1
|
Machin N, Lim MY. Evidence-Based Minireview: For overweight or obese persons with hemophilia A, should factor VIII dosing be based on ideal or actual body weight? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:215-218. [PMID: 34889357 PMCID: PMC8791112 DOI: 10.1182/hematology.2021000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Nicoletta Machin
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA
- Hemophilia Center of Western Pennsylvania, Pittsburgh, PA
| | - Ming Y Lim
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT
| |
Collapse
|
2
|
Dubé E, Merlen C, Bonnefoy A, Gauthier J, Castilloux JF, Charlebois J, Cloutier S, Demers C, Sabapathy CA, St-Louis J, Vézina C, Warner M, Rivard GÉ. Evaluation of anti-factor VIII antibodies in haemophilia A subjects switching products following a provincial tender. Haemophilia 2021; 28:e1-e4. [PMID: 34766421 DOI: 10.1111/hae.14434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Evemie Dubé
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Clémence Merlen
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Arnaud Bonnefoy
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Julie Gauthier
- Molecular Diagnostic Laboratory, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
| | | | - Janie Charlebois
- Centre Hospitalier Universitaire de Sherbrooke, Université Sherbrooke, Canada
| | - Stéphanie Cloutier
- Hôpital de l'Enfant Jésus, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Christine Demers
- Hôpital de l'Enfant Jésus, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | | | - Jean St-Louis
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada.,Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Catherine Vézina
- Montreal Children's Hospital, McGill University Health Center, Montréal, Canada
| | - Margaret Warner
- Montreal Children's Hospital, McGill University Health Center, Montréal, Canada
| | | |
Collapse
|
3
|
Population pharmacokinetic modeling of factor concentrates in hemophilia: an overview and evaluation of best practice. Blood Adv 2021; 5:4314-4325. [PMID: 34496017 PMCID: PMC8945640 DOI: 10.1182/bloodadvances.2021005096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 12/30/2022] Open
Abstract
The accuracy of pharmacokinetic (PK)-guided dosing depends on the clinical and laboratory data used to construct a population PK model, as well as the patient’s individual PK profile. This review provides a detailed overview of data used for published population PK models for factor VIII (FVIII) and factor IX (FIX) concentrates, to support physicians in their choices of which model best suits each patient. Furthermore, to enhance detailed data collection and documentation, we do suggestions for best practice. A literature search was performed; publications describing prophylactic population PK models for FVIII and FIX concentrates based on original patient data and constructed using nonlinear mixed-effect modeling were included. The following data were collected: detailed demographics, type of product, assessed and included covariates, laboratory specifications, and validation of models. Included models were scored according to our recommendations for best practice, specifically scoring the quality of data documentation as reported. Respectively, 20 models for FVIII and 7 for FIX concentrates were retrieved. Although most models (22/27) included pediatric patients, only 4 reported detailed demographics. The wide range of body weights suggested that overweight and obese adults were represented. Twenty-six models reported the assay applied to measure factor levels, whereas only 16 models named reagents used. Eight models were internally validated using a data subset. This overview presents detailed information on clinical and laboratory data used for published population PK models. We provide recommendations on data collection and documentation to increase the reliability of PK-guided prophylactic dosing of factor concentrates in hemophilia A and B.
Collapse
|
4
|
Godby RC, Raju D, Massicano F, Williams LA, Black B, Dorn D, Marques MB. Optimizing factor VIII dosing in obese individuals with haemophilia A. Blood Coagul Fibrinolysis 2021; 32:528-530. [PMID: 34285174 DOI: 10.1097/mbc.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Richard Curtis Godby
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dheeraj Raju
- Cancer Treatment Centers of America, Boca Raton, Florida
| | - Felipe Massicano
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lance A Williams
- Department of Pathology, Division of Laboratory Medicine, Mayo Clinic, Phoenix, Arizona
| | - Briley Black
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Dorn
- Cunningham Pathology, Tuscaloosa, Alabama, USA
| | - Marisa B Marques
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
5
|
van Moort I, Bukkems LH, Nieuwenhuizen L, Cnossen MH. Impact of extreme weight loss on factor VIII concentrate pharmacokinetics in haemophilia. BMJ Case Rep 2021; 14:14/4/e238036. [PMID: 33846178 PMCID: PMC8047996 DOI: 10.1136/bcr-2020-238036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We explored the effects of extreme weight loss after gastric bypass surgery on factor VIII concentrate pharmacokinetic (PK) parameters in a patient with haemophilia A. We present a 32-year-old man with severe haemophilia A, with a body mass index (BMI) of 42.6 kg/m2 who underwent laparoscopic sleeve gastrectomy. We showed that a population PK model with ideal body weight as morphometric variable instead of bodyweight led to an adequate description of the individual PKs in this patient with a variable BMI. Strikingly, no differences were observed in the individual PK parameters after extreme weight loss. Therefore, the resulting extreme weight loss after surgery did not lead to prophylactic dose changes in this patient with severe haemophilia. We carefully conclude that population PK-pharmacodynamic models are still obligatory to give more insight into functional effects of significant weight loss on the haemostatic balance.
