 4/5/6/7/8 points in 46 (23.6%)/50 (25.6%)/74 (38.0%)/13 (6.7%)/7 (3.6%) patients, respectively. During heparin therapy, 47 (24.1%) thromboembolic events, 5 (2.6%) skin lesions, 1 (0.5%) amputation, 24 (12.3%) Hb-relevant bleedings, and 2 (1.0%) fatalities occurred. A functional heparin-induced platelet activation assay was performed in 96.9%, a platelet factor 4/heparin-dependent enzyme immunoassay in 89.2%, a particle gel immunoassay in 12.3%, and a serotonin-release assay in none of the patients. Argatroban was used in 16.4%, lepirudin in 2.1%, danaparoid in 23.6%, fondaparinux in 40.0% of the patients; the sequential therapy strata were: AF (5.6%), DA (5.6%), DF (2.6%), DL (2.1%), ADF (1.5%), and DFL (0.5%). CONCLUSIONS The current diagnostic laboratory strategy for suspected HIT is mostly (>96%) based on the recommended 2-step strategy (immunoassay plus functional assay). However, there is a wide fondaparinux off-label use (up to 50.3%) for suspected HIT, even in those patients with a high clinical pretest probability. Efficacy and safety of fondaparinux for HIT-treatment require further evaluation.
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Affiliation(s)
- Marc Schindewolf
- Department of Internal Medicine, Division of Vascular Medicine/Haemostaseology, Goethe University Hospital, Frankfurt/M., Germany.
| | - Julia Steindl
- Department of Internal Medicine, Division of Vascular Medicine/Haemostaseology, Goethe University Hospital, Frankfurt/M., Germany
| | - Jan Beyer-Westendorf
- Department of Medicine III, Division of Angiology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Sebastian Schellong
- Medical Department II, Municipal Hospital Dresden Friedrichstadt, Dresden, Germany
| | - Pascal Maria Dohmen
- Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany
| | - Johannes Brachmann
- II. Medical Clinic, Department of Cardiology, Klinikum Coburg, Coburg, Germany
| | - Katharina Madlener
- Department of Haemostaseology and Transfusion Medicine, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Bernd Pötzsch
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Robert Klamroth
- Department of Internal Medicine, Haemophilia Treatment Centre, Vivantes Klinikum im Friedrichshain Berlin, Berlin, Germany
| | | | - Norbert Banik
- GlaxoSmithKline, Biostatistics & Epidemiology, München, Germany
| | - Sonja Eberle
- GlaxoSmithKline, Biostatistics & Epidemiology, München, Germany
| | - Stefan Kropff
- GlaxoSmithKline, Cardiovascular and Antithrombotics, München, Germany
| | | | - Edelgard Lindhoff-Last
- Department of Internal Medicine, Division of Vascular Medicine/Haemostaseology, Goethe University Hospital, Frankfurt/M., Germany
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111
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Klamroth R, Holzhauer S, Zimmermann R, Heller C, Kurnik K. Beriate® P in the treatment of patients with haemophilia A: results of a long-term pharmacovigilance study. Thromb Res 2014; 134 Suppl 1:S16-21. [PMID: 24418255 DOI: 10.1016/j.thromres.2013.10.014] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND The German Beriate(®) P pharmacovigilance study started in 2003 and is planned to run until December 2013. MATERIALS AND METHODS This analysis included data from 84 haemophilia A patients treated with the high-purity, plasma-derived coagulation factor VIII concentrate Beriate(®) P. Prior to study start, 69 of the 80 patients for whom data were available had received previous treatment with Beriate(®) P (mean treatment period 7.1 ± 5.4 years). The mean study duration from the start of pharmacovigilance was 43.3 ± 30.3 months (median 43.5 months; range 0-101.9months). The most common treatment at the last visit was prophylaxis (65.7% of patients), which was most commonly administered at a frequency of three infusions/week in 47.3% of patients. RESULTS Most patients experienced up to six minor bleeds/year. For 1,311 bleeding episodes, a median of one infusion/bleed was administered (mean 2.8 ± 4.7; range 0-83). The clinical response to Beriate(®) P was rated "excellent"/"good" in 94% of 32 visits of patients with major bleeding. The clinical response for patients with minor bleeding was rated "excellent"/"good" in 98.5% of 377 visits. One clinically relevant inhibitor in a previously untreated patient was documented during the study course. There were no reports of virus transmissions suspected to be caused by Beriate(®) P prior to the study start or during the study. CONCLUSIONS These findings confirm the excellent efficacy, safety, and tolerability of Beriate(®) P in the treatment of a wide spectrum of previously untreated patients up to adult patients with haemophilia A.
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Affiliation(s)
- Robert Klamroth
- Hämophiliezentrum, Klinik für Innere Medizin - Angiologie, Hämostaseologie und Pneumologie, Vivantes-Klinikum im Friedrichshain, Berlin, Germany
| | - Susanne Holzhauer
- Klinik für Pädiatrische Hämatologie und Onkologie, Campus Virchow Klinikum, Universitätsklinikum Charité Berlin, Berlin, Germany
| | - Rainer Zimmermann
- Hämophiliezentrum, Abteilung für. Innere Medizin, SRH Kurpfalzkrankenhaus, Heidelberg, Germany
| | - Christine Heller
- Pädiatrische Hämostaseologie, Klinik für Kinderheilkunde-und Jugendmedizin, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany
| | - Karin Kurnik
- Zentrum für Pädiatrische Hämostaseologie, Ludwig-Maximilian Universität, Klinikum der Universität, Campus Innenstadt, Munich, Germany.
