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Josset L, Leuci A, Janbain M, De-Wreede A, Desage S, Lienhart A, Bin V, Lebert D, Delavenne X, Dargaud Y. Multicenter evaluation of the hemostatic activity of emicizumab in patients with severe hemophilia A. J Thromb Haemost 2024; 22:1857-1866. [PMID: 38583717 DOI: 10.1016/j.jtha.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/19/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Emicizumab has been approved for the prophylaxis of patients with hemophilia A with or without inhibitors. However, spontaneous and trauma-induced breakthrough bleeds have been reported in patients on emicizumab prophylaxis, and no laboratory assay has been validated to evaluate the hemostatic activity of emicizumab. OBJECTIVES The thrombin generation assay (TGA) could be a surrogate marker of the hemostatic efficacy of emicizumab. The correlation between TGA and the methods used to measure emicizumab blood concentration was evaluated in this study. METHODS TGA was modified by the use of a trigger reagent combining a very low concentration of tissue factor and activated factor (F)XI. Emicizumab quantification was performed by 3 methods: the modified 1-step FVIII assay and 2 methods based on liquid chromatography and mass spectrometry (LC-MS). RESULTS Using tissue factor/activated FXI-triggered TGA and platelet-poor plasma, a relationship was observed between the area under the thrombin generation curve (endogenous thrombin potential [ETP]) and the clinical response of patients to emicizumab. The ultrastructure of fibrin clots was consistent with ETP results and showed that emicizumab had a hemostatic activity equivalent to 20 to 30 IU/dL of FVIII. Finally, pharmacokinetic/pharmacodynamic analyses showed no correlation between ETP and LC-MS nor with modified 1-stage FVIII assay, but a statistically significant correlation between the LC-MS methods and the time-to-peak results of the TGA. CONCLUSION Using a modified TGA, this study showed that patients who experienced breakthrough bleeds while on emicizumab had a lower thrombin-generating capacity compared with others with good clinical response to emicizumab.
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MESH Headings
- Humans
- Hemophilia A/drug therapy
- Hemophilia A/blood
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Bispecific/pharmacology
- Antibodies, Bispecific/pharmacokinetics
- Antibodies, Bispecific/therapeutic use
- Antibodies, Bispecific/blood
- Thrombin/metabolism
- Adult
- Hemostasis/drug effects
- Male
- Young Adult
- Adolescent
- Hemorrhage/blood
- Middle Aged
- Treatment Outcome
- Chromatography, Liquid
- Blood Coagulation Tests
- Hemostatics/therapeutic use
- Hemostatics/pharmacology
- Hemostatics/pharmacokinetics
- Mass Spectrometry
- Blood Coagulation/drug effects
- Child
- Severity of Illness Index
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Affiliation(s)
- Laurie Josset
- UR4609-Hémostase et Thrombose, Université Claude Bernard Lyon I, Lyon, France; Institut national de la santé et de la recherche médicale, unité mixte de recherche 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint-Etienne, France
| | - Alexandre Leuci
- UR4609-Hémostase et Thrombose, Université Claude Bernard Lyon I, Lyon, France
| | - Maissaa Janbain
- Deming Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Anaëlle De-Wreede
- Laboratoire d'Hémostase, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Stephanie Desage
- Unite d'Hémostase Clinique, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Anne Lienhart
- Unite d'Hémostase Clinique, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Valérie Bin
- Institut national de la santé et de la recherche médicale, unité mixte de recherche 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint-Etienne, France
| | | | - Xavier Delavenne
- Institut national de la santé et de la recherche médicale, unité mixte de recherche 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint-Etienne, France
| | - Yesim Dargaud
- UR4609-Hémostase et Thrombose, Université Claude Bernard Lyon I, Lyon, France; Unite d'Hémostase Clinique, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France.
