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Yao W, Ai D, Zhang Q, Li X, Zhou M, Zhang N, Yang S, Chen Z, Zhen Y, Luke KH, Wu R. A long term outcomes analysis of severe haemophilia A boys receiving 4 years prophylaxis on the Chinese Haemophilia Individualized escalating low dose Prophylaxis (CHIPS). Thromb Res 2024; 241:109110. [PMID: 39116483 DOI: 10.1016/j.thromres.2024.109110] [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: 04/24/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The Chinese Haemophilia Individualized Prophylaxis Study (CHIPS), which was launched in 2016, reported a significant reduction in haemarthrosis over a one-year study. However, its long-term efficacy requires verification. This paper summarizes the clinical outcomes of 18 severe haemophilia A (SHA) patients who completed one year on the CHIPS and 3 more years of follow-up. METHODS Clinical follow-up was based on the CHIPS protocol (from July 2018 to July 2021). Escalation was based on index joint bleeding, and serial ultrasound (greyscale and colour Doppler) examinations of the index joints (both sides of the ankles, knees and elbows) were conducted every 6 months via a scoring system. RESULTS A total of 18 SHA patients completed the 3-year study. Fifteen patients dropped out due to the financial crisis during the COVID-19 pandemic in China. The median age was 5.4 (range 4.3-6.9) years. A significant reduction in haemarthrosis was achieved, with mean annual bleeding rates reduced from 18.9 ± 2.8 to 1.7 ± 0.4 (p < 0.001), annual joint bleeding rates from 3.1 ± 0.7 to1.2 ± 0.3 (p < 0.028). 5 out of 8 target joint resolved. Sixteen doses were escalated. At study exit, the heterogeneous treatment outcomes of the SHA boys were 5 at step 4 (20-25 lU/kg, every other day), 10 at step 3 (15-20 IU/kg, 3×/week), 2 at step 2 (10-15 lU/kg, 3×/week) and 1 at step 1 (10-15 lU/kg, 2×/week). The mean FVIII consumption was 2964 IU/kg/year, with savings. The quality of life improved, with Canadian Haemophilia Outcomes-Kids Life Assessment Tool (CHO-KLAT, Chinese Version 2.0) scores ranging from 68.8 to 78.8. There was no change in the ultrasound score. CONCLUSION Our follow-up data on the 18 SHA boys after completing one year on the CHIPS verify the long-term efficacy of the CHIPS for haemarthrosis reduction, joint health preservation, improvement in the quality of life of the boys and cost savings.
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Affiliation(s)
- Wanru Yao
- Hematology Department, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Di Ai
- Hematology Department, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Qing Zhang
- Haemophilia Diagnosis and Treatment Center, Department of Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaojing Li
- Haemophilia Treatment Center, Department of Pediatrics, New Century Women's and Children's Hospital, Chengdu, China
| | - Min Zhou
- Haemophilia Diagnosis and Treatment Center, Department of Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ningning Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Sheng Yang
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yingzi Zhen
- Hematology Department, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Koon-Hung Luke
- Department of Pediatrics, Laboratory Medicine and Pathology, Division of Hematology and Oncology, University of Ottawa, Children Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Runhui Wu
- Hematology Department, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
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Qin X, Zhang A, Zhao X, Zhou T, Xia Z, Yu G. Investigation and Analysis of the Current Status of Health-Related Quality of Life in Adolescents with Hemophilia in Hubei Province. Br J Hosp Med (Lond) 2024; 85:1-12. [PMID: 39212560 DOI: 10.12968/hmed.2024.0199] [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] [Indexed: 09/04/2024]
Abstract
Aims/Background Reliable health-related quality of life data are critical in developing countries, in order to advocate for government agencies to develop national hemophilia care programmes. This study aims to explore the current status and influencing factors of health-related quality of life among adolescents with hemophilia in Hubei Province, so as to provide empirical data for professionals. Methods A total of 84 children with hemophilia aged 8 to 18, who were registered in Tongji Hemophilia Treatment Center and Hubei Hemophilia Home, were selected using a cluster sampling method. The "General Situation Questionnaire of Hemophiliac Adolescents", designed by Tongji Hemophilia Treatment Center, and "the Chinese version of Canadian hemophilia outcomes-kid's life assessment tool (CHO-KLAT)", were used for this study conducted from June 1, 2022 to December 30, 2022. Results 82 completed questionnaires were included. The average age of the 82 adolescents was 13.04 ± 3.29 years and all were males. Among them, 67 were hemophilia A and 15 were hemophilia B. 61 cases were severe type, 19 were moderate type and 2 cases were mild type. The average total score of the CHO-KLAT for adolescents with hemophilia in Hubei Province was 49.49, which was lower than their counterparts in developed countries. The statistically significant influencing factors included residence, annual family income, and disease type. Conclusion This study provides empirical data support for the health management of adolescents with hemophilia, highlighting the importance of improving medical resource access, transfusion convenience, and psychological support in enhancing the quality of life for this group. The results emphasize the need for healthcare systems and policymakers to take specific measures to address these factors to improve the treatment and care conditions for adolescents with hemophilia.
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Affiliation(s)
- Xiuli Qin
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ai Zhang
- Children's Hematology/Oncology Unit, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Zhao
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ting Zhou
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhili Xia
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Genzhen Yu
- Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Mancuso ME, McLaughlin P, Forsyth AL, Valentino LA. Joint health and pain in the changing hemophilia treatment landscape. Expert Rev Hematol 2024; 17:431-444. [PMID: 38981851 DOI: 10.1080/17474086.2024.2378936] [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: 03/05/2024] [Accepted: 07/08/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Hemophilia is an inherited bleeding disorder. Bleeding, and in particular joint hemorrhage results in chronic arthropathy and disability. Acute and chronic pain are frequent and limit activity and participation and result in decreased health-related quality of life. Remarkable progress has been made in the diagnosis and treatment of hemophilia but bleeding continues to prove recalcitrant to currently available treatments and joint disease remains problematic. Physiotherapy and pain management are mainstays of current multidisciplinary integrated care of people with hemophilia (PWH). The focus of this review is on preservation of joint health in the era of new and innovative therapies. AREAS COVERED A search of the PubMed Central was conducted on 1 February 2024 using the MeSH Major Topic terms identified as keywords for the manuscript. This review will highlight what is known and unknown about joint bleeding and arthropathy, including insights on pain as a related complication. EXPERT OPINION Recent advances in therapeutic interventions aimed at promoting healthy joints in PWH will be discussed, including both the pharmacological treatment landscape and related strategies to promote joint health.
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Affiliation(s)
- Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK
- Research Department of Haematology, University College London, London, UK
| | - Angela L Forsyth
- Physical Therapy Collaborative, Optum Infusion Pharmacy, Eden Praire, MN, USA
| | - Leonard A Valentino
- Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA
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Munawar Ali R, Abid M, Zafar S, Ali MS, Nadeem R, Ahmed R, Borhany M. Management of Severe Hemophilia A: Low-Dose Prophylaxis vs. On-Demand Treatment. Cureus 2023; 15:e41410. [PMID: 37546069 PMCID: PMC10402932 DOI: 10.7759/cureus.41410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Prophylactic clotting factor infusion regimens to prevent bleeding and joint deformity has become the standard of care in severe hemophilia A patients. AIM To assess low-dose factor prophylaxis in our population as an alternative approach to managing severe hemophilia A. METHODS A prospective cohort study that included 68 hemophilia A patients divided into two groups, i.e., Prophylaxis and on-demand. The two groups were compared for annualized bleeding rate (ABR), hospitalization, units of factor VIII (FVIII) infused, or plasma products transfused, i.e., fresh frozen plasma (FFP) and cryoprecipitate (CP), and development of FVIII inhibitors. RESULTS Of the 68 patients recruited in this study, 25 (36.7%) were in the prophylaxis group, and 43(63.3%) were in the on-demand group. The on-demand group presented a higher median-IQR ABR [8(20-3) vs. 5(10-1.5), p-value 0.024], several hospitalizations (39.7% vs. 0, p-value 0.001), and inhibitor development (9.3% vs. 0, p-value 0.289) compared to the prophylaxis group. The prophylaxis approach demonstrated a significant negative correlation of ABR with FVIII prophylaxis (r=-0484, p=value=0.014). Moreover, no hospitalizations or inhibitor development was observed in the prophylaxis group. The estimated annual consumption of FVIII was 328 IU/kg/year in the on-demand group and 1662.6 IU/kg/year in the prophylaxis group. However, a highly significant difference in plasma product utilization was observed between the two groups, i.e., p-value <0.001 and 0.038 for FFP and CP, respectively. CONCLUSION Low-dose factor prophylaxis resulted in improved outcomes compared to on-demand treatment in terms of ABR, joint bleeding, hospitalization, and the development of inhibitors. This treatment approach should be adopted as an economically feasible alternative to high-dose Prophylaxis in resource-constrained countries.