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112
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Klamroth R. [Operation and hemophilia : no problem with good interdisciplinary management]. Anaesthesist 2014; 63:5. [PMID: 24399371 DOI: 10.1007/s00101-013-2271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Klamroth
- Klinik für Innere Medizin - Angiologie, Hämostaseologie und Pneumologie, Hämophiliezentrum und Gerinnungssprechstunde, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland,
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113
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Klamroth R, Gottstein S, Orlovic M, Heinrichs C. Long-term efficacy and safety of a pasteurized, plasma-derived factor VIII concentrate (Beriate® P) in patients with haemophilia A. Thromb Res 2013; 134 Suppl 1:S38-42. [PMID: 24256767 PMCID: PMC7119351 DOI: 10.1016/j.thromres.2013.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Beriate® P was first introduced in Germany in 1990 as factor VIII (FVIII):C® HS Behring and subsequent product improvements yielded an albumin-free formulation with a specific activity of approximately 170 IU/mg protein. In 1992, the concentration was raised to 100 IU FVIII/mL in the reconstituted product, with a mean specific activity of 270 IU/mg protein. Pathogen safety is achieved by careful donor selection and a combination of pasteurization and chromatographic purification steps. Materials and methods We analysed the efficacy and safety of Beriate® P in the clinical setting from 1996 to 2005 with a focus on surgical patients. Of the 36 patients (mean age: 38 years; range 1–72 years), 29 had severe haemophilia A, two had moderate haemophilia, two had mild haemophilia, and three had sub-clinical haemophilia. Most patients (n = 28) had more than 100 exposure days, representing a total of 202 patient-years with a consumption of 27,811,500 IU of Beriate® P. Results There was no evidence of seroconversion towards relevant viruses, no inhibitor development (35 previously treated patients, one previously untreated patient), no abnormal immunological findings or allergic reactions. In all 36 patients treated for acute bleeding and prophylaxis, and 24 surgeries (15 total joint replacements, eight orthopaedic procedures, one cholecystectomy) in 16 patients with severe haemophilia A, efficacy of Beriate® P was always rated as “excellent” or “good”, and no thrombosis was reported. Conclusion Beriate® P has an excellent efficacy and safety profile. Many patients who were initiated on Beriate® P at our centre remain on the treatment today.
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Affiliation(s)
- Robert Klamroth
- Department of Internal Medicine - Angiology and Clotting Disorders, Haemophilia Treatment Centre, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
| | - Saskia Gottstein
- Department of Internal Medicine - Angiology and Clotting Disorders, Haemophilia Treatment Centre, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Marija Orlovic
- Department of Internal Medicine - Angiology and Clotting Disorders, Haemophilia Treatment Centre, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Christl Heinrichs
- Department of Internal Medicine - Angiology and Clotting Disorders, Haemophilia Treatment Centre, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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114
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Maier J, Schalinski E, Wagner J, Klamroth R, Hellmeyer L. Austragung einer Schwangerschaft mit komplizierter hereditärer Hämangiomatose. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361267] [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: 10/26/2022]
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115
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Mannucci PM, Kempton C, Millar C, Romond E, Shapiro A, Birschmann I, Ragni MV, Gill JC, Yee TT, Klamroth R, Wong WY, Chapman M, Engl W, Turecek PL, Suiter TM, Ewenstein BM. Pharmacokinetics and safety of a novel recombinant human von Willebrand factor manufactured with a plasma-free method: a prospective clinical trial. Blood 2013; 122:648-57. [PMID: 23777763 PMCID: PMC3736194 DOI: 10.1182/blood-2013-01-479527] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/06/2013] [Indexed: 12/20/2022] Open
Abstract
