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Castaman G, Miesbach W. Gene Therapy for Hemophilia B: Achievements, Open Issues, and Perspectives. Semin Thromb Hemost 2024. [PMID: 38821066 DOI: 10.1055/s-0044-1787190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Hemophilia B is the first bleeding disorder for which gene therapy clinical programs began. Presently, adenovirus-associated vectors represent the best means to deliver the transgene, and their administration by intravenous route has been used in recent clinical trials. The natural occurring factor IX (FIX) Padua variant, which allows for a 5- to 8-fold higher activity of FIX, while maintaining a normal protein concentration, was subsequently used to enhance the level of transgene expression. All the recent trials using this variant showed good results, and accumulating data suggest that long-term expression durability could be maintained at a significant hemostatic level. However, the risk of loss of transgene expression associated to immune response with liver enzymes elevation remains a concern, especially as to the efficacy and duration of immunosuppressive treatment. Notwithstanding this limitation, the results of clinical trials suggest that gene therapy in hemophilia B has the potential to provide long-term benefits with sustained factor activity levels predicted to last several years in many patients.
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Affiliation(s)
- Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Wolfgang Miesbach
- Hemophilia Center of the Medical Clinic 2, University Hospital, Frankfurt/Main, Germany
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2
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Miesbach W, von Drygalski A, Smith C, Sivamurthy K, Pinachyan K, Bensen-Kennedy D, Drelich D, Kulkarni R. The current challenges faced by people with hemophilia B. Eur J Haematol 2024; 112:339-349. [PMID: 38082533 DOI: 10.1111/ejh.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Hemophilia B (HB) is a rare, hereditary disease caused by a defect in the gene encoding factor IX (FIX) and leads to varying degrees of coagulation deficiency. The prevailing treatment for people with HB (PWHB) is FIX replacement product. The advent of recombinant coagulation products ushered in a new era of safety, efficacy, and improved availability compared with plasma-derived products. For people with severe HB, lifelong prophylaxis with a FIX replacement product is standard of care. Development of extended half-life FIX replacement products has allowed for advancements in the care of these PWHB. Nonetheless, lifelong need for periodic dosing and complex surveillance protocols pose substantive challenges in terms of access, adherence, and healthcare resource utilization. Further, some PWHB on prophylactic regimens continue to experience breakthrough bleeds and joint damage, and subpopulations of PWHB, including women, those with mild-to-moderate HB, and those with inhibitors to FIX, experience additional unique difficulties. This review summarizes the current challenges faced by PWHB, including the unique subpopulations; identifying the need for improved awareness, personalized care strategies, and new therapeutic options for severe HB, which may provide future solutions for some of the remaining unmet needs of PWHB.
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Affiliation(s)
| | | | | | | | | | | | | | - Roshni Kulkarni
- Michigan State University Center for Bleeding and Clotting Disorders, Lansing, Michigan, USA
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3
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Mokhtar FM, Rajakumar S, Zaman Huri H. Adherence tool for prophylactic haemophilia treatment in adult and adolescent patients: A systematic review and meta-analysis protocol. PLoS One 2023; 18:e0289815. [PMID: 38096257 PMCID: PMC10720990 DOI: 10.1371/journal.pone.0289815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/27/2023] [Indexed: 12/17/2023] Open
Abstract
Hemophilia is a congenital bleeding disorder resulting from a low level or deficiency of clotting factors. It is an x-linked recessive disease and happens almost exclusively in males whereas females are the carrier of the affected gene. The most common types of hemophilia are hemophilia A and Hemophilia B. Hemophilia is classified into mild, moderate and severe. Prophylaxis treatment has more advantages clinically compare to on-demand therapy. It may reduce the bleeding frequency, gives protection from joint damage, may lower the number of total bleeding episodes per year, and may reduce annualised spontaneous and trauma related bleeding events. However, prophylaxis treatment needs regular weekly infusions therefore it is painful to administer especially if the vein is difficult to access. It may cause pain at the site of injections and may lead to non-adherence to treatment. Non-adherence to a regimen will result in insufficient clotting factor levels in the body. The efficacy of the medication is reduced and may lead to a high bleeding tendency. Thus far, the study on adult haemophilic patient adherence tool is scarce and limited; and therefore this review is warranted. The study protocol is conducted as per the PRISMA-P guideline. There are 4 concepts in this systematic review which are Haemophilia, adult and adolescence, preventive treatment and adherence. Articles will be sought from electronic databases PUBMED, Ovid EMBASE, CINAHL, and SCOPUS using the MeSH term, synonym free-text word, truncation, and proximity operators as per each database. The proposed keywords within each concept will be joined using the Boolean operator "OR "and the 4 different concepts combined using the Boolean operator "AND". Search will be limited to Human, English language, and publication until 2022. Studies will be included if they meet the study inclusion criteria. The quality of the studies will be appraised using the Newcastle-Ottawa quality assessment scale (NOS) for observation-based studies. This systematic review does not require formal ethical approval as data will be extracted from selected published studies. The results will be disseminated through a peer-reviewed publication and relevant conference presentations.(PROSPERO registration CRD42021273813).
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Affiliation(s)
- Fadzlin Mohd Mokhtar
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University Malaya, Kuala Lumpur, Malaysia
| | - Sutha Rajakumar
- Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Hasniza Zaman Huri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University Malaya, Kuala Lumpur, Malaysia
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4
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Liu Z, Feng J, Fang Y, Cheng Y, Li S. Barriers to prophylactic treatment among patients with haemophilia A in Shandong Province, China: a qualitative study. Orphanet J Rare Dis 2023; 18:226. [PMID: 37537616 PMCID: PMC10398971 DOI: 10.1186/s13023-023-02838-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/21/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Haemophilia A is a rare, hereditary haemorrhagic disease that manifests as induced spontaneous bleeding and leads to disability or premature death in severe cases. Prophylactic treatment is optimal for patients to prevent uncontrolled bleeding and reduce the severity of the injury. However, little is known about the use of prophylactic treatment among patients with haemophilia A in China, especially barriers that predispose them to low or non-adherence. In this study, we explore the barriers to the prophylactic treatment of patients with haemophilia A. METHOD We used personal interviews and focus groups to collect the data and analysed the data through thematic analysis. Purposive sampling was employed to recruit our participants. We continued recruiting participants until data saturation was reached from the thematic analysis. Ultimately, we obtained 37 participants, among whom 19 participated in personal interviews and 18 participated in focus groups (i.e., 3 focus groups with 6 participants each). RESULTS Three themes and nine subthemes were identified from the thematic analysis. Nine subthemes (i.e., perceived barriers) emerged from the analysis, which were further clustered into three themes: (1) poor primary health care, (2) inadequate financial support, and (3) a lack of patient-centred care. CONCLUSION The findings presented in this descriptive qualitative study offer a unique view of Chinese patients with haemophilia A and their barriers to prophylactic treatment. Our findings not only provide an in-depth understanding of barriers to prophylactic treatment encountered by Chinese patients with haemophilia A but also address the urgent need to strengthen primary care, provide adequate financial support, and establish patient-centred care for these suffering patients.
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Affiliation(s)
- Ziyu Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Centre for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Junchao Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Centre for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Yunhai Fang
- Shandong Blood Center, Shandong Haemophilia Treatment Center, Jinan, China
| | - Yan Cheng
- Shandong Blood Center, Shandong Haemophilia Treatment Center, Jinan, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Centre for Health Preference Research, Shandong University, Jinan, 250012, China.
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5
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Castaman G, Coppens M, Pipe SW. Etranacogene dezaparvovec for the treatment of adult patients with severe and moderately severe hemophilia B. Expert Rev Hematol 2023; 16:919-932. [PMID: 37882214 DOI: 10.1080/17474086.2023.2276206] [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: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Etranacogene dezaparvovec is the first gene therapy approved for treatment of adults with severe and moderately severe hemophilia B. AREAS COVERED This review describes the results of the clinical trial program of AMT-060 and etranacogene dezaparvovec, outlining the pharmacokinetic, clinical efficacy and safety data. With the entry of etranacogene dezaparvovec into the market, this review summarizes the treatment landscape in hemophilia B and discusses the current unknowns in the field. EXPERT OPINION Gene therapy appears to be a feasible option for adults with severe and moderately severe hemophilia B. Etranacogene dezaparvovec enables most patients to reach stable factor IX (FIX) levels after a single intravenous infusion, eliminating the need for regular prophylaxis; thus, drastically reducing treatment burden and avoiding variable bleeding risk owing to fluctuating FIX activity levels. Efficacy of etranacogene dezaparvovec has been demonstrated even in the presence of preexisting neutralizing antibodies (up to a titer of 1:678), with a relative low risk of transaminitis and its associated potential loss of transgene expression. However, long-term data are required to ascertain the durability of FIX levels achieved and safety. The cost-effectiveness and adoption of innovative payment models for reimbursement are key in choosing gene therapy over existing treatments.
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Affiliation(s)
- Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Michiel Coppens
- Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
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Burke T, Shaikh A, Ali TM, Li N, Konkle BA, Noone D, O'Mahony B, Pipe S, O'Hara J. Association of factor expression levels with annual bleeding rate in people with haemophilia B. Haemophilia 2023; 29:115-122. [PMID: 36331904 PMCID: PMC10099781 DOI: 10.1111/hae.14675] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Gene therapy clinical trials measure steady-state clotting factor expression levels (FELs) to evaluate the modulation of the bleeding phenotype, aiming to offer consistent protection against breakthrough bleeding events. The link between FELs and bleeding risk in people with haemophilia B (PwHB) is not well understood. AIM We evaluated the association between FEL and ABR in PwHB. METHODS This cross-sectional study extended the CHESS burden of illness studies in Europe and the United States. Recruitment of additional adult males with haemophilia B supplemented the existing CHESS sample size of PwHB and FELs. PwHB receiving prophylaxis were excluded, as fluctuating FELs may have confounded the analysis. Demographic and clinical characteristics were reported descriptively. Any recorded baseline FEL was reported by the haemophilia-treating physicians according to the medical records. Generalised linear models with log link explored the association between changes in FEL and ABR. RESULTS The study included 407 PwHB and no inhibitors receiving on-demand treatment. Mean age was 36.7 years; 56% from the EU, 44% from the United States. Mean baseline FEL was 9.95 IU/dl (SD, 10.47); mean ABR was 2.4 bleeds/year (SD, 2.64). After adjusting for covariates, the model showed that for every 1% increase in FEL the average ABR decreased by .08 (p < .001). Predicted number of bleeding events according to FEL showed a significant non-linear relationship between FEL and ABR (p < .05). CONCLUSION This analysis showed a significant relationship between FEL and ABR, where increases in FEL were associated with decreases in ABR among men with HB in Europe and the US.