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Affiliation(s)
- Rabeea Munawar Ali
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Madiha Abid
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Sidra Zafar
- Research and Development, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Muhammad Shujat Ali
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Rukhshanda Nadeem
- Physical Medicine and Rehabilitation, Hemophilia Welfare Society, Karachi, PAK
| | - Raheel Ahmed
- Hematology, Haemophilia Welfare Society, Karachi, PAK
| | - Munira Borhany
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
- Hematology, Haemophilia Welfare Society, Karachi, PAK
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Meijón Ortigueira MDM, Álvarez-Román MT, De La Corte Rodríguez H, Butta Coll N, Jiménez-Yuste V. Long-term impact of primary prophylaxis on joint status in patients with severe hemophilia A. Res Pract Thromb Haemost 2023; 7:100005. [PMID: 36891521 PMCID: PMC9986103 DOI: 10.1016/j.rpth.2022.100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/14/2022] [Accepted: 10/23/2022] [Indexed: 01/13/2023] Open
Abstract
Background Primary prophylaxis with factor VIII concentrates is the therapeutic gold standard for severe hemophilia A. Although this approach will change substantially with the use of nonsubstitutive therapies, the long-term effects of primary prophylaxis remain unclear. We present information on joint health with tailored primary prophylaxis in a consecutive series at a single center. Methods We retrospectively analyzed 60 patients who did not develop early inhibitors. The annual bleeding rate and annual joint bleeding rate, prophylaxis characteristics, physical activity, adherence, and development of inhibitors were compared between those with and without joint involvement at the end of follow-up. Joint involvement was defined as a Hemophilia Joint Health Score or Hemophilia Early Arthropathy Detection with an ultrasound score ≥1. Results Among 60 patients with median follow-up of 113 ± 6 months after starting prophylaxis, 76.7% had no joint involvement at the end of the follow-up. Those without joint involvement started prophylaxis at a younger median age (1 [IQR 1-1] year vs 3 [IQR 2-4.3] years). They also had lower annual joint bleeding rate (0.0 [IQR 0-0.2] vs 0.2 [IQR 0.1-0.5]), were more often physically active (70% vs 50%), and had lower trough factor VIII levels. Adherence to treatment was not significantly different between groups. Conclusion Initiation of primary prophylaxis at a younger age was the main factor associated with long-term preservation of joint status in patients with severe hemophilia A.
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Affiliation(s)
| | | | | | - Nora Butta Coll
- Department of Hematology, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Víctor Jiménez-Yuste
- Department of Hematology, La Paz University Hospital-IdiPAZ, Autonoma University, Madrid, Spain
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Hsieh MHC, Chiou SS, Liao TC, Lai SJ, Lai ECC. Effectiveness of Prophylactic Coagulation Factor Replacement Therapy in Patients with Severe Hemophilia A in Taiwan - A Population-Based Study. Clin Epidemiol 2022; 14:1501-1510. [PMID: 36536898 PMCID: PMC9759011 DOI: 10.2147/clep.s391753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/02/2022] [Indexed: 09/10/2024] Open
Abstract
Purpose Taiwan launched reimbursement of prophylactic coagulation factor replacement therapy (CFRT) for patients with severe hemophilia type A (severe PWHA) in 2014. However, since then, the effectiveness of prophylactic CFRT in real-world practice has not been evaluated thoroughly. This study aimed to evaluate the effectiveness of prophylactic CFRT in severe PWHA cases on the outcome of bleeding risks. Patients and Methods We included male, severe PWHA cases from a nationwide, population-based database in Taiwan. Given that the database lacked details of the dosing regimen for prophylactic CFRT, we applied group-based trajectory modeling using the proportion of days covered (PDC) by CFRT from 2014 to 2015 in order to classify patients. A high PDC level corresponded to a greater proportion of time under CFRT, thus implying that the patient was probably receiving prophylactic therapy. We followed up patients from January 01, 2016 until occurrence of any bleeding events, death or December 31st 2017. Results We identified a total of 420 severe PWHA and classified them into high- (n = 88), medium- (n = 181) and low- (n = 151) PDC groups. The mean (±SD) PDC values of the three groups were 0.78 (±0.1), 0.40 (±0.1) and 0.12 (±0.1), respectively. Using Cox regression models with propensity score adjustment, we found patients with medium- (hazard ratio: 0.69; 95% CI: 0.56-0.89) or high-PDC (0.45; 0.36-0.68) under CFRT had reduced risks of any bleeding, compared to the low PDC group. Conclusion The findings demonstrated the effectiveness of prophylactic CFRT in the prevention of bleeding events in real-life severe PWHA.
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Affiliation(s)
- Miyuki Hsing-Chun Hsieh
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyh-Shin Chiou
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shi-Jie Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Núñez R, Álvarez-Román MT, Bonanad S, González-Porras JR, De La Corte-Rodriguez H, Berrueco R, Jiménez-Yuste V. The Limitations and Unmet Needs of the Five Cornerstones to Guarantee Lifelong Optimization of Prophylaxis in Hemophilia Patients. TH OPEN 2022; 6:e365-e377. [DOI: 10.1055/s-0042-1757745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
AbstractProphylaxis to prevent bleeding is highly recommended for hemophilia patients. The development of new drugs and tools for modeling personalized prophylaxis provides the means for people with hemophilia to lead active lives with a quality of life comparable to that of nonhemophilic individuals. The choice of regimens must be made on a highly individual basis. Unfortunately, reference guides neither always concur in their recommendations nor provide directions to cover all possible scenarios. In this review, a group of experts identify the significant limitations and unmet needs of prophylaxis, taking advantage of their clinical experience in the disease, and supported by a rigorous literature update. To perform a more systematic and comprehensive search for gaps, the main cornerstones that influence decisions regarding prophylactic patterns were first identified.Bleeding phenotype, joint status, physical activity, pharmacokinetics/medication properties, and adherence to treatment were considered as the primary mainstays that should allow physicians guiding prophylaxis to secure the best outcomes. Several challenges identified within each of these topics require urgent attention and agreement. The scores to assess severity of bleeding are not reliable, and lead to no consensus definition of severe bleeding phenotype. The joint status is to be redefined in light of new, more efficient treatments with an agreement to establish one scale as the unique reference for joint health. Further discussion is needed to establish the appropriateness of high-intensity physical activities according to patient profiles, especially because sustaining trough factor levels within the safe range is not always warranted for long periods. Importantly, many physicians do not benefit from the advantages provided by the programs based on population pharmacokinetic models to guide individualized prophylaxis through more efficient and cost-saving strategies. Finally, ensuring correct adherence to long-term treatments may be time-consuming for practitioners, who often have to encourage patients and review complex questionnaires.In summary, we identify five cornerstones that influence prophylaxis and discuss the main conflicting concerns that challenge the proper long-term management of hemophilia. A consensus exercise is warranted to provide reliable guidelines and maximize benefit from recently developed tools that should notably improve patients' quality of life.
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Affiliation(s)
- Ramiro Núñez
- Hemophilia Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | | | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, Hospital Universitari i Politècnic La Fe, València, Spain
| | - José Ramón González-Porras
- Hematology Department, Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (Ibsal), Salamanca, Spain
| | | | - Rubén Berrueco
- Pediatric Hematology Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP-HSJD0), Barcelona, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Jiménez-Yuste
- Department of Hematology and Hemotherapy, La Paz University Hospital-IdiPaz, Madrid, Spain
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Mathews N, Pluthero FG, Rand ML, Stain AM, Carcao M, Blanchette VS, Kahr WHA. Thromboelastography and thrombin generation assessments for pediatric severe hemophilia A patients are highly variable and not predictive of clinical phenotypes. Res Pract Thromb Haemost 2022; 6:e12800. [PMID: 36186102 PMCID: PMC9511091 DOI: 10.1002/rth2.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/02/2022] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Severe hemophilia A (SHA) patients vary in severity of bleeding, arthropathy, and requirements for replacement factor VIII (FVIII). Baseline hemostatic activity assays using calibrated automated thrombography (CAT) and thromboelastography (TEG) may offer insights into the physiological basis of clinical heterogeneity. Objectives Use CAT and TEG to measure baseline hemostatic activity in a cohort of 30 pediatric SHA patients with available clinical data. Determine effect of contact activation inhibition with corn trypsin inhibitor (CTI). Assess heterogeneity among patients for baseline hemostatic activity and examine correlations between assay results and clinical parameters including FVIII dosing regimen, von Willebrand factor level, and Pettersson arthropathy score. Methods SHA blood after FVIII washout was subjected to TEG, and platelet-rich (PRP) and platelet-poor plasma was used for CAT assays. Varying concentrations of tissue factor (TF) were used. Statistical analysis examined relationships between assay results, and clinical parameters. Results CTI treatment was required to obtain TEG and CAT results representative of baseline hemostatic activity. Weak activity was observed in assays with low TF concentrations (0.5-2 pM), and most but not all samples approached normal activity levels at high TF concentrations (10-20 pM). A significant positive correlation was observed between results of TEG and CAT-PRP assays. Correlations were not detected between hemostatic assay results and clinical parameters. Conclusions In vitro hemostatic assay results of samples containing platelets showed concordance. Assay results were not predictive of FVIII requirements or correlated with other clinical parameters. SHA patient heterogeneity is influenced by factors other than baseline hemostatic activity.