Safety and pharmacokinetics (PK) of recombinant von Willebrand factor (rVWF) combined at a fixed ratio with recombinant factor VIII (rFVIII) were investigated in 32 subjects with type 3 or severe type 1 von Willebrand disease (VWD) in a prospective phase 1, multicenter, randomized clinical trial. rVWF was well tolerated and no thrombotic events, inhibitors, or serious adverse events were observed. The PK of rVWF ristocetin cofactor activity, VWF antigen, and collagen-binding activity were similar to those of the comparator plasma-derived (pd) VWF-pdFVIII. In vivo cleavage of ultra-large molecular-weight rVWF multimers by ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13; the endogenous VWF protease) and generation of characteristic satellite bands were demonstrated. In 2 subjects with specific nonneutralizing anti-VWF-binding antibodies already detectable before rVWF infusion, a reduction in VWF multimers and VWF activity was observed. Stabilization of endogenous FVIII was enhanced following post-rVWF-rFVIII infusion as shown by the difference in area under the plasma concentration curve compared with pdVWF-pdFVIII (AUC0-∞) (P < .01). These data support the concept of administering rVWF alone once a therapeutic level of endogenous FVIII is achieved.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Hemophilia and Thrombosis Center and Scientific Direction, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation and University of Milan, Milan, Italy
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116
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Birschmann I, Klamroth R, Eichler H, Schenk J, Kirchmaier CM, Halimeh S. Results of the WIRK prospective, non-interventional observational study of recombinant activated factor VII (rFVIIa) in patients with congenital haemophilia with inhibitors and other bleeding disorders. Haemophilia 2013; 19:679-85. [DOI: 10.1111/hae.12156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- I. Birschmann
- Institute for Laboratory and Transfusion Medicine; Heart and Diabetes Center; Ruhr University Bochum; Bad Oeynhausen; Germany
| | - R. Klamroth
- Department of Internal Medicine - Angiology; Haemostasis and Coagulation Disorders; Vivantes Hospital im Friedrichshain; Berlin; Germany
| | - H. Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine; Saarland University Hospital; Homburg/Saar; Germany
| | - J. Schenk
- Institute of Clinical Hemostaseology and Transfusion Medicine; Saarland University Hospital; Homburg/Saar; Germany
| | - C. M. Kirchmaier
- Section Internal Medicine I - Angiology and Haemostaseology; German Diagnostic Clinic; Wiesbaden; Germany
| | - S. Halimeh
- Coagulation Centre Rhine-Ruhr, Outpatient and Specialist Laboratory for Coagulation Disorders/Haemophilia; Duisburg; Germany
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117
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Mondorf W, Kalnins W, Klamroth R. Patient-reported outcomes of 182 adults with severe haemophilia in Germany comparing prophylactic vs. on-demand replacement therapy. Haemophilia 2013; 19:558-63. [DOI: 10.1111/hae.12136] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 01/22/2023]
Affiliation(s)
| | - W. Kalnins
- German Haemophilia Society; Hamburg; Germany
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118
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Yadegari H, Driesen J, Pavlova A, Biswas A, Ivaskevicius V, Klamroth R, Oldenburg J. Insights into pathological mechanisms of missense mutations in C-terminal domains of von Willebrand factor causing qualitative or quantitative von Willebrand disease. Haematologica 2013; 98:1315-23. [PMID: 23539537 DOI: 10.3324/haematol.2013.084111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The carboxyl-terminal domains of von Willebrand factor, D4-CK, are cysteine-rich implying that they are structurally important. In this study we characterized the impact of five cysteine missense mutations residing in D4-CK domains on the conformation and biosynthesis of von Willebrand factor. These variants were identified as heterozygous in type 1 (p.Cys2619Tyr and p.Cys2676Phe), type 2A (p.Cys2085Tyr and p.Cys2327Trp) and as compound heterozygous in type 3 (p.Cys2283Arg) von Willebrand disease. Transient expression of human cell lines with wild-type or mutant von Willebrand factor constructs was performed. The mutated and wild-type recombinant von Willebrand factors were quantitatively and qualitatively assessed and compared. Storage of von Willebrand factor in pseudo-Weibel-Palade bodies was studied with confocal microscopy. The structural impact of the mutations was analyzed by homology modeling. Homozygous expressions showed that these mutations caused defects in multimerization, elongation of pseudo-Weibel-Palade bodies and secretion of von Willebrand factor. Co-expressions of wild-type von Willebrand factor and p.Cys2085Tyr, p.Cys2327Trp and p.Cys2283Arg demonstrated defective multimer assembly, suggesting a new pathological mechanism for dominant type 2A von Willebrand disease due to mutations in D4 and B domains. Structural analysis revealed that mutations p.Cys2283Arg, p.Cys2619Tyr and p.Cys2676Phe disrupted intra-domain disulfide bonds, whereas p.Cys2327Trp might affect an inter-domain disulfide bond. The p.Cys2327Trp variant is distinguished from the other mutants by an electrophoretic mobility shift of the multimer bands. The results highlight the importance of cysteine residues within the carboxyl-terminal of von Willebrand factor on structural conformation of the protein and consequently multimerization, storage, and secretion of von Willebrand factor.