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Affiliation(s)
- Tom Burke
- HCD Economics, Daresbury, Cheshire, UK.,Faculty of Health and Social Care, University of Chester, Chester, Cheshire, UK
| | | | | | - Nanxin Li
- uniQure Inc., Lexington, Massachusetts, USA
| | - Barbara A Konkle
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Declan Noone
- European Haemophilia Consortium, Brussels, Belgium
| | - Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Steven Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jamie O'Hara
- HCD Economics, Daresbury, Cheshire, UK.,Faculty of Health and Social Care, University of Chester, Chester, Cheshire, UK
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7
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Ballmann J, Ewers M. Nurse-led education of people with bleeding disorders and their caregivers: A scoping review. Haemophilia 2022; 28:e153-e163. [PMID: 35850204 DOI: 10.1111/hae.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION People with bleeding disorders (PwBd) and their caregivers face many challenges in developing viable self-management strategies for living with the condition. Nurse-led education can support them to overcome these challenges. However, it is often unclear what educational needs are addressed, how nurses educate PwBd and what didactic concepts they follow. AIM To gain deeper insights into nurse-led patient education in haemophilia care and provide a basis for a more systematic and evidence-based approach to this task. METHODS A scoping review methodology was used. A systematic search for relevant publications on this topic was conducted in various databases between November 2020 and April 2021. Data sets were analysed following the PRISMA-ScR-checklist and using content analysis. RESULTS Of 588 studies identified, 23 sources of evidence met the inclusion criteria. The educational needs of PwBd and their families are extensive, multifaceted, and variable but rarely assessed systematically. These needs were met at certain times throughout their lifetimes. Nurse-led education differed in content, duration, and modality, including interventions such as information, consultation and instruction. An improvement in treatment-oriented self-management and self-efficacy was the most reported outcome. The didactic concepts on which the educational interventions were based were rarely specified. CONCLUSIONS There is a lack of systematic approaches in assessing and addressing the educational needs of PwBd and their caregivers. High variability was found in the literature regarding nurse-led patient education in haemophilia care. This suggests that more research is needed on this topic - not least on the interventions' conceptual foundations and impact models.
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Affiliation(s)
- Julia Ballmann
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany
| | - Michael Ewers
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany
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8
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Shaikh A, Pedra G, Cawson M, Wiseman C. Examining the impact of haemophilia treatment on health-related quality of life. Haemophilia 2022; 28:796-805. [PMID: 35537107 DOI: 10.1111/hae.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/20/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Haemophilia has substantial SD effects on health-related quality of life (HRQoL), particularly for people with severe haemophilia. How certain aspects of haemophilia influence HRQoL is not well understood. AIM To develop predictive models of variables influencing HRQoL in people with severe haemophilia A or B. METHODS We used data from 514 participants with haemophilia A or B who provided EQ-5D-3L responses in the 2015 CHESS study. Treatment was categorized as always been on-demand (POD), previously on prophylaxis and moved to on-demand regimen (SOD), on prophylaxis from diagnosis (PX), and prophylaxis, previously on-demand (PXOD). Target joints were defined as 'locations of chronic synovitis' as reported by the treating physician. Regression models were evaluated to assess the impact of demographic and clinical covariates on HRQoL scores. RESULTS Significant covariates were generally consistent across models, with number of target joints, number of hospital admissions, and any haemophilia treatment regimen other than PX all independently negatively impacting estimated EQ-5D score. Higher level of treatment adherence (high vs. low/medium) and use of a prophylaxis treatment regimen had positive effects on estimated EQ-5D scores. Target joints were associated with a 0.04 decrement in EQ-5D score, and high versus low/medium adherence was associated with a 0.06 increment. PXOD, POD, and SOD treatment regimens were associated with decrements in predicted scores of 0.07, 0.09, and 0.08, respectively, versus PX. CONCLUSION This study provides a model to estimate the impact of haemophilia interventions on HRQoL, to help assess the relative impact on patient-centric outcomes for this lifelong condition.
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9
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Burke T, Shaikh A, Ali TM, Li N, Curtis R, Garcia Diego DA, Recht M, Sannie T, Skinner M, O'Hara J. Association of factor expression levels with health-related quality of life and direct medical costs for people with haemophilia B. J Med Econ 2022; 25:386-392. [PMID: 35253589 DOI: 10.1080/13696998.2022.2049552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS Gene therapy trials aim to provide a functional cure for patients with haemophilia B (HB), and treatment impact is analyzed by factor IX expression levels (FELs). We investigated the relationship of FELs with health-related quality of life (HRQoL) and costs. MATERIALS AND METHODS This was a retrospective cross-sectional analysis of the European (CHESS I-II) and US (CHESS-US) CHESS population studies. Physicians recruited consecutive patients and extracted information from the medical records; patients completed questionnaires between 2014 and 2015 (CHESS-I), 2018-2019 (CHESS-II) and 2019 (CHESS US). Patients with inhibitors were excluded. HRQoL was assessed using the EQ-5D-5L. Twelve-month haemophilia-related direct medical costs included office visits and hospitalizations based on country-level unit costs. A Tobit model was used to analyze FELs and HRQoL and generalized linear models for direct medical costs. RESULTS A total of 191 men with HB completed the EQ-5D questionnaire; the mean age was 36.8 years, with a mean FEL of 10.1 IU/dL (median, 4.0). Mean EQ-5D was 0.77 (SD, 0.23). The Tobit model adjusting for age, body mass index and blood-borne viruses showed every 1% increase in FEL was associated with +0.006 points in the mean EQ-5D score (p = .003). Mean haemophilia-related direct medical costs excluding factor replacement therapy were €2,028/year (median, €919) in CHESS I-II (EU, n = 226), and $7,171/year (median, $586) in CHESS US (n = 181). Adjusted EU and US models showed every 1% increase in FEL was associated with a decrease in haemophilia-related direct medical costs of €108/year and $529/year, respectively. LIMITATIONS Direct medical costs were based on physician extraction of encounters from medical records, potentially underestimating costs of care. The voluntary nature of participation may have introduced selection biases. CONCLUSIONS We observed a significant association of increases in FEL with increased HRQoL and decreased costs in Europe and the United States among men with HB and no inhibitors.
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Affiliation(s)
- Tom Burke
- HCD Economics, Daresbury, Cheshire, UK
- Faculty of Health and Social Care, University of Chester, Chester, Cheshire, UK
| | | | | | | | | | | | - Michael Recht
- Oregon Health & Science University, Portland, OR, USA
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Thomas Sannie
- Association Française des Hémophiles, Paris, Île-de-France, France
| | - Mark Skinner
- Institute for Policy Advancement, Ltd, Washington, DC, USA
- McMaster University, Hamilton, ON, Canada
| | - Jamie O'Hara
- HCD Economics, Daresbury, Cheshire, UK
- Faculty of Health and Social Care, University of Chester, Chester, Cheshire, UK
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10
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Burke T, Asghar S, O'Hara J, Chuang M, Sawyer EK, Li N. Clinical, humanistic, and economic burden of severe haemophilia B in adults receiving factor IX prophylaxis: findings from the CHESS II real-world burden of illness study in Europe. Orphanet J Rare Dis 2021; 16:521. [PMID: 34930388 PMCID: PMC8691083 DOI: 10.1186/s13023-021-02152-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Real-world studies of the burden of severe haemophilia B in the context of recent therapeutic advances such as extended half-life (EHL) factor IX (FIX) products are limited. We analysed data from the recent CHESS II study to better understand the clinical, humanistic, and economic burden of severe haemophilia B in Europe. Data from male adults with severe haemophilia B receiving prophylaxis were analysed from the retrospective cross-sectional CHESS II study conducted in Germany, France, Italy, Spain and the United Kingdom. Inhibitors were exclusionary. Patients and physicians completed questionnaires on bleeding, joint status, quality of life, and haemophilia-related direct and indirect costs (2019-2020). All outcomes were summarised using descriptive statistics. RESULTS A total of 75 CHESS II patients were eligible and included; 40 patients (53%) provided self-reported outcomes. Mean age was 36.2 years. Approximately half the patients were receiving EHL versus standard half-life (SHL) prophylaxis (44% vs 56%). Most patients reported mild or moderate chronic pain (76%) and had ≥ 2 bleeding events per year (70%), with a mean annualised bleed rate of 2.4. Mean annual total haemophilia-related direct medical cost per patient was €235,723, driven by FIX costs (€232,328 overall, n = 40; €186,528 for SHL, €290,620 for EHL). Mean annual indirect costs (€8,973) were driven by early retirement or work stoppage due to haemophilia. Mean quality of life (EQ-5D) score was 0.67. CONCLUSIONS These data document a substantial, persistent real-world burden of severe haemophilia B in Europe. Unmet needs persist for these patients, their caregivers, and society.
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Affiliation(s)
| | | | - Jamie O'Hara
- HCD Economics, Daresbury, UK.,Faculty of Health and Social Care, University of Chester, Chester, UK
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11
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Witkop M, Morgan G, O'Hara J, Recht M, Buckner TW, Nugent D, Curtis R, O'Mahony B, Skinner MW, Mulhern B, Cawson M, Ali TM, Sawyer EK, Li N. Patient preferences and priorities for haemophilia gene therapy in the US: A discrete choice experiment. Haemophilia 2021; 27:769-782. [PMID: 34310811 PMCID: PMC9290457 DOI: 10.1111/hae.14383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022]
Abstract
Introduction Gene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments. Aim We conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes. Methods We surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Participants indicated preferences for gene therapy attributes including dosing frequency/durability, effect on annual bleeding, uncertainty related to side effects, impact on daily activities, impact on mental health, and post‐treatment requirements. The relative importance of each attribute was analysed overall and for subgroups based on haemophilia type and severity. Results A total of 183 males with haemophilia A (n = 120) or B (n = 63) were included. Half (47%) had severe haemophilia; most (75%) were White. Overall, participants gave effect on bleeding rate the greatest relative importance (31%), followed by dose frequency/durability (26%), uncertainty regarding safety issues (17%), and impact on daily activities (11%). Dose frequency/durability had the greatest importance for those with haemophilia B (35%). Conclusion People with haemophilia prioritised reduced bleeding and treatment burden; the former was more important in haemophilia A and the latter in haemophilia B, followed by safety and impact on daily life in this DCE of gene therapy attributes. These findings and differences can inform clinical and health policy decisions to improve health equity for people with haemophilia.