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Abdulla Alzahrani H, Warsi A, Mullah-Ali A, Alotaibi G, Abu-Riash M, Alshahrani M, Siddiqui M, Owaidah T, Hashmi S. Consensus-Based Expert Recommendations on the Management of Hemophilia A in the Gulf Region. Acta Haematol 2024:1-14. [PMID: 38565097 DOI: 10.1159/000538400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hemophilia A presents a significant health challenge in the Gulf region, where it has an especially high prevalence. There are several unmet needs associated with the management of hemophilia A in the region. The aim of this manuscript was to contextualize unmet management needs, provide recommendations to optimize care, and specify requirements for the establishment of gene therapy centers in the region. SUMMARY An expert panel was assembled comprising ten clinical hematologists from Kuwait, Oman, Saudi Arabia, and the UAE. The Delphi methodology was used to obtain a consensus on statements relating to several aspects of hemophilia A. A consensus was reached for all statements by means of an online, anonymized voting system. The consensus statements pertain to screening and diagnosis, treatment approaches, and requirements for the implementation of gene therapy. KEY MESSAGES There are significant challenges that hinder the optimal management of hemophilia A in the Gulf region. The consensus statements presented provide specific recommendations to improve diagnostic and treatment approaches, promote multidisciplinary care, and optimize regional data generation and reporting. These statements also delineate the requirements for the establishment of gene therapy centers for hemophilia A in the region.
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Affiliation(s)
- Hazzaa Abdulla Alzahrani
- Consultant Hematology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Warsi
- Department of Oncology, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ali Mullah-Ali
- Consultant Pediatric Hematology, National Bank of Kuwait Specialized Hospital for Children, Shuwaikh Industrial, Kuwait
| | - Ghazi Alotaibi
- Department of Medicine (Oncology Center), King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Abu-Riash
- Senior Clinical Specialist Hematology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammad Alshahrani
- Consultant Pediatric Hematology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mustaqeem Siddiqui
- Consultant Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Tarek Owaidah
- Consultant Hemato-Pathology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- Consultant Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Goedhart TM, Bukkems LH, Moort I, Spence CC, Zwaan MC, Maat MP, Mathôt RA, Cnossen MH. Does difference between label and actual potency of factor VIII concentrate affect pharmacokinetic‐guided dosing of replacement therapy in haemophilia A? Haemophilia 2022; 28:610-618. [PMID: 35526235 PMCID: PMC9546314 DOI: 10.1111/hae.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/15/2022] [Accepted: 04/09/2022] [Indexed: 01/19/2023]
Abstract
Background Aim Methods Results Conclusion
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Affiliation(s)
- Tine M.H.J. Goedhart
- Department of Pediatric Hematology and Oncology Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam The Netherlands
| | - Laura H. Bukkems
- Department of Clinical Pharmacology ‐ Hospital Pharmacy Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Iris Moort
- Department of Hematology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Colin C. Spence
- Department of Pediatric Hematology and Oncology Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam The Netherlands
| | - Michel C. Zwaan
- Department of Pediatric Hematology and Oncology Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam The Netherlands
| | - Moniek P.M. Maat
- Department of Hematology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Ron A.A. Mathôt
- Department of Clinical Pharmacology ‐ Hospital Pharmacy Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology and Oncology Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam The Netherlands
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Hatayama Y, Motokura T, Hosoda Y, Suzuki S, Namba H, Kato K, Kojima N, Horie T, Iwamoto T, Yamashita N, Ichikawa H, Fukuda T. Regression Analysis to Estimate the Factor VIII Activity of Patients with Hemophilia A Without Inhibitor who Received Emicizumab Therapy. Clin Appl Thromb Hemost 2022; 28:10760296221082992. [PMID: 35225012 PMCID: PMC8894944 DOI: 10.1177/10760296221082992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Emicizumab, a bispecific monoclonal antibody for hemophilia A (HA), has strong pharmacodynamic effects in several coagulation assays resulting in dosing difficulties with Factor VIII (FVIII) concentrates during bleeding emergencies. MATERIALS AND METHODS Single and multiple regression models were studied to estimate FVIII activity using 27 archived plasma samples from three patients with HA without inhibitor under emicizumab treatment. Explanatory variables were FVIII chromogenic assay (CSA), Ad|min1|, Ad|min2|, the number of seconds of APTT, and the FVIII one-stage assay (OSA), which were measured without idiotype antibodies. The response variable was FVIII OSA measured with idiotype antibodies. RESULTS In the simple linear model, the FVIII CSA regression coefficient was 1.04 and the intercept was -14.55 (r2 = 0.95; p < 0.001). In the multiple regression model, FVIII OSA and FVIII CSA were selected based on the Akaike Information Criterion, with regression coefficients of 1.74 and 1.15, respectively, and an intercept of -92.03 (r2 = 0.96, p < 0.001). CONCLUSIONS The regression models can estimate the FVIII:C levels in patients with HA receiving emicizumab and would be useful in a bleeding emergency and/or surgery.