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Affiliation(s)
- Hamideh Yadegari
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Germany
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119
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Klamroth R, Orlovic M, Fritsche I, Seibt S, Seibt F, Wegscheider K, Landgraf H. The influence of thrombophilic risk factors on vascular access survival in chronic dialysis patients in a retrospective evaluation. VASA 2013; 42:32-9. [PMID: 23385224 DOI: 10.1024/0301-1526/a000245] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vascular access by dialysis graft or fistula is of major importance for hemodialysis treatment. Vascular access occlusion is one main reason for hospitalization of patients on hemodialysis. Thrombophilic risk factors are discussed as one cause for occlusion. The aim of this study was to determine if the presence of thrombophilic factors is associated with a reduced survival rate of vascular dialysis access. PATIENTS AND METHODS The following thrombophilic parameters were measured in every hemodialysis patient from five outpatient dialysis centers in Berlin: antithrombin, protein C, protein S, prothrombin mutation (G20210A), factor V mutation (G1691A), lupus anticoagulant, anticardiolipin antibodies, factor VIII, plasminogen activator inhibitor, homocysteine and lipoprotein(a). Vascular access characteristics such as vascular access material (PTFE graft or native fistula) and location were also recorded. Each patient's medical history was documented. RESULTS 199 patients with a total of 499 vascular accesses in the past (311 native fistulas (62.3 %) and 188 PTFE grafts (33.7 %)) were included in this study. The type of vascular access played an important role, with mean survival times of 34.2 months for native fistulas versus 9.5 months for grafts. There was at least one thrombophilic risk factor present in 69.8 % of the patients. In the univariate analysis thrombophilia had a significant influence on vascular access survival. The effect persisted throughout the multivariate analysis. Multivariate Cox analysis showed that the presence of thrombophilic factors was associated with a 43 % (mild) to 105 % (severe thrombophilia) increased risk of occlusion of the vascular access, corresponding to a 45 % to 68 % reduction of native access survival time. The influence of thrombophilia was evident in fistulas as well as in PTFE grafts. CONCLUSIONS Thrombophilia plays a role in vascular accesses survival in patients on hemodialysis. In hemodialysis patients with recurrent occlusions of vascular access thrombophilia testing should be performed.
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Affiliation(s)
- Robert Klamroth
- Department for Internal Medicine, Vivantes Hospital in Friedrichshain, Berlin, Germany.
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120
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Pollmann H, Klamroth R, Vidovic N, Kriukov AY, Epstein J, Abraham I, Spotts G, Oldenburg J. Prophylaxis and quality of life in patients with hemophilia A during routine treatment with ADVATE [antihemophilic factor (recombinant), plasma/albumin-free method] in Germany: a subgroup analysis of the ADVATE PASS post-approval, non-interventional study. Ann Hematol 2013; 92:689-98. [DOI: 10.1007/s00277-013-1678-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/08/2013] [Indexed: 11/29/2022]
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121
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Oldenburg J, Zimmermann R, Huth-Kühne A, Kurnik K, Klamroth R, Abraham I, Brondke H, Pirck M, Engl W, Reininger A, Spotts G. Recruitment update of AHEAD. Hamostaseologie 2013; 33 Suppl 1:S56-S60. [PMID: 24344445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
The multicenter prospective non-interventional AHEAD study was initiated to obtain long-term outcome data on joint health, HR-QoL, haemophilia-related co-morbidities, and the effectiveness and safety of ADVATE (recombinant anti-hemophilic factor VIII, plasma-free method [octocog alfa]) in routine clinical practice. The German AHEAD study arm aims to enroll up to 500 patients in up to 35 haemophilia treatment centers (HTCs); patient recruitment started in June 2010. The study arm conducted in other European countries is expected to enroll 350 patients from more than 50 HTCs; recruitment started in June 2011. In both study arms, recruitment will continue through the end of 2015, and each enrolled patient will be followed for a total of four years.
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122
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Caspers M, Pavlova A, Driesen J, Harbrecht U, Klamroth R, Kadar J, Fischer R, Kemkes-Matthes B, Oldenburg J. Deficiencies of antithrombin, protein C and protein S - practical experience in genetic analysis of a large patient cohort. Thromb Haemost 2012; 108:247-57. [PMID: 22627591 DOI: 10.1160/th11-12-0875] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/22/2012] [Indexed: 11/05/2022]
Abstract
Deficiencies of natural anticoagulant proteins including antithrombin (AT), protein C (PC) and protein S (PS) are important causes of inherited thrombophilia. This study aimed to report on the practical experience gained in performing genetic analyses of a large cohort of patients with AT, PC and PS deficiencies and to relate this knowledge to clinical application. We genotyped a large cohort of 709 unrelated patients with AT (231), PC (234) and PS (244) deficiencies referred to us by physicians throughout Germany. Mutations were detected by direct sequencing and multiplex ligation-dependent probe amplification (MLPA). The highest mutation detection rate (MDR) was found for the SERPINC1 gene (83.5%), followed by the PROC (69%) and PROS1 (43%) genes. Even at AT activities close to the normal range (75%), the MDR was 70%. Contrastingly, for PC and PS deficiencies, the MDR dropped significantly and mildly lowered to subnormal values. At PS activities >55% for PS no mutations were detected. Mutation profiles of all three genes were similar with the highest prevalence for missense mutations (63-78%), followed by nonsense (7-11%), splice-site mutations (7-13%), small deletions (1-8%), small insertions/duplications (1-4%) and large deletions (3-6%). In conclusion, genetic testing is a useful diagnostic tool for diagnosing thrombophilia. Based on our data, genetic analysis for patients with AT deficiency is indicated for all subnormal activities. In contrast, genotyping is not advisable for PC activities >70% and for PS activities >55%.