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Affiliation(s)
| | | | - Jamie O'Hara
- HCD Economics, Daresbury, UK.,Faculty of Health and Social Care, University of Chester, Chester, UK
| | - Michael Recht
- Oregon Health & Science University, Portland, Oregon, USA.,American Thrombosis & Hemostasis Network, Rochester, New York, USA
| | - Tyler W Buckner
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Diane Nugent
- Department of Pediatrics and Division of Hematology at CHOC Children's Hospital, Center for Inherited Blood Disorders, Orange, California, USA
| | | | - Brian O'Mahony
- Irish Haemophilia Society, Dublin, UK.,Trinity College, Dublin, UK
| | - Mark W Skinner
- Institute for Policy Advancement, Ltd., Washington, District of Columbia, USA.,McMaster University, Hamilton, Ontario, Canada
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia
| | | | | | | | - Nanxin Li
- uniQure Inc, Lexington, Massachusetts, USA
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12
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Hoefnagels JW, Schrijvers LH, Leebeek FWG, Eikenboom J, Schols SEM, Smit C, Schutgens REG, Gouw SC, Fischer K. Adherence to prophylaxis and its association with activation of self-management and treatment satisfaction. Haemophilia 2021; 27:581-590. [PMID: 34019720 PMCID: PMC8362086 DOI: 10.1111/hae.14333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Prophylactic replacement therapy (prophylaxis) in patients with haemophilia (PWH) requires lifelong, frequent (self)infusions. Prophylaxis effectiveness depends on adherence, and the drivers of treatment adherence among PWH are unclear. AIM To quantify prophylaxis adherence and associations between adherence and patients' treatment attitudes and satisfaction in a large cohort of children and adults with haemophilia. METHODS In a nationwide, cross-sectional, questionnaire-based study, PWH with complete information currently using prophylaxis were selected. Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis (VERITAS-Pro; normalised score range: 0-100, optimum 0) measured treatment adherence; the Patient Activation Measure (PAM-13; total score range 0-100, optimum 100) measured activation of self-management; Hemophilia Patient Satisfaction Scale (Hemo-Sat; range 0-100, optimum 0) measured treatment satisfaction. Groups were compared according to age (children: <12 years; adolescents: 12-18 years; adults >18 years) and adherence levels using non-parametric tests, and correlations were assessed using Spearman's rho. RESULTS Among 321 participants (median age 33 years, interquartile range [IQR]:15-54 years), adherence was high (median VERITAS-Pro total score 17, 89% adherent) but worsened with age, with median scores of 5, 14 and 20 in children, adolescents, adults, respectively (p < .001). Attitudes towards treatment (median 66 vs. 68) participants and treatment satisfaction (12 vs. 10) were similar between adherent and non-adherent patients. The VERITAS-Pro total score was moderately correlated with PAM-13 (r = .41) but not with Hemo-Sat (r = -.11). DISCUSSION Prophylaxis adherence was high (89%) but decreased significantly with age and was not correlated with treatment attitude or treatment satisfaction.
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Affiliation(s)
| | - Liesbeth Hélène Schrijvers
- Van CreveldkliniekUniversity Medical Center Utrecht, University UtrechtUtrechtthe Netherlands
- Institute of Nursing StudiesUtrecht University of applied sciencesUtrechtthe Netherlands
| | - Frank W. G. Leebeek
- Department of Paediatric HaematologyEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Jeroen Eikenboom
- Department of Internal MedicineDivision of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Saskia E. M. Schols
- Department of HaematologyRadboud University Medical CenterNijmegenthe Netherlands
- Hemophilia Treatment Center NijmegenEindhoventhe Netherlands
| | - Cees Smit
- Department of Internal MedicineDivision of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Roger E. G. Schutgens
- Van CreveldkliniekUniversity Medical Center Utrecht, University UtrechtUtrechtthe Netherlands
| | - Samantha C. Gouw
- Department of HaematologyErasmus MCUniversity Medical CenterRotterdamthe Netherlands
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center Utrecht, University UtrechtUtrechtthe Netherlands
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Hoefnagels JW, Fischer K, Bos RAT, Driessens MHE, Schrijvers LH. A tailored intervention for illness acceptance improves adherence and quality of life in adults with haemophilia using prophylaxis. Haemophilia 2021; 27:e434-e440. [PMID: 33960588 PMCID: PMC8360197 DOI: 10.1111/hae.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adherence to prophylactic treatment (prophylaxis) in persons with haemophilia is challenging and has been reported at only ±50%. Acceptance problems are one of the main reasons for non-adherence in haemophilia. An evidence-based intervention was developed based on an acceptance and commitment therapy (ACT) approach. AIM To evaluate a tailored intervention focused on illness acceptance in adults with haemophilia who were prescribed prophylaxis. METHODS A pre-post study was executed in adults with haemophilia who were prescribed prophylaxis. A series of 8 2-hour group trainings were held, including 3-8 participants/series. Adherence (VERITAS-Pro, optimum 0), health-related quality of life (HRQoL, SF-36, optimum 100) and illness perception (BIPQ, optimum 0) were measured at start, after six months and 12 months and analysed using Wilcoxon signed-rank test. RESULTS Twenty-four patients (median age 47 years, range 27-74) were included. After 12 months, adherence improved in 68% of patients, quality of life in 48% and illness perception in 31%. Adherence (total score) improved from 35 to 25 (P<0.01). HRQoL showed clinically relevant improvement in domains of social-functioning (P = 0.04), role-emotional, physical-functioning, role-physical and bodily pain. Illness perception improved statistically significant on domains of affect (P = 0.01), concern (P = 0.01) and understanding (P = 0.04). Patients evaluated the training useful, an eye-opener, a personal enrichment and insightful. CONCLUSION The tailored group intervention resulted in significant improvement of adherence, quality of life and illness perception. Based on our current experience, we have implemented it in clinical practice and collaborate with the patient association to make it available for all Dutch people with haemophilia.
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Affiliation(s)
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Ruud A. T. Bos
- Van CreveldkliniekUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Liesbeth H. Schrijvers
- Institute for Nursing StudiesUtrecht University of Applied SciencesUtrechtThe Netherlands
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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] [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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15
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Recombinant Factor VIII Fc Fusion Protein (rFVIIIFc) in Real Life: One-Year Clinical and Economic Outcomes. Drugs Real World Outcomes 2021; 8:527-535. [PMID: 34170499 PMCID: PMC8605945 DOI: 10.1007/s40801-021-00259-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Recombinant factor VIII Fc fusion protein (rFVIIIFc) is the first extended half-life (EHL) recombinant clotting factor with marketing authorization; it has been available in France since October 2016. However, data and literature about rFVIIIFc in clinical practice are scarce. Objective We propose a 1-year clinical and economic outcome evaluation in patients with hemophilia A taking into consideration treatment adherence. Patients and methods We reviewed the diaries of all patients treated with rFVIIIFc at Marseille Hemophilia Center for 1 year. All the data were related to the patients’ infusion (i.e., annual number of infusions, weekly dose/kg, and annual consumption) and bleeding reports. The clotting factor costs were considered, whereas additional costs (e.g., infusion devices and nurse intervention) were neglected. Results A total of 34 patients were evaluated. Their median age was 18 years (IQR = 18). Treatment adherence was observed in 62% for FVIII and 66% for rFVIIIFc. The analysis revealed a negligible decrease in the annual clotting factor consumption following the switch (− 2%, p = 0.7339). These data were combined with a significant reduction in the annual number of infusion (− 22.5%, median = 138.5, IQR = 65.8 for FVIII; median = 105, IQR = 24 for rFVIIIFc, p < 0.0001) and bleeding (− 50%, median = 5, IQR = 7.5 for FVIII; median = 1, IQR = 4 for rFVIIIFc, p < 0.0001). With regard to the cost, a decreasing trend was observed (− 8%, p = 0.1300). Conclusion The analysis in a real-life setting revealed that the input of switches toward rFVIIIFc in different treatment (age of patients and regimen) patterns seems to corroborate previous studies. The results suggest that switches have a beneficial effect in terms of efficacy, clotting factor consumption, and cost.
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16
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Cruz MS, Santillan J, Lesser J, Ortiz JP, Forzani L. Personalised Prophylaxis in a Child with Haemophilia A and Type 1 Diabetes. Clin Pract 2021; 11:287-292. [PMID: 34066835 PMCID: PMC8161436 DOI: 10.3390/clinpract11020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023] Open
Abstract
Poor management of either type 1 diabetes or haemophilia A can lead to complications such as organ dysfunction and haemarthropathy. Here, we describe the case of an 8-year-old boy diagnosed with severe haemophilia A shortly after birth. At 2 years old, he was also diagnosed with type 1 diabetes. After six years, the haemophilia treatment was changed from a plasma-derived factor VIII (FVIII) concentrate (octanate®, Octapharma, Lachen, Switzerland) to Nuwiq® (simocotocog alfa, Octapharma, Lachen, Switzerland), a recombinant FVIII (rFVIII) product from a human cell line, which allowed for a personalised treatment schedule that supported good adherence. The dosing regimen could be reduced to two weekly rFVIII infusions. The patient has experienced no spontaneous bleeds since switching to rFVIII and shows no signs of joint damage after over seven years of FVIII prophylaxis. rFVIII was well tolerated, with no treatment-related adverse events observed. This case illustrates the importance of treatment personalisation for young patients and their families managing concomitant diseases.