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Affiliation(s)
- Natalie Mathews
- Division of Haematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Fred G. Pluthero
- Cell Biology ProgramResearch Institute, Hospital for Sick ChildrenTorontoOntarioCanada
| | - Margaret L. Rand
- Division of Haematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
- Translational Medicine ProgramHospital for Sick ChildrenTorontoOntarioCanada
- Departments of Laboratory Medicine & PathobiologyBiochemistry, and Pediatrics, University of TorontoTorontoOntarioCanada
| | - Ann Marie Stain
- Division of Haematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Manuel Carcao
- Division of Haematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Victor S. Blanchette
- Division of Haematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Walter H. A. Kahr
- Division of Haematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
- Cell Biology ProgramResearch Institute, Hospital for Sick ChildrenTorontoOntarioCanada
- Departments of Pediatrics and BiochemistryUniversity of TorontoTorontoOntarioCanada
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Carcao M, Gouider E, Wu R. Low dose prophylaxis and antifibrinolytics: Options to consider with proven benefits for persons with haemophilia. Haemophilia 2022; 28 Suppl 4:26-34. [PMID: 35521737 DOI: 10.1111/hae.14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Prophylaxis has become standard of care for persons with severe phenotype haemophilia (PWsH). However, 'standard prophylaxis' with either factor or non-factor therapies (emicizumab) is prohibitively expensive for much of the world. We sought to evaluate whether haemophilia care can be provided at a lower cost yet achieve good results using Lower dose/Lower frequency prophylaxis (LDP) and with increasing use of antifibrinolytics (Tranexamic acid and Epsilon amino caproic acid). METHODS We identified 12 studies that collectively included 335 PWsH using LDP. Additionally, we undertook a literature search regarding the benefits of antifibrinolytics in haemophilia care. RESULTS Identified studies show that LDP is far superior to no prophylaxis (On demand [OD] therapy) resulting in significant patient benefits. Patients on LDP showed (in comparison to patients OD) on average: 72% less total bleeds; 75% less joint bleeds; 91% less days lost from school; 77% less hospital admission days; and improved quality of life measures. These benefits come at similar or only slightly higher (< 2-fold greater) costs than OD therapy. Antifibrinolytics are effective adjunctive agents in managing bleeds (oral, nasal, intracranial, possibly other) and providing haemostasis for surgeries (particularly oral surgeries). Antifibrinolytics can substitute for more expensive factor concentrates or can reduce the use of such concentrates. There is evidence to show that antifibrinolytics may be used in conjunction with factor concentrates/emicizumab for more effective/less costly prophylaxis. CONCLUSIONS The use of LDP along with appropriate and increased use of antifibrinolytics offers less resourced countries good options for managing patients with haemophilia.
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Affiliation(s)
- Manuel Carcao
- Haemophilia Clinic and Haemostasis Program, Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emna Gouider
- Hemophilia Treatment Centre, Aziza Othmana Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Runhui Wu
- Haemophilia Comprehensive Care Centre, Haematology Centre, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, Beijing, China
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Biomechanical Gait Analysis of an Adult with Severe Hemophilia: A Case Report. Hematol Rep 2022; 14:112-118. [PMID: 35466181 PMCID: PMC9036226 DOI: 10.3390/hematolrep14020017] [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: 02/06/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Hemophilia is characterized by recurrent bleeding into the joints leading to irreversible chronic arthropathy with reduced joint range of motion (ROM), which may lead to changes in gait patterns. To analyze the gait pattern in a 35-year-old male with severe hemophilia A, three-dimensional biomechanical analysis was performed during overground walking. The control group data from a public gait dataset of 10 healthy male individuals were used for comparison. The clinical examination was assessed with the Functional Independence Score in Hemophilia (FISH), Haemophilia Activities List (HAL), and Hemophilia Joint Health Score (HJHS). The biomechanical analysis demonstrated a pattern for both left knee and ankle joints with greater similarity to the control group compared to the right knee and ankle joints. ROM based on the HJHS questionnaire also showed greater impairment of the right-side knee joint compared to the left-side knee joint. This unique pattern could be the result of a compensation mechanism due to limited movement during the walking task and the surgical treatment.
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Soto I, Mateo J, García-Diego DA, Gil B, Ruiz-Beato E, Ivanova Y, Martín Lorenzo T, Maravilla-Herrera P, Hidalgo-Vega Á, Merino M. The impact of improving haemophilia A management within the Spanish National Healthcare System: a social return on investment analysis. BMC Health Serv Res 2022; 22:115. [PMID: 35081958 PMCID: PMC8793183 DOI: 10.1186/s12913-021-07447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Haemophilia A (HA) has been associated with poor health-related quality of life and a large economic burden, accentuated by severity, arthropathy, and inhibitors. To meet global standards of care, the management of HA should align with the principles of care outlined by the World Federation of Haemophilia. The aims of the present study were to establish a set of proposals to improve HA management within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective. METHODS A multidisciplinary group of experts agreed on a set of 15 proposals to improve HA management within the SNHS. Thereafter, a forecast-type Social Return on Investment analysis was carried out to estimate the impact of implementing this set of proposals within the SNHS over a one-year timeframe, in relation to the required investment. RESULTS This study estimated that the implementation of the complete set of 15 proposals would require a total investment of 2.34 M€ and have a total impact of 14.60 M€. Accordingly, every euro invested in the complete set of 15 proposals would yield a social return of €6.23 (€3.37 in the worst-case scenario and €9.69 in the best-case scenario) of both tangible and intangible nature in similar proportions (45.71 and 54.29%, respectively). CONCLUSIONS These results can be used to inform policy and practice such that interventions that may potentially improve current public health challenges associated with the management of HA may be implemented.
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Affiliation(s)
| | - José Mateo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Yoana Ivanova
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
| | | | | | | | - María Merino
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
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12
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Wilkins RA, Stephensen D, Siddle H, Scott MJ, Xiang H, Horn E, Palmer B, Chapman GJ, Richards M, Walwyn R, Redmond A. Twelve-month prevalence of haemarthrosis and joint disease using the Haemophilia Joint Health score: evaluation of the UK National Haemophilia Database and Haemtrack patient reported data: an observational study. BMJ Open 2022; 12:e052358. [PMID: 35022172 PMCID: PMC8756269 DOI: 10.1136/bmjopen-2021-052358] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To report the 12-month prevalence of joint bleeds from the National Haemophilia Database (NHD) and Haemtrack, a patient-reported online treatment diary and concurrent joint disease status using the haemophilia joint health score (HJHS) at individual joint level, in children and adults with severe haemophilia A and B (HA/HB) without a current inhibitor. DESIGN A 2018 retrospective database study of NHD from which 2238 cases were identified, 463 patients had fully itemised HJHS of whom 273 were compliant in recording treatment using Haemtrack. SETTING England, Wales and Scotland, UK. PARTICIPANTS Children (<18 years) and adults (≥18 years) with severe HA and HB (factor VIII/factor IX, <0.01 iu/mL) without a current inhibitor. PRIMARY AND SECONDARY OUTCOMES Prevalence of joint haemarthrosis and concurrent joint health measured using the HJHS. RESULTS The median (IQR) age of children was 10 (6-13) and adults 40 (29-50) years. Haemarthrosis prevalence in HA/HB children was 33% and 47%, respectively, and 60% and 42%, respectively, in adults. The most common site of haemarthrosis in children was the knee in HA and ankle in HB. In adults, the incidence of haemarthrosis at the ankles and elbows was equal. The median total HJHS in HA/HB children was 0 and in adults with HA/HB, were 18 and 11, respectively. In adults with HA/HB, the median ankle HJHS of 4.0 was higher than the median HJHS of 1.0 for both the knee and elbow. CONCLUSION Despite therapeutic advances, only two-thirds of children and one-third of adults were bleed-free, even in a UK cohort selected for high compliance with prophylaxis. The median HJHS of zero in children suggests joint health is relatively unaffected during childhood. In adults, bleed rates were highest in ankles and elbows, but the ankles led to substantially worse joint health scores.
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Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - Heidi Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Martin J Scott
- University Department of Clinical Haematology, Manchester Royal Infirmary, Manchester, UK
- Institute of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hua Xiang
- National Haemophilia Database, United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO), Manchester, UK
| | - Elizabeth Horn
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ben Palmer
- National Haemophilia Database, United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO), Manchester, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Michael Richards
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony Redmond
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Chiu AS, Blanchette VS, Barrera M, Hilliard P, Young NL, Abad A, Feldman BM. Social participation and hemophilia: Self-perception, social support, and their influence on boys in Canada. Res Pract Thromb Haemost 2021; 5:e12627. [PMID: 34877447 PMCID: PMC8633242 DOI: 10.1002/rth2.12627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with hemophilia may experience joint damage, which can impair participation, yet few studies have examined the impact hemophilia may have on social participation and quality of life. OBJECTIVES The aims of this study are to assess the relationship between patient social participation and self-perception, social support, and impact on the family. PATIENTS/METHODS A random representative sample of 50 boys with hemophilia from The Hospital for Sick Children, Toronto, Canada, completed measures of social participation (Participation Scale for kids), self-perception (Self-Perception Profile for children and adolescents), and social support (Social Support Scale for children). Participants' parents completed Family Impact Module of the Pediatric Quality of Life Inventory. Data were analyzed using Pearson product-moment correlations. RESULTS Social participation was strongly correlated with self-perception subscales Social Acceptance (r = -0.5, p = <0.001) and Global Self-Worth (r = -0.6, p = <0.001) for all participants. The Athletic Competence subscale was strongly correlated for adolescents only (r = -0.6, p = <0.01). There were strong correlations between social participation and social support from parents (r = -0.6, p = <0.001), teachers (r = -0.5, p = <0.001), and classmates (r = -0.6, p = <0.001) and moderate correlations for support from close friends (r = -0.4, p = <0.01). There were no significant correlations with family impact. CONCLUSION In the context of a country with unlimited access to safe clotting factor concentrates, boys with hemophilia have few social participation restrictions. Although correlational findings do not represent causality, they suggest that encouragement of social participation may be beneficial in boys with hemophilia to increase self-perception as well as strengthen their social support network.