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Affiliation(s)
- Michael Caspers
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
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123
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Richards M, Lavigne Lissalde G, Combescure C, Batorova A, Dolan G, Fischer K, Klamroth R, Lambert T, Lopez-Fernandez M, Pérez R, Rocino A, Fijnvandraat K. Neonatal bleeding in haemophilia: a European cohort study. Br J Haematol 2011; 156:374-82. [DOI: 10.1111/j.1365-2141.2011.08967.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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124
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Bidlingmaier C, Kurnik K, Escuriola-Ettingshausen C, Jager R, Klamroth R, Male C, Marosi A, Nemes L, von Stackelberg A, Kreuz W. Immune tolerance induction with a factor VIII concentrate containing von Willebrand factor (Haemoctin SDH®) in 14 patients with severe haemophilia A. Haemophilia 2011; 17:e837-40. [PMID: 21649797 DOI: 10.1111/j.1365-2516.2011.02577.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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125
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Tiede A, Friedrich U, Stenmo C, Allen G, Giangrande P, Goudemand J, Hay C, Holmström M, Klamroth R, Lethagen S, McKenzie S, Miesbach W, Negrier C, Yuste VJ, Berntorp E. Safety and pharmacokinetics of subcutaneously administered recombinant activated factor VII (rFVIIa). J Thromb Haemost 2011; 9:1191-9. [PMID: 21489128 DOI: 10.1111/j.1538-7836.2011.04293.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 11/29/2022]
Abstract
BACKGROUND Recombinant activated factor VIIa (rFVIIa) is used to treat bleeds in hemophilia patients with inhibitors. A subcutaneous formulation could potentially improve its half-life and make it suitable for prophylactic treatment. OBJECTIVES A study was conducted to determine the safety of subcutaneously administered rFVIIa in patients with hemophilia and the pharmacokinetic profile (including bioavailability). PATIENTS/METHODS This was a multicenter, open-label, cross-over comparison of single doses of intravenous rFVIIa 90μgkg(-1) and a new formulation of rFVIIa for subcutaneous injection at dose levels of 45, 90, 180, 270 and 360μgkg(-1) . Sixty subjects (12 per dose cohort) with hemophilia A or B were enrolled. RESULTS Subcutaneously administered rFVIIa showed lower mean peak plasma concentrations and prolonged FVII activity (C(max) , 0.44-5.16IU mL(-1) [across doses]; t(1/2) , 12.4h; t(max) , 5.6h) compared with intravenously administered rFVIIa (C(max) , 51.7IUmL(-1) ; t(1/2) , 2.7h; t(max) , <10min). The absolute bioavailability of subcutaneous rFVIIa ranged from 21.1 to 30.1% across dose levels. Dose proportionality was observed within a 2-fold dose increase but not across the full dose range. No thromboembolic events, drug-related serious adverse events, severe injection-site reactions or neutralizing antibodies were reported (primary endpoint). Mild and moderate injection-site reactions were more frequent with subcutaneous than with intravenous injections. CONCLUSION This phase I clinical trial did not identify safety concerns of prolonged exposure to rFVIIa administered subcutaneously in single doses to hemophilia patients.
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Affiliation(s)
- A Tiede
- Hannover Medical School, Hannover, Germany
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126
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Klamroth R. Thrombozytopenie in der Schwangerschaft. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1269964] [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] Open
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127
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Oldenburg J, Kurnik K, Huth-Kühne A, Zimmermann R, Abraham I, Klamroth R. AHEAD. Advate in HaEmophilia A outcome Database. Hamostaseologie 2010; 30 Suppl 1:S23-S25. [PMID: 21042659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The clinical picture of haemophilia A patients is often characterised by recurrent bleedings, in particular joint bleeds. Thus far, long-term data on the outcome of haemophilia A patients are scarce as regards the development of target joints, joint replacement, lost days from school or work due to bleedings, and the quality of life, as most previous studies were limited to the aspects of safety and efficacy. The Baxter-initiated AHEAD (Advate in HaEmophilia A outcome Database) study is a multi-centre, prospective, non-interventional observational study of haemophilia A patients. All patients with a residual FVIII activity of £5% who are being treated with ADVATE are eligible. There are no limitations in terms of patient age or treatment regimen. AHEAD is scientifically supported by a renowned interdisciplinary steering board and is intended to yield data on 500 patients in up to 30 haemophilia centres, collected during a period of four years. The large patient population has been chosen in order to ensure a valid database. The objective of the study is to record haemophilia-related arthropathies, which will be defined based on imaging techniques (e. g. MRI, X-ray, ultrasound) and the judgment of the attending physician. In addition, extensive data will be collected on joint replacement surgeries, pseudotumour development, bleeding-related pain, quality of life (age-related questionnaires: Haem-A-QoL, Haemo-QoL, SF10, SF12v2), risk factors (diabetes mellitus, arterial hypertension, nicotine abuse), blood group, gene mutation, physical activity, and on the efficacy and safety of Advate. The patient data will be entered into an electronic CRF system at the centres. Plausibility checks during data entry, regular monitoring visits, and the option of auditing all serve to ensure a high data quality for AHEAD. The first patient was enrolled in the study in early June 2010; recruitment is planned to continue until the end of 2011. The Ethics Committee of the University of Bonn has given its favorable opinion.