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Affiliation(s)
- Yuki Hatayama
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan.,Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, School of Medicine, 34827Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Toru Motokura
- Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, School of Medicine, 34827Tottori University Faculty of Medicine, Yonago, Tottori, Japan.,Department of Hematology, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Yuzuru Hosoda
- Department of Hematology, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Sayaka Suzuki
- Department of Hematology, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Hiroya Namba
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Konami Kato
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Nao Kojima
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Takuya Horie
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Takuya Iwamoto
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Noriko Yamashita
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Hitomi Ichikawa
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan
| | - Tetsuya Fukuda
- Division of Clinical Laboratory, 68353Tottori University Hospital, Yonago, Tottori, Japan.,Department of Hematology, 68353Tottori University Hospital, Yonago, Tottori, Japan
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Al-Samkari H, Ozonoff A, Landschaft A, Kimia R, Harper MB, Croteau SE, Kimia AA. Utility of Blood Cultures and Empiric Antibiotics in Febrile Pediatric Hemophilia Patients With Central Venous Access Devices. Pediatr Emerg Care 2021; 37:e1531-e1534. [PMID: 32349076 DOI: 10.1097/pec.0000000000002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with hemophilia frequently require long-term central venous access devices (CVADs) for regular infusion of factor products. Hemophilia patients are not immunocompromised, but the presence and use of CVADs are associated with infections including bacteremia. Currently, the utility of blood cultures in evaluation of the febrile hemophilia patient with an indwelling CVAD is unknown, nor is optimal empiric antibiotic use. METHODS We performed a retrospective cross-sectional study of febrile immunocompetent hemophilia patients with CVADs presenting to a large academic urban pediatric emergency department from 1995 to 2017. We used a natural language processing electronic search, followed by manual chart review to construct the cohort. We analyzed rate of pathogen recovery from cultures of blood in subgroups of hemophilia patients, the pathogen profile, and the reported pathogen susceptibilities to ceftriaxone. RESULTS Natural language processing electronic search identified 181 visits for fever among hemophilia patients with indwelling CVADs of which 147 cases from 44 unique patients met study criteria. Cultures of blood were positive in 56 (38%) of 147 patients (95% confidence interval, 30%-47%). Seventeen different organisms were isolated (10 pathogens and 7 possible pathogens) with Staphylococcus aureus and coagulase-negative Staphylococcus species as the most common. Thirty-four percent of isolates were reported as susceptible to ceftriaxone. Positive blood cultures were more common in cases involving patients with inhibitors (n = 71) versus those without (n = 76), odds ratio, 7.4 (95% confidence interval, 3.5-15.9). This was observed irrespective of hemophilia type. CONCLUSIONS Febrile immunocompetent hemophilia patients with indwelling CVADs have high rates of bacteremia. Empiric antimicrobial therapy should be targeted to anticipated pathogens and take into consideration local susceptibility patterns for Staphylococcus aureus.