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Affiliation(s)
| | - Victor S. Blanchette
- The Hospital for Sick ChildrenTorontoOntarioCanada
- The University of TorontoTorontoOntarioCanada
| | - Maru Barrera
- The Hospital for Sick ChildrenTorontoOntarioCanada
- The University of TorontoTorontoOntarioCanada
| | | | | | - Audrey Abad
- The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Brian M. Feldman
- The Hospital for Sick ChildrenTorontoOntarioCanada
- The University of TorontoTorontoOntarioCanada
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14
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Stimec J, Dover S, Pullenayegum E, Blanchette VS, Doria AS, Feldman BM, Carcao M, Rivard GE, Israels SJ, Chan AK, Steele M, Cloutier S, Klaassen RJ, Price VE, Sinha R, Laferriere N, Paradis E, Wu JKM, Babyn P. Magnetic resonance imaging in boys with severe hemophilia A: Serial and end-of-study findings from the Canadian Hemophilia Primary Prophylaxis Study. Res Pract Thromb Haemost 2021; 5:e12565. [PMID: 34703973 PMCID: PMC8520573 DOI: 10.1002/rth2.12565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study examined the structural outcomes for joints of boys with severe hemophilia A receiving frequency/dose-escalated primary prophylaxis using magnetic resonance imaging (MRI), and the importance of interval MRI changes. METHODS Forty-six subjects (27 with interval studies) were evaluated by radiographs (X-rays) and mid- and end-of-study MRIs (using the International Prophylaxis Study Group scale), as part of the Canadian Hemophilia Prophylaxis Study. The primary outcome was the presence of MRI osteochondral findings. RESULTS The median (range) time on study at the end-of-study MRI examination was 9.6 (4.8-16.0) years, during which 18 of 46 subjects (39%) had osteochondral changes in at least one joint. An interval change in MRI score of at least 1 point was observed in 44% of joints (43 ankles, 21 elbows, 4 knees); at least one joint showed this change in all 27 subjects. Self-reported interval hemarthrosis was associated with a higher likelihood of interval osteochondral change (odds ratio [OR], 1.49; 95% confidence interval [CI] = 1.08-2.06). Presence of synovial hypertrophy or hemosiderin on interval MRIs was associated with an OR of 4.71 (95% CI, 1.92-11.57) and 5.25 (95% CI, 2.05-13.40) of later osteochondral changes on MRI. DISCUSSION MRI changes were seen in 39% of subjects. Interval index joint bleeding was associated with an increased risk of later MRI changes, and earlier soft-tissue changes were associated with subsequent osteochondral changes.
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Affiliation(s)
- Jennifer Stimec
- Department of Medical ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
| | - Eleanor Pullenayegum
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Institute of Health Policy, Management & EvaluationThe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Andrea S. Doria
- Department of Medical ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Institute of Health Policy, Management & EvaluationThe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Manuel Carcao
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Georges E. Rivard
- Division of Hematology/OncologyDepartment of PediatricsCHU Sainte‐JustineMontrealQCCanada
| | - Sara J. Israels
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegMBCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - MacGregor Steele
- Section of Pediatric HematologyDepartment of PediatricsUniversity of Calgary and Alberta Children's HospitalCalgaryABCanada
| | - Stephanie Cloutier
- Centre de l’hémophilie de l'est du QuébecHôpital de l'Enfant‐JésusUniversité LavalQuébecQCCanada
| | - Robert J. Klaassen
- Division of Hematology OncologyChildren’s Hospital of Eastern Ontario Research InstituteOttawaONCanada
| | - Victoria E. Price
- Division of Pediatric Hematology/OncologyIWK Health CentreHalifaxNSCanada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders ProgramRoyal University HospitalSaskatoonSKCanada
| | - Nicole Laferriere
- Division of Hematology/OncologyThunder Bay Regional Cancer CareThunder BayONCanada
| | | | - John K. M. Wu
- Division of Hematology/Oncology/BMTDepartment of PediatricsUBC & BC Children’s HospitalVancouverBCCanada
| | - Paul Babyn
- Department of Medical ImagingUniversity of SaskatchewanSaskatoonSKCanada
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15
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Mancuso ME, Male C, Kenet G, Kavakli K, Königs C, Blatný J, Fijnvandraat K. Prophylaxis in children with haemophilia in an evolving treatment landscape. Haemophilia 2021; 27:889-896. [PMID: 34547160 DOI: 10.1111/hae.14412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION For children with haemophilia, early initiation of prophylaxis is crucial to prevent life-threatening bleeds and maintain joint health throughout life. Options for prophylaxis have recently increased from replacement therapy with standard or extended half-life coagulation factor products to include other haemostasis products, such as the non-replacement therapy emicizumab. AIM To review key factors that determine the choice of prophylaxis in young children. METHODS Key clinical questions on the implementation of prophylaxis for haemophilia in children were identified and PubMed was searched for evidence supporting guidance on the implementation of prophylaxis. RESULTS The results of the literature search and the practical experience of the authors were used to build consensus on when to start prophylaxis, the pros and cons of the products available to guide the choice of product, and practical aspects of starting prophylaxis to guide the choice of regimen. CONCLUSIONS In this era of increasing therapeutic choices, available information about the range of treatment options must be considered when initiating prophylaxis in young children. Parents or care givers must be sufficiently informed to allow informed shared decision making. Although plentiful data and clinical experience have been gathered on prophylaxis with clotting factor replacement therapy, its use in young children brings practical challenges, such as the need for intravenous administration. In contrast, our relatively brief experience and limited data with subcutaneously administered non-replacement therapy (i.e., emicizumab) in this patient group imply that starting emicizumab prophylaxis in young children requires careful consideration, despite the more convenient route of administration.
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Affiliation(s)
- Maria Elisa Mancuso
- Centre for Thrombosis and Haemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Christoph Male
- Thrombosis & Haemostasis Unit, Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Gili Kenet
- The National Haemophilia Centre, The Amalia Biron Thrombosis Research Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Kaan Kavakli
- Department of Haematology, Ege University Faculty of Medicine, Children's Hospital, Bornova, Izmir, Turkey
| | - Christoph Königs
- Department of Paediatrics and Adolescent Medicine, Clinical and Molecular Haemostasis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jan Blatný
- Department of Paediatric Haematology and Biochemistry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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16
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Lagassé HAD, McCormick Q, Sauna ZE. Secondary failure: immune responses to approved protein therapeutics. Trends Mol Med 2021; 27:1074-1083. [PMID: 34493437 DOI: 10.1016/j.molmed.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022]
Abstract
Recombinant therapeutic proteins are a broad class of biological products used to replace dysfunctional human proteins in individuals with genetic defects (e.g., factor VIII for hemophilia) or, in the case of monoclonal antibodies, bind to disease targets involved in cancers, autoimmune disorders, or other conditions. Unfortunately, immunogenicity (immune response to the drug) remains a key impediment, potentially affecting the safety and efficacy of these therapeutics. Immunogenicity risk is routinely evaluated during the licensure of therapeutic proteins. However, despite eliciting anti-drug immune responses in at least some patients, most protein drugs are nevertheless licensed as they address unmet medical needs. The pre-licensure immunogenicity assessments of therapeutic proteins are the subject of numerous reviews and white papers. However, observation and clinical management of the immunogenicity of approved therapeutic proteins face additional challenges. We survey the immunogenicity of approved therapeutic proteins, discuss the clinical management of immunogenicity, and identify the challenges to establishing clinically relevant immunogenicity assays for use in routine clinical practice.
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Affiliation(s)
- H A Daniel Lagassé
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Quinn McCormick
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Zuben E Sauna
- Hemostasis Branch, Division of Plasma Protein Therapeutics, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, MD, USA.