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Affiliation(s)
- J Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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128
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Klamroth R, Orlovic M, Kubicek-Hofman C, Gottstein S. [Haemophilia A and haemophilia B. Are there relevant clinical differences?]. Hamostaseologie 2010; 30 Suppl 1:S26-S27. [PMID: 21042678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
UNLABELLED Haemophilia B (HB) was described in 1952 as a single disease for the first time. In comparison to haemophilia A (HA) the bleeding tendency seemed to be less severe. The aim of this study was to investigate this hypothesis in all patients with HA and HB treated in the haemophilia care center of the Vivantes Klinikum. PATIENTS, METHODS All patients with severe HA and HB treated at the haemophilia care center were included. We evaluated the regimen of replacement therapy and factor concentrate consumption within the last 5 years (1/2004 to 12/2008). Intracerebral bleeds were analysed over the whole life span of the included patients. RESULTS 111/181 patients with HA had the severe form and 12/34 patients severe HB. 4/12 patients with severe HB had a history of intracerebral bleeding in comparison to 5/111 patients with severe HA. 2/8 adult patients with severe HB used a prophylactic treatment with factor concentrates (mean consumption 1289 IU factor IX/kg BW/year) in contrast to 60/95 adult patients with HA (mean consumption 2109 IU factor VIII /kg BW/year). CONCLUSION The data suggest a milder bleeding type of patients with severe HB in comparison to patients with severe HA but may be patients with severe HB are at higher risk for intracerebral bleeds.
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Affiliation(s)
- R Klamroth
- Klinik für Innere Medizin - Angiologie und Hämostaseologie, Vivantes - Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin.
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129
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Siegmund B, Pollmann H, Richter H, Orlovic M, Gottstein S, Klamroth R. [Inhibitor development against FVIII in previously treated patients with haemophilia A. A retrospective data collection]. Hamostaseologie 2010; 30 Suppl 1:S37-S39. [PMID: 21042673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
UNLABELLED In a retrospective study 118 haemophilia A patients from two treatment centres (Berlin and Muenster) were evaluated with respect to safety, i. e. inhibitor development, and efficacy of bleeding control of recombinant FVIII products. During approx. 57 thousand injections with more than 87 million I.U. rFVIII no de novo inhibitor was observed in patients previously treated with pFVIII after switch to a recombinant product. A total of 75 thousand injections with more than 111 million I.U. FVIII had been applied during the investigation period of 14 years. Before as well as after switch of the product type bleeding episodes could be controlled with one to two injections per bleed. CONCLUSION According to our results equal safety and efficacy of plasma derived and recombinant FVIII products can be assumed.
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Affiliation(s)
- B Siegmund
- Institut für Thrombophilie und Hämostaseologie, Praxis Dr. med. Hartmut Pollmann, Loerstraße 19, 48143 Münster.
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130
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Klamroth R, Berthold B, Landgraf H, Gottstein S. Endoprothesenchirurgie bei mittelschwerer Hämophilie A und niedrigtitrigem Hemmkörper. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619088] [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: 10/17/2022] Open
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131
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Orlovic M, Kubicek-Hofman C, Gottstein S, Klamroth R. Hämophilie A und Hämophilie B. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryHaemophilia B (HB) was described in 1952 as a single disease for the first time. In comparison to haemophilia A (HA) the bleeding tendency seemed to be less severe. The aim of this study was to investigate this hypothesis in all patients with HA and HB treated in the haemophilia care center of the Vivantes Klinikum. Patients, methods: All patients with severe HA and HB treated at the haemophilia care center were included. We evaluated the regimen of replacement therapy and factor concentrate consumption within the last 5 years (1/2004 to 12/2008). Intracerebral bleeds were analysed over the whole life span of the included patients. Results: 111/181 patients with HA had the severe form and 12/34 patients severe HB. 4/12 patients with severe HB had a history of intracerebral bleeding in comparison to 5/111 patients with severe HA. 2/8 adult patients with severe HB used a prophylactic treatment with factor concentrates (mean consumption 1289 IU factor IX/kg BW/ year) in contrast to 60/95 adult patients with HA (mean consumption 2109 IU factor VIII /kg BW/year). Conclusion: The data suggest a milder bleeding type of patients with severe HB in comparison to patients with severe HA but may be patients with severe HB are at higher risk for intracerebral bleeds.
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132
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Kurnik K, Huth-Kühne A, Zimmermann R, Abraham I, Klamroth R, Oldenburg J. AHEAD. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryThe clinical picture of haemophilia A patients is often characterised by recurrent bleedings, in particular joint bleeds. Thus far, long-term data on the outcome of haemophilia A patients are scarce as regards the development of target joints, joint replacement, lost days from school or work due to bleedings, and the quality of life, as most previous studies were limited to the aspects of safety and efficacy. The Baxter-initiated AHEAD (Advate in HaEmophilia A outcome Database) study is a multi-centre, prospective, non-interventional observational study of haemophilia A patients. All patients with a residual FVIII activity of ≤ 5% who are being treated with ADVATE are eligible. There are no limitations in terms of patient age or treatment regimen.AHEAD is scientifically supported by a renowned interdisciplinary steering board and is intended to yield data on 500 patients in up to 30 haemophilia centres, collected during a period of four years. The large patient population has been chosen in order to ensure a valid database. The objective of the study is to record haemophilia-related arthropathies, which will be defined based on imaging techniques (e. g. MRI, X-ray, ultrasound) and the judgment of the attending physician. In addition, extensive data will be collected on joint replacement surgeries, pseudotumour development, bleeding-related pain, quality of life (age-related questionnaires: Haem-A-QoL, Haemo-QoL, SF10, SF12v2), risk factors (diabetes mellitus, arterial hypertension, nicotine abuse), blood group, gene mutation, physical activity, and on the efficacy and safety of Advate.The patient data will be entered into an electronic CRF system at the centres. Plausibility checks during data entry, regular monitoring visits, and the option of auditing all serve to ensure a high data quality for AHEAD. The first patient was enrolled in the study in early June 2010; recruitment is planned to continue until the end of 2011. The Ethics Committee of the University of Bonn has given its favorable opinion.