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Chelle P, Hajducek D, Mahdi M, Young S, Iorio A, Silvertown J, Edginton A. External qualification of the Web-Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo) models for octocog alfa using real patient data. Res Pract Thromb Haemost 2021; 5:e12599. [PMID: 34761154 PMCID: PMC8563921 DOI: 10.1002/rth2.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Existing adult patient pharmacokinetic (PK) data from the published Advate vs Kovaltry PK crossover study were used for this validation study. This data set is appropriate for qualification, given that it has not been previously submitted to Web-Accessible Population Pharmacokinetic Service-Hemophilia (WAPPS-Hemo) and will not have impacted the WAPPS-Hemo models for Kovaltry. OBJECTIVE To compare the population PK parameters for Kovaltry (BAY 81-8973) derived from the WAPPS-Hemo models with PK parameters derived from noncompartmental analysis (NCA), using a validation PK dataset. METHODS The qualification data set included Kovaltry factor activity (10 samples per infusion) and anthropometric data for 18 patients. Two analyses were performed comparison of Bayesian forecasting from the WAPPS-Hemo models versus NCA using the full 10-sample data set; and comparison of Bayesian forecasting using the full versus reduced 4- and 3-sample data sets. Agreement between outcomes was assessed by quantifying the variability and bias of the error. RESULTS Comparison of WAPPS-Hemo models versus NCA led to well-correlated outcomes despite a systematic overprediction of clearance. Population PK models demonstrated greater consistency with NCA on one-stage data, compared with chromogenic data. WAPPS-Hemo model results were consistent in reduced sampling compared to full sampling. Inclusion of a 48-hour time point in the reduced sampling greatly improved the consistency with full sampling. DISCUSSION Qualification of population PK models and their use for Bayesian forecasting in full and reduced sampling is an essential step toward their validation. The evaluations performed in this study support the confidence of PK parameter estimates provided by the models.
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Affiliation(s)
- Pierre Chelle
- School of PharmacyUniversity of WaterlooWaterlooONCanada
| | | | | | | | - Alfonso Iorio
- McMaster‐Bayer Endowed Research Chair for Clinical Epidemiology of Congenital Bleeding DisordersDepartment of MedicineDepartment of Health Research Methods, Evidence and ImpactMcMaster UniversityONCanada
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7
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Abstract
Remarkable changes are occurring in the diagnosis and management of individuals with hemophilia A. Genetic testing, including next-generation sequencing, enables family planning, carrier testing, and prenatal diagnosis. Musculoskeletal ultrasound examination facilitates the early detection of acute bleeds and joint disease in clinic, enabling more rapid bleed resolution and treatment planning. Novel therapies offer simpler weekly or monthly administration, some by subcutaneous injection, with better compliance and quality of life, as well as fewer bleeds. Gene therapy provides a 1-time phenotypic "cure" that is cost effective, but may be complicated by waning levels, vector immune responses, and hepatotoxicity.
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8
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Croteau SE, Wang M, Wheeler AP. 2021 clinical trials update: Innovations in hemophilia therapy. Am J Hematol 2021; 96:128-144. [PMID: 33064330 DOI: 10.1002/ajh.26018] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 01/19/2023]
Abstract
Therapies engineered to prolong clotting factor protein circulation time, manipulate the balance of pro-coagulant and anti-coagulant proteins, or introduce new genetic material to enable endogenous factor protein production dominate the clinical trial landscape of hemophilia. The availability of clotting factor concentrates and the establishment of primary prophylaxis have dramatically improved health outcomes for hemophilia patients. But, the burden of hemostatic therapy remains significant, and many barriers to consistent longitudinal use of prophylaxis exist. Several types of emerging therapeutics including engineered factor concentrates, substitutive therapies, rebalancing therapies, and gene transfer/editing all aim to reduce the challenges of current hemophilia treatment. Emerging treatment options may reduce treatment frequency or need for intravenous administration. They may also introduce new challenges in laboratory assessment of hemostasis. These novel therapies must not introduce significant new health risks and continue to support similar or improved outcomes. The potential ramifications of rebalancing the coagulation cascade, particularly in a stress or inflammatory state, or introduction of new genetic material are not trivial. The focus of this review is to provide an overview of active and recently completed clinical trials as well as emerging preclinical data investigating new therapeutic possibilities for hemophilia patients and potentially other rare bleeding disorders.