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17
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Hotea I, Brinza M, Blag C, Zimta AA, Dirzu N, Burzo C, Rus I, Apostu D, Benea H, Marian M, Mester A, Pasca S, Iluta S, Teodorescu P, Jitaru C, Zdrenghea M, Bojan A, Torok-Vistai T, Niculescu R, Tarniceriu C, Dima D, Truica C, Serban M, Tomuleasa C, Coriu D. Current therapeutic approaches in the management of hemophilia-a consensus view by the Romanian Society of Hematology. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1091. [PMID: 34423003 PMCID: PMC8339806 DOI: 10.21037/atm-21-747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
Hemophilia A (HA) and hemophilia B (HB) are rare disorders, being caused by the total lack or under-expression of two factors from the coagulation cascade coded by genes of the X chromosome. Thus, in hemophilic patients, the blood does not clot properly. This results in spontaneous bleeding episodes after an injury or surgical intervention. A patient-centered regimen is considered optimal. Age, pharmacokinetics, bleeding phenotype, joint status, adherence, physical activity, personal goals are all factors that should be considered when individualizing therapy. In the past 10 years, many innovations in the diagnostic and treatment options were presented as being either approved or in development, thus helping clinicians to improve the standard-of-care for patients with hemophilia. Recombinant factors still remain the standard of care in hemophilia, however they pose a challenge to treatment adherence because they have short half-life, which where the extended half-life (EHL) factors come with the solution, increasing the half-life to 96 hours. Gene therapies have a promising future with proven beneficial effects in clinical trials. We present and critically analyze in the current manuscript the pros and cons of all the major discoveries in the diagnosis and treatment of HA and HB, as well as identify key areas of hemophilia research where improvements are needed.
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Affiliation(s)
- Ionut Hotea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Melen Brinza
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Blag
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Emergency Clinical Children's Hospital, Cluj Napoca, Romania
| | - Alina-Andreea Zimta
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Noemi Dirzu
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Corina Burzo
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Ioana Rus
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dragos Apostu
- Department of Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Orthopedics, Emergency Clinical County Hospital, Cluj Napoca, Romania
| | - Horea Benea
- Department of Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Orthopedics, Emergency Clinical County Hospital, Cluj Napoca, Romania
| | - Mirela Marian
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Alexandru Mester
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ciprian Jitaru
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Anca Bojan
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Tunde Torok-Vistai
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Radu Niculescu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristina Tarniceriu
- Department of Anatomy, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Hematology, St. Spiridon County Clinical Emergency Hospital, Iasi, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Cristina Truica
- Department of Hematology, Constantin Opris Emergency Hospital, Baia Mare, Romania
| | - Margit Serban
- Department of Hematology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,European Haemophilia Treatment Center, Timisoara, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Daniel Coriu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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18
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Wu R, Li X, Yao W, Zhang Q, Zhou M, Zhang N, Yang S, Chen Z, Wang Y, Kuang Y, Tang L, Zhen Y, Abad A, Doria AS, Hilliard P, Ignas DM, Mathew P, Stephens D, Blanchette VS, Luke K. Significant reduction in hemarthrosis in boys with severe hemophilia A: The China hemophilia individualized low-dose secondary prophylaxis study. Res Pract Thromb Haemost 2021; 5:e12552. [PMID: 34568725 PMCID: PMC8449287 DOI: 10.1002/rth2.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In countries with restricted access to clotting factor concentrates, early implementation of low-dose prophylaxis is recommended over episodic treatment. OBJECTIVE The objective of this 1-year prospective secondary prophylaxis study was to evaluate the efficacy of a dose/frequency escalating protocol in young boys with hemophilia A in China. METHODS Boys were started on a low-dose protocol (minimum 10-15 IU/kg of factor VIII [FVIII] twice weekly). Escalation was based on index joint bleeding, swelling/persistent joint swelling, and serial ultrasound (gray scale and color Doppler) examinations of index joints. RESULTS Thirty-three boys, median age 4.8 years (interquartile range, 3.8-6.1) were enrolled in a 3-month observation period that preceded a 1-year prophylaxis phase. A significant reduction in total bleeding events (43.0%, P = .001), index joint bleeds (53.2%, P = .002), and target index joint bleeds (70.0%, P = 0.02) was observed during the prophylaxis phase. During the prophylaxis period, 40% of target joints resolved. The percentage of boys with zero index joint bleeds increased significantly (P = .004) from 51.5% during the observation phase to 81.8% in last quarter of the prophylaxis phase (months 10-12). There was no progression of arthropathy based on physical examination (Hemophilia Joint Health Score), X-ray, and ultrasound obtained at entry into the prophylaxis phase and at study exit. The median FVIII consumption over the prophylaxis phase was 1786 IU/kg/y. CONCLUSION A low-dose, individualized prophylaxis protocol, guided by individual bleeding profiles and serial assessment of joint status, enables escalation of treatment intensity in boys with severe hemophilia A, leading to a significant reduction in bleeding events and reduction in target joint bleeding.
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Affiliation(s)
- Runhui Wu
- Hemophilia Comprehensive Care CenterHematology DepartmentBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xiaojing Li
- Hemophilia Diagnosis and Treatment CenterDepartment of Hematology and OncologyChengdu Women’s and Children’s Central HospitalSchool of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
- Hemophilia Treatment CenterDepartment of PediatricsNew Century Women’s and Children’s HospitalChengduChina
| | - Wanru Yao
- Hemophilia Comprehensive Care CenterHematology DepartmentBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Qing Zhang
- Hemophilia Diagnosis and Treatment CenterDepartment of Hematology and OncologyChengdu Women’s and Children’s Central HospitalSchool of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Min Zhou
- Hemophilia Diagnosis and Treatment CenterDepartment of Hematology and OncologyChengdu Women’s and Children’s Central HospitalSchool of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Ningning Zhang
- Hemophilia Comprehensive Care Center, Radiology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Sheng Yang
- Hemophilia and Diagnosis Treatment CenterDepartment of UltrasoundChengdu Women’s and Children’s Central HospitalSchool of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Zhenping Chen
- Hemophilia Comprehensive Care CenterHematology DepartmentBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yan Wang
- Hemophilia Comprehensive Care Center, Rehabilitation DepartmentBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yangying Kuang
- Hemophilia Diagnosis and Treatment CenterDepartment of RadiologyChengdu Women’s and Children’s Central HospitalSchool of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Ling Tang
- Hemophilia Comprehensive Care CenterHematology DepartmentBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yingzi Zhen
- Hemophilia Comprehensive Care CenterHematology DepartmentBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Audrey Abad
- Child Health Evaluative Sciences, Research InstituteThe Hospital for Sick ChildrenTorontoONCanada
| | - Andrea S. Doria
- Department of Diagnostic ImagingMedical Imaging DepartmentThe Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
- The Hospital for Sick ChildrenResearch InstituteUniversity of TorontoTorontoONCanada
| | - Pamela Hilliard
- Child Health Evaluative Sciences, Research InstituteThe Hospital for Sick ChildrenTorontoONCanada
| | - Danial M. Ignas
- Child Health Evaluative Sciences, Research InstituteThe Hospital for Sick ChildrenTorontoONCanada
| | - Prasad Mathew
- Division of Pediatric Hematology/OncologyPresbyterian Health Services HospitalAlbuquerqueNMUSA
| | - Derek Stephens
- The Hospital for Sick ChildrenResearch InstituteUniversity of TorontoTorontoONCanada
| | - Victor S. Blanchette
- Division of Hematology/OncologyThe Hospital for Sick Children and Department of PediatricsUniversity of TorontoTorontoONCanada
| | - Koon‐Hung Luke
- Department of PediatricsLaboratory Medicine and PathologyDivision of Hematology and OncologyUniversity of OttawaChildren Hospital of Eastern OntarioOttawaONCanada
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19
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Saultier P, Guillaume Y, Demiguel V, Berger C, Borel-Derlon A, Claeyssens S, Harroche A, Oudot C, Rafowicz A, Trossaert M, Wibaut B, Vinciguerra C, Boucekine M, Baumstarck K, Meunier S, Calvez T, Chambost H. Compliance with Early Long-Term Prophylaxis Guidelines for Severe Hemophilia A. J Pediatr 2021; 234:212-219.e3. [PMID: 33676933 DOI: 10.1016/j.jpeds.2021.02.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/10/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the applicability and compliance with guidelines for early initiation of long-term prophylaxis in infants with severe hemophilia A and to identify factors associated with guideline compliance. STUDY DESIGN This real-world, prospective, multicenter, population-based FranceCoag study included almost all French boys with severe hemophilia A, born between 2000 and 2009 (ie, after guideline implementation). RESULTS We included 333 boys in the study cohort. The cumulative incidence of long-term prophylaxis use was 61.2% at 3 years of age vs 9.5% in a historical cohort of 39 boys born in 1996 (ie, before guideline implementation). The guidelines were not applicable in 23.1% of patients due to an early intracranial bleeding or inhibitor development. Long-term prophylaxis was delayed in 10.8% of patients. In the multivariate analysis, 2 variables were significantly associated with "timely long-term prophylaxis" as compared with "delayed long-term prophylaxis": hemophilia treating center location in the southern regions of France (OR 23.6, 95% CI 1.9-286.7, P = .013 vs Paris area) and older age at long-term prophylaxis indication (OR 7.2 for each additional year, 95% CI 1.2-43.2, P = .031). Long-term prophylaxis anticipation was observed in 39.0% of patients. Earlier birth year (OR 0.5, 95% CI 0.3-0.8, P = .010 for birth years 2005-2009 vs 2000-2004) and age at first factor replacement (OR 1.9 for each additional year, 95% CI 1.2-3.0, P = .005) were significantly associated with "long-term prophylaxis guideline compliance" vs "long-term prophylaxis anticipation." CONCLUSIONS This study suggests that long-term prophylaxis guidelines are associated with increased long-term prophylaxis use. However, early initiation of long-term prophylaxis remains a challenge.