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133
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Epstein JD, Leod JM, Yarlas A, Klamroth R. Auswirkung eines Zielgelenks auf die Lebensqualität bei erwachsenen Hämophilie-A-Patienten. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619072] [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: 10/17/2022] Open
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134
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Klamroth R, von Depka M, Richards M, de Moerloose P, Fischer K, Lambert T, Lavigne-Lissalde G, Perez R, Dolan G, Hermans C, Holstein K. Management of acute haemarthrosis in haemophilia A. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619070] [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: 10/17/2022] Open
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135
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Holstein K, von Depka M, Richards M, Lavigne-Lissalde G, Fijnvandraat K, Klamroth R. Major haemorrhage in neonates with haemophilia. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619097] [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: 10/17/2022] Open
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136
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Klamroth R, von Depka M, Gringeri A, Lambert T, Lopez-Fernandez M, Diniz MJ, Rocino A, Holstein K. ITER study of patients with haemophilia A and factor VIII inhibitors. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619076] [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: 10/17/2022] Open
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137
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Epstein JD, Leod JM, Yarlas AS, Hammond GC, Klamroth R. Der Einfluss von Hämophilie A auf die gesundheitsbezogene Lebensqualität. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619071] [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: 10/17/2022] Open
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138
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Holstein K, von Depka M, Gringeri A, Fischer K, Karafoulidou A, Lopez-Fernandez MF, Klamroth R. Sequential combined bypassing therapy of bleeds unresponsive to a single bypassing agent. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619073] [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: 10/17/2022] Open
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139
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Orlovic M, Kubicek-Hofman C, Gottstein S, Klamroth R. Prophylaxe mit FEIBA bei einem Erwachsenen mit schwerer Hämophilie B und Inhibitor. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619074] [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: 10/17/2022] Open
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140
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Abstract
Overall life expectancy and quality of life among persons with haemophilia have increased in recent years, primarily because of the advances in factor replacement therapy and better treatment of infectious diseases. Older haemophilic patients now face aging co-morbidities that are common in the general male population, such as cardiovascular or metabolic diseases, prostate hypertrophy and hepatic, prostate and other cancers. The prevalence of cardiovascular disease and incidence of vascular events among older haemophilic patients can be expected to increase and haemophilic patients may become prone to some cardiovascular risk factors, warranting preventative measures. The treatment of long-term complications of hepatitis C virus infection such as liver cirrhosis and hepatic cancer can be expected to be required in a large portion of the older haemophilia population for some years to come. Appropriate antiviral treatment and close monitoring for possible disease advancement will constitute an important part of routine medical care, and special considerations may be appropriate in conjunction with invasive procedures, chemo- or radiotherapy. At the moment, hard data on which to base the management of these conditions are largely lacking, but can be expected to increase dramatically in the coming decades. In the meantime, the ageing population of haemophilia patients should be offered the same comprehensive health care offered to the general population, which may require a restructuring of health care delivery.
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Affiliation(s)
- G Dolan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK.
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141
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Astermark J, Negrier C, Hermans C, Holme PA, Klamroth R, Kotsi P, de Moerloose P, Pasi J, Rocino A, von Depka M, Windyga J, Ludlam CA. European curriculum for thrombosis and haemostasis. Haemophilia 2009; 15:337-44. [PMID: 19149857 DOI: 10.1111/j.1365-2516.2008.01836.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Astermark
- Department for Coagulation Disorders, Malmö University Hospital, Malmö, Sweden.
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142
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Auerswald G, Muntean W, Kemkes-Matthes B, Klamroth R, Krause M, Kurnik K, Oldenburg J, Pabinger-Fasching I, Schramm W, Zimmermann R, Zotz RB. [Relevance of a single dose of 270 microg/kg recombinant factor VIIa for the treatment of patients with haemophilia and inhibitors - Recommendations from the GTH experts]. Hamostaseologie 2009; 29:197-203. [PMID: 19404511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Recombinant factor VIIa (rFVIIa; NovoSeven) is, besides other indications, authorised for the treatment of bleeding episodes in patients with hereditary haemophilia A or B and inhibitors. Based on the results of three clinical studies, marketing authorisation was granted for the single dose of 270 microg/kg body weight rFVIIa for the treatment of mild to moderate bleeding episodes in patients with haemophilia A or B with inhibitors in March 2007. Thereupon, an expert group analysed the relevance of this additional treatment option for clinical routine. Compared with the repeated application of 90 microg/kg body weight rFVIIa, quality of life may be improved if the single dose of 270 microg/kg body weight rFVIIa reduces the number of injections. The single dose has a benefit for those patients who require several rFVIIa applications or who do not respond adequately to low doses. Moreover, patients with poor venous access or patients who fear injections or reject them (especially children) may benefit from the single dose. The prescription of 270 microg/kg body weight rFVIIa as a single dose instead of multiple dosing of 90 microg/kg body weight is basically an individual and indication-related decision.