Collapse
Affiliation(s)
- Iris van Moort
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Childrens Hospital Rotterdam, Rotterdam, The Netherlands
| | - Laura H Bukkems
- Department of Clinical Pharmacology-Hospital Pharmacy, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Laurens Nieuwenhuizen
- Department of Hematology, Maxima Medical Centre Location Veldhoven, Veldhoven, Noord-Brabant, The Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Childrens Hospital Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Yu JK, Iorio A, Chelle P, Edginton AN. Pharmacokinetic implications of dosing emicizumab based on vial size: A simulation study. Haemophilia 2021; 27:358-365. [PMID: 33650745 DOI: 10.1111/hae.14292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Emicizumab is dosed as mg/kg and, according to the label, any unused drug left in the vial(s) must be discarded, thereby wasting expensive resources. The aim of this study was to use population pharmacokinetics to illustrate the implications of changing the dosing interval to avoid wastage. METHODS We used a previously published emicizumab PopPK model after extending its validation to children. We simulated PK parameters for labelled dosing regimens and for regimens using full vials with infusion frequency varied to keep the steady-state drug concentration unchanged. Cost and drug savings were calculated. RESULTS The model evaluation was successful. When rounding up, the average individual below 53, 47 and 39 has a time-to-trough increase of up to 5.7, 7.9 and 5.8 days for the QW, Q2 W and Q4 W regimen, respectively. This resulted in an annual cost reduction of up to $173,136, $75,747 and $61,319 USD per patient. At higher body weights, rounding down the dose to the nearest vial resulted in negligible changes in the steady state concentration and cost savings of up to $93,781, $46,891 and $23,446 USD per patient, respectively. CONCLUSION Individuals with a lower body weight may benefit from increasing dose intervals and rounding up dose up to the nearest vial, and individuals with a higher body weight from maintaining the injection frequency and rounding dose down to the nearest vial without significant change in emicizumab levels. Administering the entire vial may result in a reduction of vials used annually and potential cost savings.
Collapse
Affiliation(s)
- Jacky K Yu
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Alfonso Iorio
- McMaster-Bayer Endowed Research Chair for Clinical Epidemiology of Congenital Bleeding Disorders, Department of Medicine; and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pierre Chelle
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | |
Collapse
|
7
|
van Moort I, Preijers T, Hazendonk HCAM, Schutgens REG, Laros-van Gorkom BAP, Nieuwenhuizen L, van der Meer FJM, Fijnvandraat K, Leebeek FWG, Meijer K, Mathôt RAA, Cnossen MH. Dosing of factor VIII concentrate by ideal body weight is more accurate in overweight and obese haemophilia A patients. Br J Clin Pharmacol 2020; 87:2602-2613. [PMID: 33232535 PMCID: PMC8246536 DOI: 10.1111/bcp.14670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022] Open
Abstract
Aims Under‐ and, especially, overdosing of replacement therapy in haemophilia A patients may be prevented by application of other morphometric variables than body weight (BW) to dose factor VIII (FVIII) concentrates. Therefore, we aimed to investigate which morphometric variables best describe interindividual variability (IIV) of FVIII concentrate pharmacokinetic (PK) parameters. Methods PK profiling was performed by measuring 3 FVIII levels after a standardized dose of 50 IU kg−1 FVIII concentrate. A population PK model was constructed, in which IIV for clearance (CL) and central volume of distribution (V1) was quantified. Relationships between CL, V1 and 5 morphometric variables (BW, ideal BW [IBW], lean BW, adjusted BW, and body mass index [BMI]) were evaluated in normal weight (BMI < 25 kg m−2), overweight (BMI 25–30 kg m−2) and obese haemophilia A patients (BMI > 30 kg m−2). Results In total, 57 haemophilia A patients (FVIII≤0.05 IU mL−1) were included with median BW of 83 kg (range: 53–133) and median age of 48 years (range: 18–77). IBW best explained observed variability between patients, as IIV for CL and V1 was reduced from 45.1 to 37.6 and 26.% to 14.1%, respectively. CL, V1 and half‐life were similar for all BMI categories. The national recommended dosing schedule did not result in adequate trough levels, both in case of dosing based on BW and IBW. However, dosing based on IBW prevented unnecessary high FVIII peaks. Conclusion IBW is the most suitable morphometric variable to explain interindividual FVIII PK variability and is more appropriate to dose overweight and obese patients.