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Affiliation(s)
| | - Michael Wang
- University of Colorado Hemophilia and Thrombosis Center Aurora Colorado
| | - Allison P. Wheeler
- Department of Pathology, Microbiology & Immunology Vanderbilt University Medical Center Nashville Tennessee
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9
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Escuriola-Ettingshausen C, Auerswald G, Königs C, Kurnik K, Scholz U, Klamroth R, Oldenburg J. Optimizing the management of patients with haemophilia A and inhibitors in the era of emicizumab: Recommendations from a German expert panel. Haemophilia 2020; 27:e305-e313. [PMID: 32937002 DOI: 10.1111/hae.14010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Standard treatment of haemophilia A is based on replacing the missing coagulation factor VIII (FVIII) to treat and prevent bleeding episodes. The most challenging complication of FVIII therapy is the development of neutralizing antibodies (inhibitors) that can render treatment ineffective. Eradication of the inhibitor through immune tolerance induction (ITI) remains the most effective strategy for managing these patients. Bypassing agents can be used to help restore haemostasis in inhibitor patients. Several novel agents have recently been developed, such as the FVIII mimetic agent emicizumab, which has been effective in reducing the annualized bleeding rate in haemophilia A patients with inhibitors. When coadministered with repetitive high doses of activated prothrombin complex concentrate (ie >100 U/kg/d for ≥24 hours), emicizumab was associated with thrombotic microangiopathy and thrombosis events. As a consequence the United Kingdom Haemophilia Centres Doctors' Organisation (UKHCDO) issued the first guidance on the treatment of bleeding episodes in patients receiving emicizumab. To build on and extend this work, a panel of German haemophilia specialists met to discuss the UK guidance, review current evidence and provide additional guidance for German healthcare professionals on how to optimize the management of patients with haemophilia A receiving emicizumab. Recommendations are provided on the use of bypassing and other agents to manage breakthrough bleeding, ITI in the emicizumab era, haemostatic support during surgery and issues relating to laboratory monitoring.
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Affiliation(s)
| | - Günter Auerswald
- Department of Comprehensive Care in Haemostasis and Thrombosis, Professor Hess Children's Hospital, Bremen, Germany
| | - Christoph Königs
- Department of Pediatrics and Adolescent Medicine, Centre for Hemostasis, University Hospital Frankfurt, Frankfurt, Germany
| | - Karin Kurnik
- Department of Paediatric Haemostasis, University Children's Hospital, Munich, Germany
| | | | - Robert Klamroth
- Department for Internal Medicine, Vascular Medicine and Haemostaseology, Vivantes Klinikum, Berlin, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
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10
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Al-Samkari H, Croteau SE. Beliefs, opinions and impact of emicizumab in haemophilia A patients: A National US Survey Study. Haemophilia 2020; 27:e270-e273. [PMID: 32897603 DOI: 10.1111/hae.14140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Boston Hemophilia Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy E Croteau
- Boston Hemophilia Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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11
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Escobar M, Santagostino E, Mancuso ME, Coppens M, Balasa V, Taylor JA, Iorio A, Negrier C. Switching patients in the age of long-acting recombinant products? Expert Rev Hematol 2020; 12:1-13. [PMID: 31282771 DOI: 10.1080/17474086.2018.1564032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Prophylaxis with factor replacement therapy is the gold standard for the treatment of hemophilia, but this often requires frequent infusions. A number of long-acting factor products have been developed to reduce the burden on patients. Areas covered: This is an overview of information presented at two symposia held at the World Federation of Hemophilia and International Society on Thrombosis and Haemostasis - Scientific and Standardization Committee annual meetings. The pharmacokinetic, safety and efficacy data for long-acting recombinant products are reviewed, with a focus on recombinant factor IX albumin fusion protein (rIX-FP) and rVIII-SingleChain. This overview also provides a guide for managing a patient's switch to long-acting products. Expert opinion: Long-acting products may allow patients to maintain or decrease bleeding rates whilst increasing their dosing interval, which may in turn reduce the burden on patients and caregivers. When switching patients to long-acting products health-care professionals should provide balanced and thorough education to the patient, whilst supporting their emotional well-being. Regimens should address patients' needs and goals but should also be guided by clinical phenotype and pharmacokinetic assessment. Follow-up should assess safety concerns, bleeding rates, joint health and the impact of the regimen on patients' lifestyle.