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Affiliation(s)
- Günter Auerswald
- Zentrum für Kinder- und Jugendheilkunde, Klinikum Bremen-Mitte, Professor-Hess-Kinderklinik, 28205 Bremen, Germany.
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143
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Budde U, Klamroth R, Gottstein S. A transient high titer inhibitor in a boy with severe haemophilia A treated with recombinant factor VIII. Hamostaseologie 2009. [DOI: 10.1055/s-0037-1617206] [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: 10/17/2022] Open
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144
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Alesci S, Klamroth R, Holstein K, Krause M, Fischer R, Scholz U, Oldenburg J, Horneff S, Tiede A. Cardiovascular interventions in patients with haemophilia and severe von Willebrand disease. Hamostaseologie 2009. [DOI: 10.1055/s-0037-1617207] [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: 10/17/2022] Open
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145
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Klamroth R. Age-related FVIII consumption in patients with severe haemophilia A. Hamostaseologie 2009. [DOI: 10.1055/s-0037-1617194] [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: 10/17/2022] Open
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146
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Tiede A, Huth-Kühne A, Oldenburg J, Großmann R, Geisen U, Krause M, Brand B, Alberio L, Klamroth R, Spannagl M, Knöbl P. Immunosuppressive treatment for acquired haemophilia: current practice and future directions in Germany, Austria and Switzerland. Ann Hematol 2008; 88:365-70. [DOI: 10.1007/s00277-008-0665-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 12/04/2008] [Indexed: 11/25/2022]
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147
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Rentz A, Flood E, Altisent C, Bullinger M, Klamroth R, Garrido RP, Scharrer I, Schramm W, Gorina E. Cross-cultural development and psychometric evaluation of a patient-reported health-related quality of life questionnaire for adults with haemophilia. Haemophilia 2008; 14:1023-34. [PMID: 18665853 DOI: 10.1111/j.1365-2516.2008.01812.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Rentz
- The Center for Health Outcomes Research at UBC, Bethesda, MD, USA
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148
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Gottstein S, Essers E, Fischer J, Joschko K, Landgraf H, Klamroth R. Low molecular weight heparin in pregnancy. Hamostaseologie 2008. [DOI: 10.1055/s-0037-1621633] [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: 10/17/2022] Open
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149
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Huth-Kühne A, Oldenburg J, Großmann R, Geisen U, Krause M, Brand B, Alberio L, Klamroth R, Spannagl M, Knöbl P, Tiede A. Erhebung zur immunsuppressiven Therapie der erworbenen Hämophilie in Deutschland, Österreich und der Schweiz. Hamostaseologie 2008. [DOI: 10.1055/s-0037-1617121] [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: 10/17/2022] Open
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150
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Scholz U, Syrbe G, Koscielny J, Klamroth R. [Haemophilia A, B or von Willebrand disease type 3. Census of patients in the eastern part of Germany]. Hamostaseologie 2008; 28:150-154. [PMID: 18521493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
UNLABELLED Diagnostics and treatment of severe forms of haemorrhagic diatheses (HD), such as haemophilia A, B or type 3 von Willebrand disease (VWD) need high standards in haemophilia treatment centers (HTCs). Due to their generally low incidence, a close cooperation of haemophilia treaters is needed to optimize treatment strategies. For this purpose, the Kompetenznetz Hämorrhagische Diathesen Ost was founded. The first project was the conduction of a survey of epidemiological data of patients with HA, HB and type 3 VWD in all HTCs in the eastern part of Germany. METHOD The study assessed the data regarding numbers of patients treated with HA, HB or type 3 VWD, disease severity, regime of coagulation factor replacement (CFR) and the frequency of factor VIII and IX inhibitors. RESULTS Up to now, data of 838 patients from 27 HTCs were evaluated (5-151 per HTCs). Among the included patients, 201 were children or adolescents (<18 years). 81 children suffered from severe HA, 20 from severe HB and 10 from type 3 VWD. In 637 adults we found 246 with severe HA, 51 severe HB and 28 VWD of type 3. The most commonly used treatment of CFR in patients with severe disease was prophylactic modality. 90% of the children received prophylaxis, but also in 64% of the adults an intermittent or long-term secondary prophylaxis was the preferred treatment. At the time of survey conduction, a factor VIII or IX inhibitor was present in 1.9% of the children and in 1.6% of the adults with haemophilia. CONCLUSION Our data allow an overview of the number of patients and treatment strategies in the eastern part of Germany.
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Affiliation(s)
- U Scholz
- Praxis für Blutgerinnungsstörungen, Leipzig
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