Collapse
Affiliation(s)
- Iris van Moort
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, The Netherlands
| | - Tim Preijers
- Department of Clinical Pharmacology - Hospital Pharmacy, Amsterdam University Medical Centers, The Netherlands
| | - Hendrika C A M Hazendonk
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, The Netherlands
| | - Roger E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | | | - Laurens Nieuwenhuizen
- Department of Thrombosis and Hemostasis, Maxima Medical Center, Veldhoven, The Netherlands
| | - Felix J M van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron A A Mathôt
- Department of Clinical Pharmacology - Hospital Pharmacy, Amsterdam University Medical Centers, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, The Netherlands
| | | |
Collapse
|
8
|
Pouplard C, Sattler L, Ryman A, Eschwege V, De Maistre E, Flaujac C, Szymezak J, Grand F, Repesse Y, Galinat H, Donnard M, Ternisien C, Iorio A, Chelle P, Jeanpierre E. Multicentre pharmacokinetic evaluation of rFVIII‐Fc (efmoroctocog alfa) in a real life and comparison with non‐extended half‐life FVIII concentrates. Haemophilia 2020; 26:282-289. [DOI: 10.1111/hae.13946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/06/2020] [Accepted: 02/06/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Claire Pouplard
- EA7501 GICC Université de Tours Tours France
- Service d'Hématologie‐Hémostase CHU de Tours Tours France
| | - Laurent Sattler
- Laboraoire d'Hématologie CHU de Strasbourg Strasbourg France
| | - Anne Ryman
- Service d'Hématologie Biologique CHU de Bordeaux Bordeaux France
| | | | | | - Claire Flaujac
- Laboratoire d'Hématologie Centre Hospitalier de Versailles Le Chesnay France
| | | | - François Grand
- Service d'Hématologie Biologique CHU Poitiers Poitiers France
| | | | | | | | - Catherine Ternisien
- laboratoire d'Hémostase Service d'Hématologie Biologique CHU de Nantes Nantes France
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
- Department of Medicine McMaster University Hamilton ON Canada
| | - Pierre Chelle
- School of Pharmacy University of Waterloo Waterloo ON Canada
| | | | | |
Collapse
|
9
|
Strategies for Individualized Dosing of Clotting Factor Concentrates and Desmopressin in Hemophilia A and B. Ther Drug Monit 2019; 41:192-212. [DOI: 10.1097/ftd.0000000000000625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
10
|
Wilding J, Zourikian N, Di Minno M, Khair K, Marquardt N, Benson G, Ozelo M, Hermans C. Obesity in the global haemophilia population: prevalence, implications and expert opinions for weight management. Obes Rev 2018; 19:1569-1584. [PMID: 30188610 DOI: 10.1111/obr.12746] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/24/2018] [Indexed: 12/18/2022]
Abstract
Overweight and obesity may carry a significant disease burden for patients with haemophilia (PWH), who experience reduced mobility due to joint inflammation, muscle dysfunction and haemophilic arthropathy. This review aimed to define the prevalence and clinical impact of overweight/obesity in the global population of PWH. A detailed literature search pertaining to overweight/obesity in haemophilia in the last 15 years (2003-2018) was conducted, followed by a meta-analysis of epidemiological data. The estimated pooled prevalence of overweight/obesity in European and North American PWH was 31%. Excess weight in PWH is associated with a decreased range in motion of joints, accelerated loss of joint mobility and increase in chronic pain. Additionally, the cumulative disease burden of obesity and haemophilia may impact the requirement for joint surgery, occurrence of perioperative complications and the prevalence of anxiety and depression that associates with chronic illness. Best practice guidelines for obesity prevention and weight management, based on multidisciplinary expert perspectives, are considered for adult and paediatric PWH. Recommendations in the haemophilia context emphasize the importance of patient education and tailoring engagement in physical activity to avoid the risk of traumatic bleeding.