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17
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Burke T, Asghar S, O'Hara J, Sawyer EK, Li N. Clinical, humanistic, and economic burden of severe hemophilia B in the United States: Results from the CHESS US and CHESS US+ population surveys. Orphanet J Rare Dis 2021; 16:143. [PMID: 33743752 PMCID: PMC7981988 DOI: 10.1186/s13023-021-01774-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemophilia B is a rare congenital bleeding disorder that has a significant negative impact on patients' functionality and health-related quality of life. The standard of care for severe hemophilia B in the United States is prophylactic factor IX replacement therapy, which incurs substantial costs for this lifelong condition. Accurate estimates of the burden of hemophilia B are important for population health management and policy decisions, but have only recently accounted for current management strategies. The 'Cost of Severe Hemophilia across the US: a Socioeconomic Survey' (CHESS US) is a cross-sectional database of medical record abstractions and physician-reported information, completed by hematologists and care providers. CHESS US+ is a complementary database of completed questionnaires from patients with hemophilia. Together, CHESS US and CHESS US+ provide contemporary, comprehensive information on the burden of severe hemophilia from the provider and patient perspectives. We used the CHESS US and CHESS US+ data to analyze the clinical, humanistic, and economic burden of hemophilia B for patients treated with factor IX prophylaxis between 2017 and 2019 in the US. RESULTS We conducted analysis to assess clinical burden and direct medical costs from 44 patient records in CHESS US, and of direct non-medical costs, indirect costs, and humanistic burden (using the EQ-5D-5L) from 57 patients in CHESS US+. The mean annual bleed rate was 1.73 (standard deviation, 1.39); approximately 9% of patients experienced a bleed-related hospitalization during the 12-month study period. Nearly all patients (85%) reported chronic pain, and the mean EQ-5D-5L utility value was 0.76 (0.24). The mean annual direct medical cost was $614,886, driven by factor IX treatment (mean annual cost, $611,971). Subgroup analyses showed mean annual costs of $397,491 and $788,491 for standard and extended half-life factor IX treatment, respectively. The mean annual non-medical direct costs and indirect costs of hemophilia B were $2,371 and $6,931. CONCLUSIONS This analysis of patient records and patient-reported outcomes from CHESS US and CHESS US+ provides updated information on the considerable clinical, humanistic, and economic burden of hemophilia B in the US. Substantial unmet needs remain to improve patient care with sustainable population health strategies.
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Affiliation(s)
| | | | - Jamie O'Hara
- HCD Economics, Daresbury, UK.,Faculty of Health and Social Care, University of Chester, Chester, UK
| | | | - Nanxin Li
- uniQure Inc, 113 Hartwell Avenue, Lexington, MA, 02421, USA.
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18
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Santos AO, Ricciardi JBS, Pagnano R, Pereira LFM, Sakuma ET, Matsuda MMN, Bernardes ES, Araújo EB, Brunetto SQ, Takahashi MES, Brunetto EM, Zulli R, Ozelo MC, Etchebehere ECSC. Knee radiosynovectomy with 153Sm-hydroxyapatite compared to 90Y-hydroxyapatite: initial results of a prospective trial. Ann Nucl Med 2021; 35:232-240. [PMID: 33389651 DOI: 10.1007/s12149-020-01557-5] [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: 07/30/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. PURPOSE The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. METHODS Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. RESULTS After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12 months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. CONCLUSION Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12 months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children.
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Affiliation(s)
- Allan O Santos
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil.
| | - Janaina B S Ricciardi
- Hemophilia Unit of Hemocentro UNICAMP, University of Campinas (UNICAMP), Campinas, Brazil
| | - Rodrigo Pagnano
- Department of Orthopedics and Traumatology of the Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luis Fernando M Pereira
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Emerson T Sakuma
- Division of Ultrasound of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Margareth M N Matsuda
- Radiopharmacy Center of the Nuclear and Energy Research Institute (IPEN/CNEN), São Paulo, Brazil
| | - Emerson S Bernardes
- Radiopharmacy Center of the Nuclear and Energy Research Institute (IPEN/CNEN), São Paulo, Brazil
| | - Elaine B Araújo
- Radiopharmacy Center of the Nuclear and Energy Research Institute (IPEN/CNEN), São Paulo, Brazil
| | - Sérgio Q Brunetto
- Center of Biomedical Engineering, University of Campinas, Campinas, Brazil
| | | | - Edna M Brunetto
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Roberto Zulli
- Hemophilia Unit of Hemocentro UNICAMP, University of Campinas (UNICAMP), Campinas, Brazil
| | - Margareth C Ozelo
- Hemophilia Unit of Hemocentro UNICAMP, University of Campinas (UNICAMP), Campinas, Brazil
| | - Elba C S C Etchebehere
- Division of Nuclear Medicine of the Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
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Mendell JR, Al-Zaidy SA, Rodino-Klapac LR, Goodspeed K, Gray SJ, Kay CN, Boye SL, Boye SE, George LA, Salabarria S, Corti M, Byrne BJ, Tremblay JP. Current Clinical Applications of In Vivo Gene Therapy with AAVs. Mol Ther 2020; 29:464-488. [PMID: 33309881 PMCID: PMC7854298 DOI: 10.1016/j.ymthe.2020.12.007] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/16/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023] Open
Abstract
Hereditary diseases are caused by mutations in genes, and more than 7,000 rare diseases affect over 30 million Americans. For more than 30 years, hundreds of researchers have maintained that genetic modifications would provide effective treatments for many inherited human diseases, offering durable and possibly curative clinical benefit with a single treatment. This review is limited to gene therapy using adeno-associated virus (AAV) because the gene delivered by this vector does not integrate into the patient genome and has a low immunogenicity. There are now five treatments approved for commercialization and currently available, i.e., Luxturna, Zolgensma, the two chimeric antigen receptor T cell (CAR-T) therapies (Yescarta and Kymriah), and Strimvelis (the gammaretrovirus approved for adenosine deaminase-severe combined immunodeficiency [ADA-SCID] in Europe). Dozens of other treatments are under clinical trials. The review article presents a broad overview of the field of therapy by in vivo gene transfer. We review gene therapy for neuromuscular disorders (spinal muscular atrophy [SMA]; Duchenne muscular dystrophy [DMD]; X-linked myotubular myopathy [XLMTM]; and diseases of the central nervous system, including Alzheimer’s disease, Parkinson’s disease, Canavan disease, aromatic l-amino acid decarboxylase [AADC] deficiency, and giant axonal neuropathy), ocular disorders (Leber congenital amaurosis, age-related macular degeneration [AMD], choroideremia, achromatopsia, retinitis pigmentosa, and X-linked retinoschisis), the bleeding disorder hemophilia, and lysosomal storage disorders.
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Affiliation(s)
- Jerry R Mendell
- Center of Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics and Neurology, The Ohio State University, Columbus, OH, USA
| | | | | | - Kimberly Goodspeed
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Steven J Gray
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Sanford L Boye
- Department of Pediatrics, Powell Gene Therapy Center, University of Florida, Gainesville, FL, USA
| | - Shannon E Boye
- Division of Cellular and Molecular Therapeutics, University of Florida, Gainesville, FL, USA
| | - Lindsey A George
- Division of Hematology and the Perelman Center for Cellular and Molecular Therapeutics, Philadelphia, PA, USA; Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie Salabarria
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Manuela Corti
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA; Powell Gene Therapy Center, University of Florida, Gainesville, FL, USA
| | - Barry J Byrne
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA; Powell Gene Therapy Center, University of Florida, Gainesville, FL, USA
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20
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Hoefnagels JW, Fischer K, Bos RAT, Driessens MHE, Meijer SLA, Schutgens REG, Schrijvers LH. A feasibility study on two tailored interventions to improve adherence in adults with haemophilia. Pilot Feasibility Stud 2020; 6:189. [PMID: 33292771 PMCID: PMC7708110 DOI: 10.1186/s40814-020-00723-w] [Citation(s) in RCA: 5] [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: 04/28/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Haemophilia is a congenital bleeding disorder mainly affecting males. To prevent bleeding, patients need to perform regular intravenous injections (prophylaxis) throughout life. Non-adherence often occurs. Problems with acceptance or self-management appear to be the main reasons for non-adherence in haemophilia. The aim of this study was to test the feasibility and effects of two interventions focussed on acceptance (face-to-face) and self-management (online). METHODS Patients with severe haemophilia and acceptance or self-management problems were eligible. The face-to-face group intervention was based on Acceptance and Commitment Therapy (ACT) (8 sessions/6 months, target N = 8 participants). The online intervention was based on a successful online programme in rheumatoid arthritis (5-8 modules/2 months, target N = 8). Both interventions were designed according to the MRC framework in collaboration with the patient society and experts. We compared adherence (VERITAS-Pro, optimum 0), quality of life (SF-36, optimum 100) and illness perception (BIPQ, optimum 0) before start (T0) and after 2 months (T2). Feasibility criteria were as follows: completion of training by > 50% of participants and ability to collect at least 80% of outcome parameters. RESULTS The face-to-face intervention was feasible (89% enrolment and recruitment, 100% retention). One hundred percent of the outcome parameters was collected. Results were promising: although adherence (VERITAS-Pro) was stable (from 64 to 62 points), quality of life (SF-36) showed a clinically relevant improvement (> 5 points) in five of eight domains. Illness perception (BIPQ) showed a clinically relevant increase from 47 to 39 points. Patient evaluation was positive. The online intervention, however, was infeasible: enrolment was only 20% (6/30). Only three patients signed informed consent (recruitment 10%), and none completed more than one module (retention 0%). Consequently, the online intervention was terminated. CONCLUSION The face-to-face acceptance intervention was considered feasible with promising results. Unfortunately, the online intervention was infeasible and therefore terminated. These findings suggest that adapting effective interventions to other settings does not guarantee success, despite the use of established methodology and patient participation. Population differences (only male participants, congenital disease) could be an explanation for failure of the online intervention in haemophilia despite success in rheumatoid arthritis. TRIAL REGISTRATION NL55883.041.16.