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Affiliation(s)
- Paul Saultier
- APHM, La Timone Children's Hospital, Department of Pediatric Hematology, Immunology and Oncology, Marseille, France; Aix Marseille Univ, INSERM, INRAe, C2VN, Marseille, France.
| | - Yves Guillaume
- APHM, La Timone Children's Hospital, Department of Pediatric Hematology, Immunology and Oncology, Marseille, France
| | - Virginie Demiguel
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Claire Berger
- Saint-Etienne University Hospital, Hematology and Oncology Pediatric Unit, Saint Etienne, France
| | - Annie Borel-Derlon
- La Côte de Nacre University Hospital, Center for Bleeding Disorders, Caen, France
| | | | - Annie Harroche
- AP-HP, Necker University Hospital, Center for Bleeding Disorders, Paris, France
| | - Caroline Oudot
- Limoges University Hospital, Hematology and Oncology Pediatric Unit, Limoges, France
| | - Anne Rafowicz
- AP-HP, Bicêtre University Hospital, Center for Bleeding Disorders, Le Kremlin Bicêtre, France
| | - Marc Trossaert
- Nantes University Hospital, Center for Bleeding Disorders, Nantes, France
| | - Bénédicte Wibaut
- Lille 2 University Hospital, Center for Bleeding Disorders, Lille, France
| | - Christine Vinciguerra
- Hospices Civils de Lyon, Service d'Hématologie Biologique, Centre de Biologie et Pathologie Est, Bron, France; Université Claude Bernard Lyon 1, Univ Lyon, EA 4609 Hémostase et Cancer, Lyon, France
| | - Mohamed Boucekine
- Aix-Marseille Univ, EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille Univ, EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Marseille, France
| | - Sandrine Meunier
- Hospices Civils de Lyon, Lyon University Hospital, Center for Bleeding Disorders, Lyon, France
| | - Thierry Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Hervé Chambost
- APHM, La Timone Children's Hospital, Department of Pediatric Hematology, Immunology and Oncology, Marseille, France; Aix Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
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20
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Sun J, Zhou X, Hu N. Factor VIII replacement prophylaxis in patients with hemophilia A transitioning to adults: a systematic literature review. Orphanet J Rare Dis 2021; 16:287. [PMID: 34174912 PMCID: PMC8236177 DOI: 10.1186/s13023-021-01919-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the advantages of prophylactic treatment for hemophilia, patients tend to discontinue or not adhere to it because of several challenges such as long-term use, high cost, young patients transitioning to adolescents, and switch to self-infusion or self-care. The goal of this systematic literature review is to emphasize adherence to and efficiency of prophylactic treatment in adults. METHODS A literature review was conducted in PubMed, Embase, and Cochrane databases until April 2021 according to PRISMA guidelines, and the protocol was registered with PROSPERO (CRD42020220085). Studies evaluating the efficacy of prophylaxis in enhancing the quality of life were included. RESULTS A total of 31 articles involving 2379 patients with hemophilia were included in this systematic review. Of these, 26 studies were observational, questionnaire-based studies, and 5 were randomized controlled trials. The majority of studies reported lower annualized bleeding rates in patients receiving prophylaxis compared with those receiving on-demand treatment or those who discontinued prophylaxis. Standard-dose prophylaxis was reported to be effective in most of the studies. In developing countries like China, data suggest that low doses were administered because of limited available resources. However, standard dose or individualized prophylaxis should be provided to prevent joint damage in the long term. Compared with adults, greater adherence to treatment was observed in patients aged < 16 years. CONCLUSION This systematic review emphasizes the importance of adherence to prophylaxis among young adults transitioning from childhood. In countries like China, low-dose prophylaxis can help in preventing joint bleeds in the short term, but in the long term, standard-dose therapy has shown high adherence among young adults and better joint health, in turn improving the quality of life.
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Affiliation(s)
- Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Xuan Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Nan Hu
- Medical Affairs, Pharmaceuticals, Bayer Healthcare Company Ltd, Beijing, 100020, China
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21
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Abstract
INTRODUCTION Emicizumab is a bispecific antibody exerting cofactor function of FVIIIa irrespective of the presence of FVIII inhibitors. Long-term data of phase 1/2 and phase 3 studies have been accumulated. Various questions such as indicated patients, ITI, application to PUPs, hemostatic treatment including surgeries, and emicizumab-related morbidity remain to be solved. AREAS COVERED The review describes the mode of action, data from pre-/post-marketing and ongoing clinical studies according to PubMed search and our own works. EXPERT OPINION For patients with a persistent inhibitor, emicizumab is a definite therapeutic option, although the possibility of BPAs-associated thromboembolic/TMA events raises concerns. The use of ITI together with emicizumab prophylaxis is being examined in clinical trials. For non-inhibitor, especially pediatric patients, emicizumab prophylaxis can be an option. Outcome assessment 'beyond ABR' such as joint health, physical/mental activity, QOL is required. Furthermore, continuous data collection for emicizumab-related adverse events and morbidity would be recommended.
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Affiliation(s)
- Midori Shima
- Thrombosis and Hemostasis Research Center, Nara Medical University, Kashihara-shi, Japan
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22
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Goren R, Pullenayegum E, Blanchette VS, Dover S, Carcao M, Israels SJ, Chan A, Rivard GE, Steele M, Cloutier S, Klaassen RJ, Sinha R, Price VE, Laferriere N, Paradis E, Wu JK, Feldman BM. Patterns of joint damage in severe haemophilia A treated with prophylaxis. Haemophilia 2021; 27:666-673. [PMID: 34015166 DOI: 10.1111/hae.14345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objective of this study was to assess whether there are different patterns (classes) of joint health in young boys with severe haemophilia A (SHA) prescribed primary tailored prophylaxis. We also assessed whether age at first index joint bleed, blood group, FVIII gene abnormality variant, factor VIII trough level, first-year bleeding rate and adherence to the prescribed prophylaxis regimen significantly predicted joint damage trajectory, and thus class membership. METHODS Using data collected prospectively as part of the Canadian Hemophilia Primary Prophylaxis Study (CHPS), we implemented a latent class growth mixture model technique to determine how many joint damage classes existed within the cohort. We used a multinomial logistic regression to predict the odds of class membership based on the above predictors. We fitted a survival model to assess whether there were differences in the rate of dose escalation across the groups. RESULTS We identified three distinct classes of trajectory: persistently low, moderately increasing and rapidly increasing joint scores. By multinomial regression, we found that only age at first index joint bleed predicted rapidly increasing joint scores. The rapidly increasing joint score class group moved through dose escalation significantly faster than the other two groups. CONCLUSIONS Using tailored prophylaxis, boys with SHA follow one of three joint health trajectories. By using knowledge of disease trajectories, clinicians may be able to adjust treatment according to a subject's predicted long-term joint health and institute cost-effective programmes of prophylaxis targeted at the individual subject level.
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Affiliation(s)
- Rachel Goren
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victor S Blanchette
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Manuel Carcao
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Anthony Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, AB, Canada
| | - Stéphanie Cloutier
- Centre de l'hémophilie de l'est du Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada
| | - Robert J Klaassen
- Division of Pediatric Hematology/Oncology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders Program, Royal University Hospital, Saskatoon, SK, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | | | - John K Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - Brian M Feldman
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
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23
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Collins PW, Obaji SG, Roberts H, Gorsani D, Rayment R. Clinical phenotype of severe and moderate haemophilia: Who should receive prophylaxis and what is the target trough level? Haemophilia 2021; 27:192-198. [PMID: 33639027 DOI: 10.1111/hae.14201] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION One of the most often stated tenets of haemophilia care is that prophylaxis converts a person from a severe to a moderate phenotype. In this review, we argue that this is not an accurate assumption and that people on prophylaxis predominantly have factor VIII/IX levels in the mild range. MODERATE HAEMOPHILIA AND PROPHYLAXIS People with moderate haemophilia, who are treating with on-demand regimens, experience joint bleeds and often develop significant arthropathy. This is especially true for people with a baseline level of 1-3 IU/dl, as first reported 55 years ago, and confirmed in more recent studies. Evidence is emerging suggesting that people with severe haemophilia who are using prophylaxis have better musculoskeletal outcomes than people with moderate haemophilia treated episodically. TROUGH LEVELS The debate around the optimum trough level whilst on prophylaxis is ongoing. It is not appropriate to extrapolate information about baseline levels to recommendations about target trough levels on prophylaxis because these are different situations. Studies are emerging that support higher target trough levels than previously used, but in spite of this, the aim of achieving zero bleeds remains elusive with both factor replacement and non-replacement therapies. CONCLUSIONS We recommend that people with moderate haemophilia, especially those with a baseline of 1-3 IU/dl, should be offered prophylaxis based on the same criteria as people with severe haemophilia. Trough levels should be maintained above 3 IU/dl or higher if a level of 3 IU/dl does not control breakthrough bleeding and prophylaxis should be tailored to the bleeding phenotype. This advice is in line with recently published guidelines from the World Federation of Haemophilia and the UK Haemophilia Centre Doctors' Organisation.