Collapse
Affiliation(s)
- J Wilding
- Obesity and Endocrinology Research Group, Institute of Ageing and Chronic Disease, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - N Zourikian
- Pediatric/Adult Comprehensive Hemostasis Center, CHU Sainte-Justine/Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - M Di Minno
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - K Khair
- Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children, London, UK
| | - N Marquardt
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - G Benson
- Northern Ireland Haemophilia Comprehensive Care Centre and Thrombosis Unit, Belfast City Hospital, Belfast, UK
| | - M Ozelo
- International Haemophilia Training Centre (IHTC) 'Claudio L.P. Correa', INCT do Sangue Hemocentro UNICAMP, University of Campinas, Campinas, Brazil
| | - C Hermans
- Division of Haematology, Haemostasis and Thrombosis Unit, Haemophilia Clinic, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
11
|
Dubé E, Bonnefoy A, Merlen C, Castilloux JF, Cloutier S, Demers C, Sabapathy CA, St-Louis J, Vezina C, Warner M, Rivard GÉ. A prospective surveillance study of inhibitor development in haemophilia A patients following a population switch to a third-generation B-domain-deleted recombinant factor VIII. Haemophilia 2018; 24:236-244. [DOI: 10.1111/hae.13410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 01/04/2023]
Affiliation(s)
- E. Dubé
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| | - A. Bonnefoy
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| | - C. Merlen
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| | - J.-F. Castilloux
- Centre Hospitalier Universitaire de Sherbrooke; Université Sherbrooke; Sherbrooke QC Canada
| | - S. Cloutier
- Centre Hospitalier Universitaire de Québec; Hôpital de l'Enfant Jésus; Québec QC Canada
| | - C. Demers
- Centre Hospitalier Universitaire de Québec; Hôpital de l'Enfant Jésus; Québec QC Canada
| | - C. A. Sabapathy
- McGill University Health Center; Montreal Children's Hospital; Montréal QC Canada
| | - J. St-Louis
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
- Hôpital Maisonneuve-Rosemont; Montréal QC Canada
| | - C. Vezina
- McGill University Health Center; Montreal Children's Hospital; Montréal QC Canada
| | - M. Warner
- McGill University Health Center; Montreal Children's Hospital; Montréal QC Canada
| | - G.-É. Rivard
- Centre Hospitalier Universitaire Sainte-Justine; Montréal QC Canada
| |
Collapse
|
12
|
Kahan S, Cuker A, Kushner RF, Maahs J, Recht M, Wadden T, Willis T, Majumdar S, Ungar D, Cooper D. Prevalence and impact of obesity in people with haemophilia: Review of literature and expert discussion around implementing weight management guidelines. Haemophilia 2017. [DOI: 10.1111/hae.13291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S. Kahan
- Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - A. Cuker
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - R. F. Kushner
- Feinberg School of Medicine; Northwestern University; Chicago IL USA
| | - J. Maahs
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - M. Recht
- Oregon Health & Science University; Portland OR USA
| | - T. Wadden
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - T. Willis
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - S. Majumdar
- Division of Hematology; Children's National Medical Center; Washington DC USA
| | - D. Ungar
- Clinical, Medical, and Regulatory Affairs; Novo Nordisk Inc.; Plainsboro NJ USA
| | - D. Cooper
- Clinical, Medical, and Regulatory Affairs; Novo Nordisk Inc.; Plainsboro NJ USA
| |
Collapse
|
13
|
Witkop ML, Peerlinck K, Luxon BA. Medical co-morbidities of patients with haemophilia: pain, obesity and hepatitis C. Haemophilia 2017; 22 Suppl 5:47-53. [PMID: 27405676 DOI: 10.1111/hae.12996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
Clinical care of patients with haemophilia (PWH) has progressed rapidly over the past decade. Current therapy has allowed patients with haemophilia to live longer and many patients are now experiencing the co-morbidities of the general population. In this review article, we focus on three common diseases states that affect PWH: chronic pain, obesity and hepatitis C. Pain has been a co-morbidity for many years and PWH often have unusual needs for chronic pain relief compared to the general population. Obesity is not only increasing in the general population but also in patients with hereditary bleeding disorders. The co-morbidity of obesity not only causes increased pain progression and joint damage but also affects the dosing of factor concentrates. Finally, hepatitis C is known to have infected the majority of patients who received non-virally inactivated pooled factor concentrates in the past. New treatment regimens have been developed that allow the nearly uniform cure of chronic hepatitis C with a short course of oral medications.
Collapse
Affiliation(s)
- M L Witkop
- Northern Regional Bleeding Disorders Center, Munson Medical Center, Traverse City, MI, USA
| | - K Peerlinck
- Department of Vascular Medicine and Haemostasis, Haemophilia Centre University Hospitals, Leuven, Belgium
| | - B A Luxon
- Department of Medicine, Georgetown University, Washington, DC, USA
| |
Collapse
|