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Affiliation(s)
- J W Hoefnagels
- Division Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - K Fischer
- Division Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - R A T Bos
- Division Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - M H E Driessens
- Netherlands Haemophilia Patient Society (NVHP), Nijkerk, The Netherlands
| | - S L A Meijer
- Netherlands Haemophilia Patient Society (NVHP), Nijkerk, The Netherlands
| | - R E G Schutgens
- Division Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - L H Schrijvers
- Division Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
- Utrecht University of Applied Sciences, Utrecht, The Netherlands
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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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22
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Oldenburg J, Shima M, Kruse-Jarres R, Santagostino E, Mahlangu J, Lehle M, Selak Bienz N, Chebon S, Asikanius E, Trask P, Mancuso ME, Jiménez-Yuste V, von Mackensen S, Levy GG. Outcomes in children with hemophilia A with inhibitors: Results from a noninterventional study. Pediatr Blood Cancer 2020; 67:e28474. [PMID: 32776489 DOI: 10.1002/pbc.28474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/22/2020] [Accepted: 05/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Data regarding management of pediatric persons with hemophilia A (PwHA) with factor VIII (FVIII) inhibitors are limited. This prospective noninterventional study (NCT02476942) evaluated annualized bleeding rates (ABRs), safety, and health-related quality of life (HRQoL) in pediatric PwHA with FVIII inhibitors. PROCEDURE PwHA aged <12 years with current FVIII inhibitors and high-titer inhibitor history were enrolled. Participants remained on usual treatment; no interventions were applied. Outcomes included ABR, safety, and HRQoL. RESULTS Twenty-four PwHA aged 2-11 years (median 7.5) were enrolled and monitored for 8.7-44.1 weeks (median 23.4). In the episodic (n = 10) and prophylactic (n = 14) groups, respectively, 121 of 185 (65.4%) and 101 of 186 (54.3%) bleeds were treated using activated prothrombin complex concentrate (aPCC) and/or recombinant activated FVII (rFVIIa). ABRs (95% confidence interval) were 19.4 (13.2-28.4) and 18.5 (14.2-24.0) for treated bleeds, and 32.7 (20.5-52.2) and 33.1 (22.4-48.9) for all bleeds, respectively. Most prophylactic group participants (92.9%) were prescribed aPCC; 50% adhered to their prescribed treatment regimen. Adherence to prophylactic rFVIIa was not assessed. Serious adverse events included hemarthrosis (12.5%) and mouth hemorrhage (12.5%); the most common nonserious adverse event was viral upper respiratory tract infection (12.5%). HRQoL showed functional impairment at baseline; scores remained stable throughout, with little intergroup variation. CONCLUSIONS ABRs remained high in pediatric PwHA with inhibitors receiving standard treatment. This study demonstrates the need for more effective treatments, with reduced treatment burden, to prevent bleeds, increase prophylaxis adherence, and improve patient outcomes.
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Affiliation(s)
- Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Nara, Japan
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, University of Washington, Seattle, Washington
| | - Elena Santagostino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Johnny Mahlangu
- Haemophilia Comprehensive Care Centre, Faculty of Health Sciences, University of the Witwatersrand and NHLS, Johannesburg, South Africa
| | | | | | | | | | - Peter Trask
- Genentech, Inc., South San Francisco, California
| | - Maria Elisa Mancuso
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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Özceylan G. Evaluation of Patients’ Behavior with Bleeding Disorder in Preferring Primary Health Care Centre for Follow-Up and Treatment. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of this study is to examine the behaviors of patients who are members of the hemophilia association due to bleeding disorder, and due to health problems related to their diseases preferring primary health care institutions first, and to determine the reasons if they do not.
Methods: The study was a descriptive cross-sectional study. The universe of the study was composed of hemophilia patients who are members of the hemophilia association living in Tekirdağ province (n=48). In the study face to face questionnaire was applied. People were asked about their first medical institutions in their complaints about their illness. The patients were asked about their age, gender, working status, educational status, types of bleeding disorders, severity and history of diseases.
Results: Nobody preferred the primary health care institution for his complaints about bleeding disorder. Of the participants, 42.9% (n=18) stated that family physicians do not have sufficient information about this disease as the reason for not choosing primary health care institution.
Conclusion: The trust of patients with bleeding disorders to family physicians is not sufficient. Regardless of the severity, type and prophylactic drug use of their disease, they do not prefer primary health care institution for their follow-up and treatment.
Keywords: hemophilia, bleeding, family practice
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Strike K, Chan A, Iorio A, Maly MR, Stratford PW, Solomon P. Predictors of treatment adherence in patients with chronic disease using the Multidimensional Adherence Model: unique considerations for patients with haemophilia. ACTA ACUST UNITED AC 2020. [DOI: 10.17225/jhp00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Adherence to treatment recommendations in patients with chronic disease is complex and is influenced by numerous factors. Haemophilia is a chronic disease with reported levels of adherence ranging from 17–82%.
Aim
Based on the theoretical foundation of the World Health Organization Multidimensional Adherence Model, the objective of this study was to identify the best combination of the variables infusion frequency, annualised bleed rate, age, distance to haemophilia treatment centre (HTC) and Haemophilia Joint Health Score (HJHS), to predict adherence to treatment recommendations in patients with haemophilia A and B on home infusion prophylaxis in Canada.
Methods
A one-year retrospective cohort study investigated adherence to treatment recommendations using two measures: 1) subjective report via home infusion diaries, and 2) objective report of inventory ordered from Canadian Blood Services. Stepwise regression was performed for both measures.
Results
Eighty-seven patients with haemophilia A and B, median age 21 years, were included. Adherence for both measures was 81% and 93% respectively. The sample consisted largely of patients performing an infusion frequency of every other day (34%). Median scores on the HJHS was 10.5; annualised bleed rate was two. Distance to the HTC was 51km. Analysis of the objective measure weakly supported greater infusion frequency as a treatment-related factor for the prediction of lower adherence, however the strength of this relationship was not clinically relevant (R2=0.048). For the subjective measure, none of the explanatory variables were significant.
Conclusion
Adherence is a multifaceted construct. Despite the use of theory, most of the variance in adherence to treatment recommendations in this sample of patients with haemophilia remains unknown. Further research on other potential predictors of adherence, and possible variables and relationships within factors of the MAM is required.
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Affiliation(s)
- Karen Strike
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
| | - Anthony Chan
- Department of Pediatrics , McMaster University , Hamilton , Ontario , Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact (HEI) , McMaster University , Hamilton , Ontario , Canada
| | - Monica R. Maly
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario ; Department of Kenesiology, Faculty of Applied Health Sciences , University of Waterloo , Waterloo , Canada
| | - Paul W. Stratford
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
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Bonanad S, García-Dasí M, Aznar JA, Mingot-Castellano ME, Jiménez-Yuste V, Calle M, Palma A, López-Fernández MF, Marco P, Paloma MJ, Fernández-Mosteirin N, Galmés B, Sanabria M, Álvarez M. Adherence to prophylaxis in adult patients with severe haemophilia A. Haemophilia 2020; 26:800-808. [PMID: 32700426 DOI: 10.1111/hae.14039] [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: 11/08/2019] [Revised: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adherence is a cornerstone of factor VIII prophylactic treatment. Information regarding the factors with potential influence on adherence is limited, particularly in adult patients. AIM To assess adherence in adult patients with severe haemophilia A receiving prophylactic treatment in a real-life setting, and investigate the factors influencing adherence. METHODS Observational, prospective study including adult patients receiving factor VIII therapy in 15 Spanish centres. Patients recorded infusion doses on a logbook and answered various questionnaires to assess their health beliefs. Adherence rate was the percentage of infused doses over the prescribed ones. Self-perceived adherence was assessed using the VERITAS-Pro questionnaire, the psychometric properties of which were validated in the Spanish population. The relationship between adherence rate and treatment, clinical and demographic characteristics, health beliefs and perceived self-efficacy was investigated. RESULTS A total of 66 patients were followed up for 12 months. Mean adherence rate at the end of follow-up was 82.5%. Most of the study patients (n = 53, 80.3%) showed a moderate-to-high adherence rate (>70%). The VERITAS-Pro revealed a high perception of adherence. Multivariate analyses to predict treatment adherence identified the knee as a target joint and longer treatment duration as variables with significant (negative) influence on adherence. Adherence rate was not influenced by the patient's health beliefs or perceived self-efficacy. CONCLUSION Most adult patients receiving factor VIII prophylactic treatment in Spain have moderate-to-high treatment adherence. Treatment duration and the knee as a target joint are factors with a moderate negative influence on treatment adherence.
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Affiliation(s)
| | - María García-Dasí
- Instituto de Investigaciones Sanitarias La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José A Aznar
- Instituto de Investigaciones Sanitarias La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | - Martín Sanabria
- Medical Department Hematology, Bayer Hispania S.L., Barcelona, Spain
| | - MªPilar Álvarez
- Medical Department Hematology, Bayer Hispania S.L., Barcelona, Spain
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Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis. Intensive Care Med 2020; 46:995-1004. [PMID: 32100061 PMCID: PMC7210239 DOI: 10.1007/s00134-020-05965-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/09/2020] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. METHODS This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. RESULTS A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13-15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatments (MOR = 2.9, p < 0.001); and smaller in 6-month outcome (MOR = 1.2, p = 0.01). CONCLUSIONS Half of contemporary TBI patients at the ICU have mild to moderate head injury. Substantial between-center variations exist in ICU stay and treatment policies, and less so in outcome. It remains unclear whether admission of short-stay patients represents appropriate prudence or inappropriate use of clinical resources.
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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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Hoefnagels JW, Kars MC, Fischer K, Schutgens REG, Schrijvers LH. The Perspectives of Adolescents and Young Adults on Adherence to Prophylaxis in Hemophilia: A Qualitative Study. Patient Prefer Adherence 2020; 14:163-171. [PMID: 32158199 PMCID: PMC6986248 DOI: 10.2147/ppa.s232393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/05/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYAs) with severe hemophilia use prophylaxis that requires a high level of adherence. The present study aimed to explore the underlying reason for adherence and non-adherence to prophylaxis in hemophilia from the perspective of AYAs. PATIENTS AND METHODS A qualitative study in Dutch AYAs with hemophilia (14-25 years) using prophylaxis was executed. Focus group interviews and individual interviews were recorded, transcribed, coded and analyzed using an iterative process. Member checking in three respondents was used to validate the potential model. RESULTS A total of 21 interviews were performed. Parental support decreased when AYAs gained more treatment responsibilities, which resulted in a higher risk for non-adherence. AYAs were weighing their potential bleeding risk per activity based on the wish to do what they prefer while also wanting to simultaneously feel safe. When bleeding with low impact on their daily life occurred, or when bleeding remained absent, AYAs felt safe and the perceived need for prophylaxis decreased. CONCLUSION The level of treatment responsibility per AYA and estimated risks per activity were the two main underlying reasons for (non-)adherence. CLINICAL IMPLICATIONS We suggest using a conversation technique to discuss adherence, especially during bleeding assessment visits.