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Affiliation(s)
- Peter W Collins
- Cardiff Haemophilia Centre, Cardiff and Vale University Health Board, Cardiff, UK.,Institute of Infection and Immunity, School of Medicine Cardiff University, Cardiff, UK
| | - Samya G Obaji
- Cardiff Haemophilia Centre, Cardiff and Vale University Health Board, Cardiff, UK.,Institute of Infection and Immunity, School of Medicine Cardiff University, Cardiff, UK
| | - Heledd Roberts
- Cardiff Haemophilia Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Deepan Gorsani
- Cardiff Haemophilia Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rachel Rayment
- Cardiff Haemophilia Centre, Cardiff and Vale University Health Board, Cardiff, UK
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24
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Mancuso ME, Mahlangu JN, Pipe SW. The changing treatment landscape in haemophilia: from standard half-life clotting factor concentrates to gene editing. Lancet 2021; 397:630-640. [PMID: 33460559 DOI: 10.1016/s0140-6736(20)32722-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
Congenital haemophilia A (factor VIII deficiency) and B (factor IX deficiency) are X-linked bleeding disorders. Replacement therapy has been the cornerstone of the management of haemophilia, aiming to reduce the mortality and morbidity of chronic crippling arthropathy. Frequent intravenous injections are burdensome and costly for patients, consequently with poor adherence and restricted access to therapy for many patients worldwide. Bioengineered clotting factors with enhanced pharmacokinetic profiles can reduce the burden of treatment. However, replacement therapy is associated with a risk for inhibitor development that adversely affects bleeding prevention and outcomes. Novel molecules that are subcutaneously delivered provide effective prophylaxis in the presence or absence of inhibitors, either substituting for the procoagulant function of clotting factors (eg, emicizumab) or targeting the natural inhibitors of coagulation (ie, antithrombin, tissue factor pathway inhibitor, or activated protein C). The ultimate goal of haemophilia treatment would be a phenotypical cure achievable with gene therapy, currently under late phase clinical investigation.
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Affiliation(s)
- Maria Elisa Mancuso
- Centre for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
| | - Johnny N Mahlangu
- Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Steven W Pipe
- Pediatrics and Pathology, University of Michigan, Ann Arbor, MI, USA
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25
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Majeed H, Ahmed H, Sussman MS, Macgowan C, Rayner T, Weiss R, Feldman BM, Doria AS. Understanding Early Hemophilic Arthropathy in Children and Adolescents Through MRI T 2 Mapping. J Magn Reson Imaging 2020; 53:827-837. [PMID: 33135834 DOI: 10.1002/jmri.27406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Persons with hemophilia experience hemarthrosis, which can lead to cartilage degeneration, causing physical impairment. MRI T2 mapping has the potential to be used as a tool to evaluate early arthropathic changes and cartilage degeneration in patients with hemophilia. PURPOSE To assess the value of MRI-T2 mapping as a tool for investigating the cartilage status of children and adolescents with hemophilic arthropathy. STUDY TYPE Prospective, cross-sectional. SUBJECTS Twenty-eight boys with hemophilia (aged 5-17 years) and 23 healthy boys (aged 7-17 years). FIELD STRENGTH/SEQUENCES A multiecho spin-echo T2 -weighted gradient echo sequence was used on a 3.0T magnet. ASSESSMENT MRI-T2 maps of ankle (tibia-talus) (n = 19) or knee (femur-tibia) (n = 9) cartilage were assessed in hemophilia and healthy groups. An anatomically-based MRI score was also assigned to each ankle/knee. STATISTICAL TESTS Pearson's correlation coefficient (r), linear regression, intraclass correlation coefficient (ICC), and analysis of variance (ANOVA) test. RESULTS Negative associations between age and ankle/knee cartilage T2 relaxation times were found in hemophilia (r = -0.72 [P = 0.03] to -0.55 [P = 0.01]) and healthy (r = -0.84 [P < 0.001] to -0.55 [P = 0.20]) groups. There were nonsignificant associations between ankle cartilage T2 relaxation times and MRI scores (r = -0.15 [P = 0.54] to 0.31 [P = 0.19]). DATA CONCLUSION Results of this clinical investigation emphasize the potential importance of MRI-T2 maps as a tool to understand the functional status of cartilage in children and adolescents with hemophilic arthropathy, while holding promise for the detection of early cartilage degeneration prior to macroscopic characterization by conventional MRI. MRI-T2 mapping may provide novel information that is not reflected in the anatomically-based MRI scoring system. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Haris Majeed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Humayun Ahmed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Marshall S Sussman
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Christopher Macgowan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tammy Rayner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ruth Weiss
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, Institute of Health Policy, Management & Evaluation, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea S Doria
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Tiede A, Bonanad S, Santamaria A, Goldmann G, Canaro M, Palomero A, Frade LJG, Eduardo Megias‐Vericat J, Martinez F, Garcia Candel F, Jimenez Yuste V, Sparber‐Sauer M, Halimeh S, Adolf D, Hukauf M, Reichmann J, Oldenburg J. Quality of electronic treatment records and adherence to prophylaxis in haemophilia and von Willebrand disease: Systematic assessments from an electronic diary. Haemophilia 2020; 26:999-1008. [DOI: 10.1111/hae.14178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023]
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27
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Valentino LA, Khair K. Prophylaxis for hemophilia A without inhibitors: treatment options and considerations. Expert Rev Hematol 2020; 13:731-743. [PMID: 32573295 DOI: 10.1080/17474086.2020.1775576] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hemophilia A is a bleeding disorder traditionally managed with standard half-life (SHL) factor (F) VIII concentrates. Extended half-life (EHL) FVIII products and emicizumab-kywh, a nonfactor therapy, are newer treatment options. Additional nonfactor agents and gene therapy are expected to reach the market in the near future. AREAS COVERED A PubMed (MEDLINE) search from 1962 to April 2020 related to hemophilia A, its management, and the products currently available for prophylaxis was performed to comprehensively review these topics and analyze the benefits and drawbacks of each therapeutic. EXPERT OPINION Prophylaxis with SHL FVIII concentrates remains the standard of care for patients with severe hemophilia A and may also be considered for selected individuals with moderate disease. Several years of real-world experience with EHL FVIII, emicizumab-kywh, and other agents in development will be necessary to determine their ultimate roles in the prevention of bleeding and its complications. Gene therapy may not provide a permanent cure for hemophilia A.
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Affiliation(s)
- Leonard A Valentino
- Rush University , Chicago, IL, USA.,National Hemophilia Foundation , New York, NY, USA
| | - Kate Khair
- Centre for Outcomes Research and Experience in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children, NHS Trust , London, UK
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28
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Rayment R, Chalmers E, Forsyth K, Gooding R, Kelly AM, Shapiro S, Talks K, Tunstall O, Biss T. Guidelines on the use of prophylactic factor replacement for children and adults with Haemophilia A and B. Br J Haematol 2020; 190:684-695. [PMID: 32390158 DOI: 10.1111/bjh.16704] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | - Anne M Kelly
- Cambridge University Hospitals NHS foundation Trust, Cambridge, UK
| | - Susan Shapiro
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Talks
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Oliver Tunstall
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tina Biss
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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29
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[Chinese guidelines on the treatment of hemophilia (version 2020)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:265-271. [PMID: 32295333 PMCID: PMC7364913 DOI: 10.3760/cma.j.issn.0253-2727.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/24/2022]
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30
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Kenet G, Ljung R, Rusen L, Kerlin BA, Blanchette V, Saulytė Trakymienė S, Uscatescu V, Beckmann H, Tseneklidou-Stoeter D, Church N. Continued benefit demonstrated with BAY 81-8973 prophylaxis in previously treated children with severe haemophilia A: Interim analysis from the LEOPOLD Kids extension study. Thromb Res 2020; 189:96-101. [PMID: 32197139 DOI: 10.1016/j.thromres.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION BAY 81-8973 (Kovaltry®), a recombinant factor VIII (rFVIII) product, was efficacious and well tolerated in paediatric previously treated patients (PTPs) with severe haemophilia A for ≥50 exposure days (EDs) in the LEOPOLD Kids study. Because long-term prophylaxis (≥100 EDs) can provide substantial patient benefits, FVIII products should demonstrate long-term safety and efficacy. AIM To demonstrate long-term (≥100 EDs) efficacy and safety of BAY 81-8973 in paediatric PTPs. METHODS PTPs aged ≤12 years with severe haemophilia A without inhibitors could continue in the ongoing open-label extension study after completing ≥50 EDs in the LEOPOLD Kids main study. Patients received BAY 81-8973 for prophylaxis (25-50 IU/kg ≥2×/week), bleed treatment, and surgery. Bleeds were documented in electronic patient diaries. Inhibitor development was monitored every 6 months. RESULTS At the August 2017 interim data cutoff, 46 patients (median [range] age at enrolment, 6.0 [1.0-11.0] years) had spent a median (range) of 602.5 (148-1069) EDs and 4.6 (1.0-5.9) years in the main plus extension studies. Median (quartile [Q]1; Q3) annualised bleeding rate for bleeds within 48 h after a prophylaxis infusion and total bleeds was 1.0 (0.2; 1.9) and 2.0 (0.4; 3.6), respectively. Most (>94%) bleeds were mild or moderate; 71.8% were treated with ≤1 infusion. BAY 81-8973 was also well tolerated with only one treatment-related adverse event (transient, low-titre inhibitor which did not require treatment adjustment). CONCLUSION BAY 81-8973 was efficacious for prophylaxis and treatment of bleeds during >4.5 years in paediatric PTPs with severe haemophilia A.