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Affiliation(s)
- Miguel Escobar
- a Department of Internal Medicine and Pediatrics, Division of Hematology , University of Texas Health Science Center and the Gulf States Hemophilia and Thrombophilia Center , Houston , TX , USA
| | - Elena Santagostino
- b Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico , Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre , Milan , Italy
| | - Maria Elisa Mancuso
- b Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico , Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre , Milan , Italy
| | - Michiel Coppens
- c Department of Vascular Medicine , Amsterdam Cardiovascular Sciences, Amsterdam UMC , Amsterdam , the Netherlands
| | - Vinod Balasa
- d Division Chief and Medical Director, Hematology/Oncology , Valley Children's Hospital , Madera , CA , USA
| | - Jason A Taylor
- e Division of Hematology and Medical Oncology , The Hemophilia Center, Knight Cancer Institute, Oregon Health & Science University and Portland VA Medical Center , Portland , OR , USA
| | - Alfonso Iorio
- f Department of Health Research Methods, Evidence and Impact , McMaster University , Hamilton , ON , Canada
| | - Claude Negrier
- g National Reference Centre for Haemophilia, Louis Pradel Hospital , University Claude Bernard Lyon I , Lyon , France
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12
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Leksa NC, Aleman MM, Goodman AG, Rabinovich D, Peters R, Salas J. Intrinsic differences between FVIIIa mimetic bispecific antibodies and FVIII prevent assignment of FVIII-equivalence. J Thromb Haemost 2019; 17:1044-1052. [PMID: 30887655 PMCID: PMC6850022 DOI: 10.1111/jth.14430] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/08/2019] [Indexed: 12/11/2022]
Abstract
Essentials Non-factor VIII (FVIII) therapies for hemophilia A, such as bispecific antibodies (bsAbs), are in development. Bispecific antibodies are intrinsically different from FVIII and lack many of the same regulatory mechanisms. These differences complicate assignment and interpretation of FVIII-equivalent activity. Inability to assign FVIII equivalence compromises our capacity to assess hemostatic potential of bsAb therapies. BACKGROUND Activated factor VIII (FVIIIa) mimetic bsAbs aim to enable prophylactic treatment of hemophilia A patients with and without inhibitors. With different mechanisms of action, benchmarking their activity against FVIII to determine efficacious yet safe dosage is difficult. OBJECTIVE To compare the activities of sequence identical emicizumab (SI-Emi) and another bsAb, BS-027125, to recombinant FVIII (rFVIII) using clinical and nonclinical assays and to evaluate our ability to assign a FVIII-equivalent value to bsAbs and implications thereof. METHODS Activities of SI-Emi, BS-027125, and rFVIII were measured by one-stage clotting assay, chromogenic factor Xa generation assay, and thrombin generation assay. We also assessed the activity of anti-FIXa and anti-FX bivalent homodimers of each bsAb and probed the effect of different reagents in thrombin generation assay (TGA). RESULTS The FVIII-like activity of SI-Emi and BS-027125 ranged greatly across each assay, varying both by parameter measured within an assay and by reagents used. Notably, SI-Emi anti-FIXa bivalent homodimer had meaningful activity in several assays, whereas BS-027125 anti-FIXa bivalent homodimer only had activity in the chromogenic assay. Surprisingly, SI-Emi displayed activity in the absence of phospholipids, while BS-027125 had minimal phospholipid-independent activity. CONCLUSIONS Bispecific antibodies demonstrate little consistency between assays tested here owing to intrinsic differences between FVIII and bsAbs. While some trends are shared, the bsAbs also differ in mechanism. These inconsistencies complicate assignment of FVIII-equivalent values to bsAbs. Ultimately, a deeper mechanistic understanding of bsAbs as well as bsAb-tailored assays are needed to monitor and predict their hemostatic potential and long-term efficacy and safety confidently.