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Affiliation(s)
- JW Hoefnagels
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
- Correspondence: JW Hoefnagels Van Creveldkliniek, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Room C01.409, PO Box 85500, Utrecht3508, GA, the NetherlandsTel +31 88 75 584 50Fax +31 88755438 Email
| | - MC Kars
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - REG Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - LH Schrijvers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
- Institute of Nursing Studies, University of Applied Sciences, Utrecht, the Netherlands
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Soares BMD, Simeoni LA, de Almeida KJQ, de Souza JL, Mizusaki Imoto A, Swain Braverman M, Bezerra LB, Ribeiro AJT, Costa AM, Amorim FF. Factors Associated with Compliance with the Treatment Protocol and Mortality in Adults with Hemophilia. Patient Prefer Adherence 2020; 14:2279-2285. [PMID: 33262579 PMCID: PMC7691649 DOI: 10.2147/ppa.s279401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Hemophilia is associated with a high prevalence of disabilities and mortality. This finding can be influenced by patient compliance with the treatment protocol. This study aims to identify compliance with a treatment protocol in adult patients with hemophilia and to evaluate the factors associated with and the impact on mortality of noncompliance with a hemophilia treatment protocol. METHODS This was a cross-sectional study that was performed between June 2015 and May 2016, followed by a cohort to evaluate mortality until July 2019 that included all adult patients with hemophilia registered in the Federal District, Brazil. RESULTS Among 138 patients enrolled in the study, 35 patients were compliant with all items of the treatment protocol (25.4%). Regarding each item, compliance with the medical consultations was 71.0% (98/138); the clotting factor regimen was 65.9% (91/138); and the serological tests were 51.4% (71/138). The mortality was 7.2% (10/138). Noncompliance with any aspect of the protocol was associated with mortality: medical consultations (p<0.001), clotting factor regimen (p=0.013), and serological tests (p=0.006). All deaths occurred in those who did not comply with the protocol, and the majority were due to bleeding. Patients who were noncompliant with all protocol items showed the highest mortality (50.0%, 5/10). Treatment at the hemophilia treatment center (OR: 2.388; 95% CI: 1.052-5.418, p=0.037) was positively and independently associated with compliance with the protocol in multivariate analysis. CONCLUSION Noncompliance with the treatment protocol was high. Treatment at a hemophilia treatment center was positively and independently associated with compliance with the protocol, which reinforces the importance of comprehensive care by a multidisciplinary team.
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Affiliation(s)
- Beatriz Mac Dowell Soares
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Faculty of Health Sciences, University of Brasilia (UnB) – Brasília, Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Correspondence: Beatriz Mac Dowell Soares School of Medicine, Escola Superior de Ciências da Saúde (ESCS), SMHN Conjunto A Bloco 01 Edifício Fepecs – Asa Norte, Brasília – DF, BrasíliaCEP: 70710-907, Federal District, Brazil, Tel +55 61999836446 Email
| | - Luiz Alberto Simeoni
- Faculty of Health Sciences, University of Brasilia (UnB) – Brasília, Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Karlo Jozefo Quadros de Almeida
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Jaqueline Lima de Souza
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Aline Mizusaki Imoto
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Brasília Hemocentro Foundation (FHB), SMHN Conjunto A Bloco 3, Brasília, Federal District, Brazil
| | - Melina Swain Braverman
- Brasília Hemocentro Foundation (FHB), SMHN Conjunto A Bloco 3, Brasília, Federal District, Brazil
| | - Lucas Barbosa Bezerra
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Alexandre Jorge Teixeira Ribeiro
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Brasília Hemocentro Foundation (FHB), SMHN Conjunto A Bloco 3, Brasília, Federal District, Brazil
| | - Ana Maria Costa
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
| | - Fábio Ferreira Amorim
- School of Medicine, Higher Education School of Health Sciences (ESCS), Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
- Faculty of Health Sciences, University of Brasilia (UnB) – Brasília, Faculdade de Ciências de Saúde Campos Univ, Brasília, Federal District, Brazil
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Torres-Ortuño A, Cuesta-Barriuso R, Nieto-Munuera J, Castiello-Munuera Á, Moreno-Moreno M, López-Pina JA. Haemo-Adhaesione: A New Measure of Adherence for Adolescent and Adult Patients with Haemophilia. Patient Prefer Adherence 2020; 14:455-465. [PMID: 32184574 PMCID: PMC7060779 DOI: 10.2147/ppa.s233601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/11/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To build a multidimensional questionnaire of adherence for a patient with hemophilia that includes not only clinical but also psychosocial aspects. PATIENTS AND METHODS One hundred and forty-six patients with haemophilia (A and B) were recruited from several Hemophilia Treatment Centers for this study. The recruitment was performed through a personal interview (20-25 mins for each patient). A literature review was carried out (different databases). In the first version (136 items), all items were subjected to an external judgment (experts in hemophilia) and also presented and discussed with a group of patients. It was made a study of content validity and homogeneity index and reliability coefficients of score were calculated with an alpha coefficient. Empirical validation was made with Pearson correlation. RESULTS The Haemo-Adhaesione scale was composed of 5 dimensions and 10 questions about basic haemophilia concepts. It was shown to be valid and reliable to assess adherence in the Spanish population. Its internal consistency was good in all dimensions. The Rasch model was used to confirm the multidimensional structure of the scale. Significant and negative correlations were observed with the VERITAS-Pro and VERITAS-PRN scale in all dimensions, and in the total score. CONCLUSIONS The Haemo-Adhaesione scale is a good measure of adherence for PWH. Its multidimensional structure favors the inclusion of the objective and subjective aspects implicit in its definition, as well as its dynamic nature. Patients with greater adherence are those who have more awareness of their disease, and as a result, they are more compliant with prescription and their self-care. It also discriminates between patients who follow one treatment or another.
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Affiliation(s)
- Ana Torres-Ortuño
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
- Association of Hemophilia, Murcia, Spain
- Correspondence: Ana Torres-Ortuño Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Campus de Espinardo s/n, 30100, SpainTel +34 868887170Fax +34 913508 Email
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
- Royal Foundation Victoria Eugenia, Madrid, Spain
| | - Joaquín Nieto-Munuera
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Álvaro Castiello-Munuera
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Manuel Moreno-Moreno
- Association of Hemophilia, Murcia, Spain
- Royal Foundation Victoria Eugenia, Madrid, Spain
- Hematology and Hemotherapy Service, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain
| | - José Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
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Chowdary P. Extended half-life recombinant products in haemophilia clinical practice - Expectations, opportunities and challenges. Thromb Res 2019; 196:609-617. [PMID: 31883700 DOI: 10.1016/j.thromres.2019.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
Extended half-life (EHL) products have shown robust efficacy in clinical trials, whilst allowing for less intense treatment regimens when compared with standard half-life products. Regimen optimisation with EHL products could lead to further improvements in bleeding rates, quality of life and reductions in treatment burden. Patients now expect good efficacy, a lower treatment burden and equivalent safety when compared with standard half-life products. As our knowledge base grows these expectations have evolved and targeting an annualised bleeding rate of zero has become a more realistic clinical goal. Personalised prophylaxis can help patients achieve these goals. However, a number of challenges still remain, including cost, challenges in predicting outcomes for patients and differences in patients' and clinicians' expectations. When switching a patient, comprehensive patient care can reduce the impact of these issues. This review presents in brief the protein therapeutics with an extended half-life, including key trial results, challenges of chronic care that impact on patients' outcomes and how the modified proteins might help address some of these issues. In addition, practical steps for managing the switch to EHL products are presented.
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Affiliation(s)
- Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK.
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Wells JR, Gater A, Marshall C, Tritton T, Vashi P, Kessabi S. Exploring the Impact of Infusion Frequency in Hemophilia A: Exit Interviews with Patients Participating in BAY 94-9027 Extension Studies (PROTECT VIII). THE PATIENT 2019; 12:611-619. [PMID: 31313270 PMCID: PMC6884429 DOI: 10.1007/s40271-019-00374-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Prophylactic treatment of severe hemophilia A is burdensome, requiring frequent intravenous injections. Extended half-life (EHL) factor VIII replacement therapies offer longer intervals between infusions while still meeting efficacy and safety outcomes; however, patient perspectives following long-term use of such products in the real-world remain unknown. OBJECTIVE We aimed to explore the importance of infusion frequency and the potential benefits of reduced infusion frequency among patients receiving prophylactic treatment with an EHL product (BAY 94-9027). METHODS Patients with severe hemophilia A participating in the PROTECT VIII extension study were invited to participate in a semi-structured, concept elicitation 'exit' interview to discuss their experiences. Participants were recruited from Israel, The Netherlands, and the US. Interview transcripts were translated into English and analyzed using thematic analysis methods. RESULTS Sixteen participants (29-68 years of age) infusing with BAY 94-9027 once every 7 days, once every 5 days, or twice weekly were interviewed. Participants reported infusion frequency (alongside efficacy) as the most important treatment attribute influencing their satisfaction with therapy. Patient-reported benefits of reduced infusion frequency and longer duration of factor coverage included greater ability to participate in physical activities; better vein health; less time to schedule and administer factor VIII; reduced impact on work; and improved emotional well-being. CONCLUSIONS This study provides rich insights into the experiences of patients with EHL products and the value of reduced infusion frequency. Such data could be of value to a range of stakeholders (e.g. regulators, payers) and facilitate patient-clinician discussions to promote tailored treatment decisions.