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Affiliation(s)
- Gili Kenet
- Israel National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Rolf Ljung
- Lund University, Department of Clinical Sciences Lund-Pediatrics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | | | - Bryce A Kerlin
- Nationwide Children's Hospital & The Ohio State University College of Medicine, Columbus, OH, USA
| | - Victor Blanchette
- Department of Pediatrics, University of Toronto, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
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31
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Dover S, Blanchette VS, Wrathall D, Pullenayegum E, Kazandjian D, Song B, Hawes SA, Cloutier S, Rivard GE, Klaassen RJ, Paradis E, Laferriere N, Stain AM, Chan AK, Israels SJ, Sinha R, Steele M, Wu JKM, Feldman BM. Hemophilia prophylaxis adherence and bleeding using a tailored, frequency-escalated approach: The Canadian Hemophilia Primary Prophylaxis Study. Res Pract Thromb Haemost 2020; 4:318-325. [PMID: 32110763 PMCID: PMC7040543 DOI: 10.1002/rth2.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Standard of care for persons with severe hemophilia A includes regular replacement of factor VIII (FVIII). Prophylaxis regimens using standard half-life (SHL) FVIII concentrates, while effective, are costly and require frequent intravenous infusions. AIM This study evaluated the adherence of 56 boys with severe hemophilia A to tailored, frequency-escalated prophylaxis with an SHL recombinant FVIII concentrate. METHODS We reviewed the factor infusion and bleeding logs of study subjects. Adherence to the prescribed regimen was calculated on a weekly basis, and bleeding rates were determined from self/proxy-reported bleeding logs. The primary outcome was adherence to the prescribed prophylaxis regimen. RESULTS The median (range of values [ROV]) weekly adherence to prophylaxis was 85.7% (37.4%-99.8%). The median (ROV) adherent weeks on steps 1 (weekly), 2 (twice weekly), and 3 (alternate-day) were 92.9% (50%-100%), 80.3 (32%-96%), and 72.6% (14%-98%); relative to step 1, subjects were less likely to be adherent on steps 2 and 3 (P < 0.00). On step 1, our cohort had higher adherence than previously reported rates. The median (ROV) adherence to the breakthrough bleeding protocol was 47.1% (0%-100%). At any given time, bleeding risk was reduced by 15% for each 10% increase in adherence during the preceding 12 weeks (hazard ratio, 0.85; 95% confidence interval, 0.81-0.90). CONCLUSION This cohort had high rates of adherence to the prescribed prophylaxis regimen. Initiating prophylaxis with once-weekly infusions facilitated adherence to the prophylaxis regimen in this cohort of boys with severe hemophilia A started on primary prophylaxis at a very young age.
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Affiliation(s)
- Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Darius Wrathall
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Eleanor Pullenayegum
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Institute of Health Policy, Management and Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Daniel Kazandjian
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Byron Song
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/OncologyIWK Health CentreHalifaxNSCanada
| | - Stéphanie Cloutier
- Centre de l'hémophilie de l'est du QuébecHôpital de l’Enfant‐JésusUniversité LavalQuébecQCCanada
| | - Geroges E. Rivard
- Division of Hematology/OncologyDepartment of PediatricsCHU Sainte‐JustineMontrealQCCanada
| | - Robert J. Klaassen
- Division of Pediatric Hematology/OncologyChildren’s Hospital of Eastern OntarioUniversity of OttawaOttawaONCanada
| | | | - Nicole Laferriere
- Division of Hematology/OncologyThunder Bay Regional Cancer CareThunder BayONCanada
| | - Ann Marie Stain
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children’s HospitalMcMaster UniversityHamiltonONCanada
| | - Sara J. Israels
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegMBCanada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders ProgramRoyal University HospitalSaskatoonSKCanada
| | - MacGregor Steele
- Section of Pediatric HematologyDepartment of PediatricsUniversity of Calgary and Alberta Children’s HospitalCalgaryABCanada
| | - John K. M. Wu
- Division of Hematology/Oncology/BMTDepartment of PediatricsUBC & BC Children’s HospitalVancouverBCCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsFaculty of MedicineUniversity of TorontoTorontoONCanada
- Institute of Health Policy, Management and Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
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32
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Usuba K, Price VE, Blanchette V, Abad A, Altisent C, Buchner‐Daley L, Carneiro JDA, Feldman BM, Fischer K, Grainger J, Holzhauer S, Luke K, Meunier S, Ozelo M, Tang L, Antunes SV, Villaça P, Wakefield C, Wharfe G, Wu R, Young NL. Impact of prophylaxis on health-related quality of life of boys with hemophilia: An analysis of pooled data from 9 countries. Res Pract Thromb Haemost 2019; 3:397-404. [PMID: 31294327 PMCID: PMC6611476 DOI: 10.1002/rth2.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prophylaxis reduces the frequency of bleeds in boys with severe hemophilia and is the standard care for their management in resource-abundant countries. The effect of prophylaxis on Health-Related Quality of Life (HRQoL) has not been established, because the sample sizes of most studies are too small to explore the relationship of multiple factors that influence HRQoL. METHODS The aim of this study was to assess the impact of hemophilia severity and treatment regimen on HRQoL and to establish the minimum important difference (MID) using the international level of score distributions. HRQoL data were pooled from 7 studies across 9 countries. HRQoL was measured using the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT). A mixed-effect linear regression analysis was employed to assess the impact of prophylaxis on the CHO-KLAT score. RESULTS Data from 401 boys with hemophilia were analyzed (57.6% severe hemophilia and 57.6% receiving prophylaxis). The model revealed that receiving prophylaxis was significantly associated with higher HRQoL (regression coefficient 8.5, 95% confidence interval [CI] 3.9-13.1). Boys with severe hemophilia had a significantly lower HRQoL as compared to boys with moderate and mild hemophilia whose CHO-KLAT scores were 7.0 and 6.6 points higher, respectively. There was a significant interaction between treatment and disease severity (P = 0.023), indicating prophylaxis has the most significant impact in boys with severe hemophilia. Based on these pooled data, the MID of the CHO-KLAT was established at 6.5. CONCLUSIONS This study confirms the positive effect of prophylaxis on HRQoL in boys with hemophilia in a real-world setting and provides initial benchmarks for interpreting HRQoL scores based on use of the CHO-KLAT instrument.
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Affiliation(s)
- Koyo Usuba
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
- Evaluating Children's Health Outcomes Research CentreLaurentian UniversitySudburyOntarioCanada
| | - Victoria E. Price
- Division of Pediatric Hematology/OncologyDepartment of PediatricsIWK Health CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - Victor Blanchette
- Division of Hematology/OncologyDepartment of PediatricsThe Hospital for Sick Children (SickKids)University of TorontoTorontoOntarioCanada
| | - Audrey Abad
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
| | | | | | - Jorge D. A. Carneiro
- Centro de Hemofilia e Instituto da CriançaHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Brian M. Feldman
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Institute of Health PolicyManagement & Evaluation, the Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Susanne Holzhauer
- Department of Pediatric Hematology and OncologyCharité University MedicineBerlinGermany
| | - Koon‐Hung Luke
- Department of PediatricsLaboratory Medicine and PathologyUniversity of OttawaOttawaOntarioCanada
| | - Sandrine Meunier
- Hemostase CliniqueGroupement Hospitalier Universitaire EstHospices Civils de LyonBronFrance
| | - Margareth Ozelo
- Unit of Hemophilia IHTCCláudio L.P. CorreaHemocentro UnicampINCT do SangueUniversity of CampinasCampinasBrazil
| | - Ling Tang
- Hematology/Oncology CenterBeijing Children's Hospital, Capital Medical UniversityBeijingChina
| | - Sandra V. Antunes
- Department of HematologyUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Paula Villaça
- Service of HematologyHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Cindy Wakefield
- Department of NursingThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
| | - Gilian Wharfe
- Department of PathologyUniversity of the West Indies (UWI)MonaJamaica
| | - Runhui Wu
- Hematology/Oncology CenterBeijing Children's Hospital, Capital Medical UniversityBeijingChina
| | - Nancy L. Young
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
- Evaluating Children's Health Outcomes Research CentreLaurentian UniversitySudburyOntarioCanada
- School of Rural and Northern HealthLaurentian UniversitySudburyOntarioCanada
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33
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Thornburg CD. How I approach: Previously untreated patients with severe congenital hemophilia A. Pediatr Blood Cancer 2018; 65:e27466. [PMID: 30251355 DOI: 10.1002/pbc.27466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 01/19/2023]
Abstract
Previously untreated patients with severe hemophilia A are a vulnerable population at risk for severe bleeding which is currently managed with exogenous clotting factor replacement. The primary burden of current treatment is high-titer inhibitor development. Evolving data on current treatment products as well as emerging therapeutics may inform treatment decisions to prevent bleeding and inhibitor formation. Considerations for diagnosis, education, and shared decision-making related to product choice and treatment regimen are discussed.
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Affiliation(s)
- Courtney D Thornburg
- Rady Children's Hospital San Diego, San Diego, California.,UC San Diego, La Jolla, California
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