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Tjärnlund‐Wolf A, Lassila R. Phenotypic characterization of haemophilia B – Understanding the underlying biology of coagulation factor IX. Haemophilia 2019; 25:567-574. [DOI: 10.1111/hae.13804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Anna Tjärnlund‐Wolf
- CSL Behring AB Danderyd Sweden
- Institute of Neuroscience and Physiology The Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
| | - Riitta Lassila
- Coagulation Disorders Unit, EHCCC, Hematology and Comprehensive Cancer Center and HUSLAB Helsinki University Hospital University of Helsinki, Research Program Unit in Systems Oncology Helsinki Finland
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Smock KJ, Moser KA. What have we learned from coagulation laboratory participation in external quality programs? Int J Lab Hematol 2019; 41 Suppl 1:49-55. [DOI: 10.1111/ijlh.12998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Kristi J. Smock
- Department of PathologyUniversity of Utah Health Sciences Center and ARUP Laboratories Salt Lake City Utah
| | - Karen A. Moser
- Department of PathologyUniversity of Utah Health Sciences Center and ARUP Laboratories Salt Lake City Utah
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15
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Strategies for Individualized Dosing of Clotting Factor Concentrates and Desmopressin in Hemophilia A and B. Ther Drug Monit 2019; 41:192-212. [DOI: 10.1097/ftd.0000000000000625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Ramiz S, Hartmann J, Young G, Escobar MA, Chitlur M. Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia. Am J Hematol 2019; 94:249-256. [PMID: 30328141 DOI: 10.1002/ajh.25319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/19/2023]
Abstract
Hemophilia A and B are rare inherited bleeding disorders resulting from deficiency of coagulation factors VIII and IX respectively. In the past few decades, the field of hemophilia has witnessed pivotal management challenges and therapeutic advances. Routine coagulation and factor assays, while useful in the classification of severity and treatment monitoring in hemophilia patients, have been shown to be of limited use in managing clinical presentations and outcomes. This prompted the investigation of viscoelastic studies in hemophilia care, which have established their utility in various bleeding and thrombotic states. In this review, we will discuss and critically assess the current literature highlighting the use of viscoelastic studies in various aspects of hemophilia including the determination of clinical phenotype, management of patients with inhibitors, perioperative management, and monitoring of novel agents.
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Affiliation(s)
- Sarah Ramiz
- Wayne State University School of MedicineChildren's Hospital of Michigan Detroit Michigan
| | | | - Guy Young
- University of Southern California Keck School of Medicine, Children's Hospital Los Angeles Los Angeles California
| | - Miguel A. Escobar
- University of Texas Health Science Center and the McGovern Medical School Houston Texas
| | - Meera Chitlur
- Wayne State University School of MedicineChildren's Hospital of Michigan Detroit Michigan
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17
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Abstract
Acquired hemophilia A (AHA) is a rare autoimmune disease caused by autoantibodies inhibiting the function of coagulation factor VIII. It is characterized by spontaneous bleeding in patients with no previous family or personal history of bleeding. Although several large registries have collected clinical data on AHA, limited information is available on the optimal management of AHA because controlled clinical trials are lacking. AHA can easily be diagnosed if the problem (prolonged activated partial thromboplastin time in a bleeding patient) is recognized. After the effects of anticoagulants are excluded, low factor VIII activity and the detection of circulating inhibitors confirms the diagnosis. However, lack of familiarity with this rare condition may delay diagnosis and adequate therapy. Treatment of AHA is based on measures for prompt hemostatic control to stop (and prevent) bleeding, immunosuppression to eradicate the autoantibodies, and supportive care for the adverse effects of that treatment and patients' often complex comorbidities. This article gives a comprehensive overview of the current knowledge about the pathophysiology, diagnosis, and treatment of AHA.
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Affiliation(s)
- Paul Knöbl
- Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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