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Affiliation(s)
- Jane R Wells
- Adelphi Values Ltd, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK.
| | - Adam Gater
- Adelphi Values Ltd, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - Chris Marshall
- Adelphi Values Ltd, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
| | - Theo Tritton
- Adelphi Values Ltd, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK
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Adherence to prophylactic treatment. Blood Coagul Fibrinolysis 2019; 30:S19-S21. [PMID: 31517712 DOI: 10.1097/mbc.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Prophylaxis has helped improve patients' perception of their quality of life, enabling them to lead a more normal life. For these reasons prophylactic treatment is nowadays considered a gold standard in the treatment of severe hemophilia A or B. Despite its benefits in terms of preventing bleeding and preserving patients' health, this intensive treatment is not always adhered to by patients with hemophilia - promotion of adherence should involve a multidisciplinary team which addresses not only the clinical aspects of a condition but also the different psychosocial aspects affecting patients and their (social, family and healthcare) environment.
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Physical activity improved by adherence to prophylaxis in an Italian population of children, adolescents and adults with severe haemophilia A: the SHAPE Study. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 18:152-158. [PMID: 31184581 DOI: 10.2450/2019.0040-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Physical activity in people with haemophilia (PWH) reduces the development of severe arthropathy, but it must be performed after regular, proper prophylaxis. Strict adherence to treatment is crucial to achieving effectiveness and established outcomes. The primary aim of this study was to collect prospective data on adherence to prophylaxis for over 36 months. A secondary aim was to verify whether adherence correlates with physical activity. MATERIALS AND METHODS Italian patients with severe haemophilia A treated on prophylaxis with octocog alfa were included in the study. Physical findings were assessed by the Haemophilia and Exercise Project (HEP)-Test-Q and the Early Prophylaxis Immunologic Challenge (EPIC)-Norfolk Physical Activity Questionnaire; orthopaedic status was assessed by the Hemophilia Joint Health Score (HJHS). Adherence was measured as percentage of empty vials returned with respect to the prescribed amount. RESULTS Forty-two PWH were enrolled: 31% children, 21.4% adolescents, and 47.6% adults. Type, frequency and impact of physical activities differed among the three groups. The HEP-Test-Q showed the highest impairments in the domains "endurance" and "strength/co-ordination". Eight percent of patients were classified as adherent to prophylaxis. Among them, 50% had at least one bleeding episode in the year before enrolment; this percentage dropped during the three years of the study. While remaining stable in the "non-adherent" group, the HJHS score decreased in the "adherent" patients. The mean number of school/work days lost was lower in adherent patients (from 3.4±6.8 to 0.2±0.9) than in non-adherent ones. DISCUSSION PWH with better orthopaedic scores reported better physical performance. Adherence to long-term prophylaxis proved to be high and correlated with a reduction in bleeds, target joints, school/work days lost, and with a performance improvement in endurance sports activities over time.
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Lee Mortensen G, Strand AM, Almén L. Adherence to prophylactic haemophilic treatment in young patients transitioning to adult care: A qualitative review. Haemophilia 2019; 24:862-872. [PMID: 30485633 DOI: 10.1111/hae.13621] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Abstract
Recombinant prophylactic treatment (PTX) has greatly improved morbidity, mortality and health-related quality of life (HRQoL) in patients with severe haemophilia. Yet, treatment adherence appears suboptimal in adolescents and young adults with haemophilia (YWH). Young patients experience major biopsychosocial changes challenging their adherence through the transition from parental to self-care, from paediatric to adult care. In clinical practice, a systematic approach to transition is rarely used and there is little evidence on best practices. This qualitative review was based on a systematic literature search including quantitative as well as qualitative research reports to examine all relevant factors influencing adherence to PTX in YWH. We aimed to gain comprehensive insight into main drivers and barriers to adherence by exploring them in the context of YWH's disease perceptions, characteristics, HRQoL and needs. The outcome is an overview of the latest published recommendations to support treatment adherence in YWH during the transition from family-oriented care to self-care and from paediatric to adult care. The literature suggests that adherence to PTX is best supported when individual patient needs and preferences are taken into consideration when planning treatment. Preserving normality is a main priority in young patients making it crucial to support patients from early childhood in considering PTX as enabling rather than hindering a normal social and physically active life. Education in self-management should include psychosocial support of patients as well as caregivers. This requires systematic transition planning including milestone assessments and ongoing multidisciplinary support until full self-management is secured.
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Di Minno G, Santagostino E, Morfini M, Ettorre C, Cultrera D, Baldacci E, Russo E, Gallucci C. Patient satisfaction and acceptability of an on-demand and on-prophylaxis device for factor VIII delivery in patients with hemophilia A. Patient Prefer Adherence 2019; 13:233-240. [PMID: 30774319 PMCID: PMC6362933 DOI: 10.2147/ppa.s175254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND FuseNGO is a relatively new device consisting of a prefilled dual-chamber syringe (DCS) that was recently introduced for the reconstitution of recombinant factor VIII. Herein, the DCS device was assessed using five questionnaires with the primary aim of evaluating patient perceptions and preferences. METHODS An observational, non-interventional, longitudinal study on 86 patients with a confirmed diagnosis of hemophilia A was carried out at 21 sites in Italy. Each patient underwent a baseline visit and final study visit within 3-6 months. Patients were administered five questionnaires: HemoPREF; Treatment Satisfaction Questionnaire for Medication (TSQM); VeritasPRO; Hemophilia Well-being Index (HWBI); Work Productivity and Activity Impairment Questionnaire (WPAI) + Classroom Impairment Questions (CIQ): Hemophilia Specific (HS). RESULTS Compared to baseline, scores for HemoPREF were higher at follow-up; significant increases in the percentage of positive responses were seen for all questions regarding the ease of use (P<0.05). The mean time needed for the reconstruction of the device at baseline was 11 minutes (range 1-30 minutes), which decreased to 6 minutes (range 30 seconds to 25 minutes) at follow-up. All scores in the TSQM indicated good satisfaction with the device. Patients reported an adherence of >70% in the VeritasPRO questionnaire, and the majority of patients reported in the HWBI that hemophilia A did not affect their lives in a significant way. The perceived level of overall impairment was 30% as reported in the WPAI + CIQ: HS, indicating little impairment. There were no safety concerns. CONCLUSION Considering patient-reported outcomes, the DCS device was associated with easier preparation, storage, disposal of equipment, and overall use. Of particular note, preparation times were reduced by around 50%. The majority of patients were satisfied with the device and overall adherence scores were high. Considering these results, the device has the potential to increase adherence to therapy and, possibly, reduce healthcare costs.
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Affiliation(s)
- Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Azienda Universitaria Policlinico Federico II, Naples, Italy,
| | - Elena Santagostino
- Hemophilia and Thrombosis Center, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Morfini
- Scientific Committee, Italian Association of Haemophilia Centres (AICE), Florence, Italy
| | - Cosimo Ettorre
- Haemophilia and Thrombosis Center, Policlinico Giovanni XXIII, Bari, Italy
| | - Dorina Cultrera
- Hematology Unit, Regional Center for Hemophilia, Italy Ospedaliera-Universitaria "Policlinico - Vittorio Emanuele", Catania, Italy
| | - Erminia Baldacci
- Hemophilia, Thrombosis, and Hematology Center, Dipartimento Biotecnologie cellulari ed Ematologia, Università la Sapienza, Rome, Italy
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Nagao A, Yeung CH, Germini F, Suzuki T. Clinical outcomes in hemophilia A patients undergoing tailoring of prophylaxis based on population-based pharmacokinetic dosing. Thromb Res 2019; 173:79-84. [DOI: 10.1016/j.thromres.2018.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 01/19/2023]
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Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study. Orphanet J Rare Dis 2018; 13:151. [PMID: 30176883 PMCID: PMC6122620 DOI: 10.1186/s13023-018-0884-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/29/2018] [Indexed: 11/25/2022] Open
Abstract
Background Elbow arthropathy is characteristic in patients with hemophilia. Arthropathy is manifested by decreased range of motion, pain, loss of strength and muscular atrophy, and axial changes. The objective is to evaluate the safety of two physiotherapy programs combining manual therapy and home exercises with educational sessions in patients with hemophilic elbow arthropathy. Methods This is a randomized study with 27 patients with elbow hemophilic arthropathy with a mean age of 34.48 (SD: 12.99) years, were randomised to Manual Therapy group, educational group and control group. The physiotherapy programmes were: manual therapy through joint traction, passive muscles stretching and proprioceptive neuromuscular facilitation; and educational sessions and daily home exercises. The study lasted for twelve weeks, with two sessions a week in manual therapy group and one session every two weeks with daily home exercises in educational group. The variables measured were range of motion of elbow, biceps strength, circumference of arm, and elbow pain. Results The treatment with manual therapy improved the circumference of arm, flexion elbow and elbow pain. Six months later, MT group still enjoyed improved. In the educational group there were improvements, but not significant, in the measured variables. Conclusion Neither of the two physiotherapy interventions caused elbow hemarthrosis. The treatment with manual therapy improved the range of movement and circumference of arm, and lessened pain in hemophilic patients with chronic elbow arthropathy. No hemarthrosis was recorded during treatment or during the follow-up period. Larger randomized clinical trials are required to confirm the results of this study. Trial registration (NCT02198040). Registered 22 July 2014, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13023-018-0884-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain. .,Real Fundación Victoria Eugenia, Instituto de Salud Carlos III, 4 Sinesio Delgado Street, 28029, Madrid, Spain. .,Fishemo CEE-Federación Española de Hemofilia, Madrid, Spain.
| | - Antonia Gómez-Conesa
- Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, Spain
| | - José-Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
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Morfini M, Gherardini S. Pharmacokinetic-based prediction of real-life dosing of extended half-life clotting factor concentrates on hemophilia. Ther Adv Hematol 2018; 9:149-162. [PMID: 29899890 PMCID: PMC5992810 DOI: 10.1177/2040620718774258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/09/2018] [Indexed: 01/12/2023] Open
Abstract
The improvement of clotting factor concentrates (CFCs) has undergone an impressive boost during the last six years. Since 2010, several new recombinant factor (rF)VIII/IX concentrates entered phase I/II/III clinical trials. The improvements are related to the culture of human embryonic kidney (HEK) cells, post-translational glycosylation, PEGylation, and co-expression of the fragment crystallizable (Fc) region of immunoglobulin (Ig)G1 or albumin genes in the manufacturing procedures. The extended half-life (EHL) CFCs allow an increase of the interval between bolus administrations during prophylaxis, a very important advantage for patients with difficulties in venous access. Although the inhibitor risk has not been fully established, phase III studies have provided standard prophylaxis protocols, which, compared with on-demand treatment, have achieved very low annualized bleeding rates (ABRs). The key pharmacokinetics (PK) parameter to tailor patient therapy is clearance, which is more reliable than the half-life of CFCs; the clearance considers the decay rate of the drug concentration-time profile, while the half-life considers only the half concentration of the drug at a given time. To tailor the prophylaxis of hemophilia patients in real-life, we propose two formulae (expressed in terms of the clearance, trough and dose interval between prophylaxis), respectively based on the one- and two-compartmental models (CMs), for the prediction of the optimal single dose of EHL CFCs. Once the data from the time decay of the CFCs are fitted by the one- or two-CMs after an individual PK analysis, such formulae provide to the treater the optimal trade-off among trough and time-intervals between boluses. In this way, a sufficiently long time-interval between bolus administration could be guaranteed for a wider class of patients, with a preassigned level of the trough. Finally, a PK approach using repeated dosing is discussed, and some examples with new EHL CFCs are shown.
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Affiliation(s)
| | - Stefano Gherardini
- Department of Physics and Astronomy, LENS, and
QSTAR, University of Florence, Sesto Fiorentino (Italy)
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Torres-Ortuño A, Cuesta-Barriuso R, Nieto-Munuera J, Galindo-Piñana P, López-Pina JA. The behaviour and perception of illness: modulating variables of adherence in patients with haemophilia. Vox Sang 2018; 113:577-583. [PMID: 29797724 DOI: 10.1111/vox.12669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/13/2018] [Accepted: 05/03/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The recommended treatment in patients with severe haemophilia is prophylaxis. This prevents bleedings and reduces or delays the haemophilic arthropathy. Adherence defined as the follow-up of the patient to the prescriptions of the health professional to his treatment, both pharmacological and modifications in habits or stylelifes. Adherence rates in haemophilia are better than in other chronic diseases, but there remain reasons for nonadherence. The aim was to see if disease behaviour and disease perception together with coping strategies modulate adherence to treatment. MATERIAL AND METHODS Multicenter cross-sectional descriptive study. Patients recruited in Units of Hemophilia Hospitals and Regional Haemophilia Associations. Twenty-three patients participated The instruments used are as follows: data sheet, SF-36, A36 Hemophilia-Qol, Illness Perception Questionnaire-Revised (IPQ-R), Illness Behavior Questionnaire (IBQ) and Coping Strategies Inventory (CSI) and VERITAS-Pro. RESULTS We found that 56% of patients with haemophilia are adherent. The most relevant clinical variables were hemarthrosis, diagnosis of arthropathy and presence of any coinfection, as well as family history, labour status and sociodemographic variables. Age was not a relevant variable in adherence. The worst adherence coincides with poorer quality of life and inadequate coping style. Nonadherent patients show greater conviction of disease, perception of cyclicity, more hypochondriacal behaviour towards the illness and perception concern about possible side effects of medication. CONCLUSION Adherence in haemophilia requires a more experiential approach and individualized education. It is important that professionals take into account the patient's perception, behaviour and attitude towards the disease to achieve a better adaptation of their coping resources.
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Affiliation(s)
- A Torres-Ortuño
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - R Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
- Royal Foundation Victoria Eugenia, Madrid, Spain
| | - J Nieto-Munuera
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - P Galindo-Piñana
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - J-A López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
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Cuesta-Barriuso R, López-Pina JA, Nieto-Munuera J, Sagarra-Valls G, Panisello-Royo JM, Torres-Ortuño A. Effectiveness of the Medtep Hemophilia online platform for adherence to prophylactic treatment in haemophilia patients: Results from a 1-year observational study. Haemophilia 2018; 24:452-459. [DOI: 10.1111/hae.13444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- R. Cuesta-Barriuso
- Department of Physiotherapy, School of Biomedical and Health Sciences; European University of Madrid; Madrid Spain
- Real Fundación Victoria Eugenia; Madrid Spain
- Fishemo Federación Española de Hemofilia-Fedhemo; Madrid Spain
| | - J. A. López-Pina
- Department of Basic Psychology and Methodology; Faculty of Psychology; University of Murcia; Murcia Spain
| | - J. Nieto-Munuera
- Department of Psychiatry and Social Psychology; Faculty of Medicine; University of Murcia; Murcia Spain
| | | | | | - A. Torres-Ortuño
- Department of Psychiatry and Social Psychology; Faculty of Medicine; University of Murcia; Murcia Spain
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Sultan S, El-Hourani M, Rondeau É, Garnier N. Categorizing factors of adherence to parenteral treatment in growth hormone deficiencies and hemophilia: What should be the targets for future research? Patient Prefer Adherence 2018; 12:2039-2063. [PMID: 30349200 PMCID: PMC6188171 DOI: 10.2147/ppa.s177624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Adherence to treatment regimens in growth hormone dysregulations and hemophilia is related to better outcome and fewer complications over time. Subcutaneous growth hormone injection and intravenous blood factor replacement therapies are parenteral treatments with a comparable regimen calling for similar behavioral processes. Although we have lists of possible factors influencing adherence in these conditions, the evidence is scattered. The objective of this study was to systematically review empirical studies linking factors of adherence with measures of adherence. To categorize the factors, we used a taxonomy from the diabetes literature. We used four major electronic databases to identify articles. We synthesized 27 articles dated 2011-2017 corresponding to inclusion criteria. Results showed a consistent proportion of 20%-25% participants with adherent issues. Strong arguments pointed to the transition to self-care in pediatrics as a vulnerability period (7/27 reports). We found the domains of individual factors (<30% reports), relational factors (<13%), health care (<30%), to be understudied in comparison with that of demographic or clinical context (>74%), and practical issues (>37%). The results suggest that future research should focus on modifiable factors of adherence, with appropriate measurement and intervention strategies. One central methodological limitation of reviewed reports was the lack of longitudinal designs, and the quasi absence of behavioral trial targeting modifiable factors of adherence. A new research agenda should be set in these rare diseases as higher adherence should translate into improved outcome and better quality of life for patients and their families.
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Affiliation(s)
- Serge Sultan
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, Québec, Canada,
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada,
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada,
| | - Mira El-Hourani
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada,
| | - Émélie Rondeau
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, Québec, Canada,
| | - Nicolas Garnier
- Pfizer Canada Inc, Rare Disease Unit, Medical Affairs, Kirkland, Québec, Canada
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Bonanad S, Schulz M, Gordo A, Spurden D, Cicchetti M, Cappelleri JC, Tolley C, Staunton H, Brohan E. HaemoPREF: Further evaluation of patient perception and preference for treatment in a real world setting. Haemophilia 2017; 23:884-893. [PMID: 28925586 DOI: 10.1111/hae.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Adherence to haemophilia A (HA) treatment may be influenced by patients' beliefs about their condition and treatment. Furthermore, difficulties administering treatment may lead to poor adherence. New treatment strategies aim to reduce the burden associated with administration and to improve patient perception of treatment, which, in turn, increase adherence levels. AIMS This study aimed to examine patient perception of HA treatment and related factors using patient-reported outcome (PRO) questionnaires and to confirm the psychometric properties of a recently developed questionnaire, the HaemoPREF. METHODS A non-interventional, cross-sectional, questionnaire study was conducted with adult HA patients in Spain (n=31), Germany (n=10) and Italy (n=48), who were using ReFacto AF with the FuseNGo administration device. Patients completed the HaemoPREF and other questionnaires measuring related constructs: treatment adherence, satisfaction and well-being, online at two time points. Correlational, regression and psychometric analyses were conducted. RESULTS PRO scores indicated that patients are satisfied with and adherent to their treatment. Multivariate regression of the HaemoPREF global score identified a number of significant predictors (P≤.05). The HaemoPREF Global Score had a moderate relationship with subscales on the related questionnaires (mean correlation=0.43; range=0.39-0.48). The HaemoPREF demonstrated good test-retest reliability (intraclass correlation coefficient=0.82), internal consistency reliability (Cronbach's alpha range=0.69-0.82) and convergent validity with measures of treatment satisfaction (Spearman correlation coefficient, r=.48) and well-being (r=.41). CONCLUSION The findings suggest that patients using ReFacto AF with FuseNGo were satisfied with and adherent to their treatment. The HaemoPREF can identify important concepts relating to patient treatment experience in HA.
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Affiliation(s)
- S Bonanad
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Schulz
- Pfizer Pharma GmbH, Berlin, Germany
| | - A Gordo
- Lab.Pfizer, Lda, Porto Salvo, Portugal
| | | | - M Cicchetti
- A Parexel Company, Execupharm, Groton, CT, USA
| | | | - C Tolley
- Adelphi Values, Bollington, Cheshire, UK
| | - H Staunton
- Adelphi Values, Bollington, Cheshire, UK
| | - E Brohan
- Adelphi Values, Bollington, Cheshire, UK
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A new, promising, extended half-life rFIX concentrate. LANCET HAEMATOLOGY 2017; 4:e59-e60. [DOI: 10.1016/s2352-3026(17)30003-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/18/2022]
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Schrijvers LH, Cnossen MH, Beijlevelt-Van der Zande M, Peters M, Schuurmans MJ, Fischer K. Defining adherence to prophylaxis in haemophilia. Haemophilia 2016; 22:e311-4. [PMID: 27227699 DOI: 10.1111/hae.12935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 11/26/2022]
Affiliation(s)
- L H Schrijvers
- Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Beijlevelt-Van der Zande
- Haemophilia Treatment Center, Emma Children's' Hospital-Academical Medical Center, Amsterdam, The Netherlands
| | - M Peters
- Haemophilia Treatment Center, Emma Children's' Hospital-Academical Medical Center, Amsterdam, The Netherlands
| | - M J Schuurmans
- Nursing Science, Faculty of Health Care, University of Applied Science, Utrecht, The Netherlands.,Nursing Science, University Medical Centre, Utrecht, The Netherlands
| | - K Fischer
- Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
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