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The inhibitors - a challenge for the management of patients with hereditary haemophilia A. ACTA ACUST UNITED AC 2018; 56:143-152. [PMID: 29791318 DOI: 10.2478/rjim-2018-0013] [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: 03/03/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Our research strategy was aimed at evaluating the possible implication of the type of factor VIII product administered as substitution treatment to haemophilia A patients in the occurrence of inhibitors and their consequences on the management. METHODS Scientific articles from July 2015 to July 2017 were searched using the PubMed and PubMed Central databases. The used search terms included "haemophilia A", "inhibitors", "plasma-derived factor VIII" and "recombinant factor VIII". RESULTS The risk factors for inhibitors occurrence may be patients-related (genetic and nongenetic) and treatment-related. The possibility of a correlation between the increased purity of factor VIII given as substitution treatment and the occurrence of inhibitors is discussed in the light of literature data. Plasma-derived factor VIII is less immunogenic, but not entirely safe from the point of view of the possibility of transmitting biological agents. It is obvious that there is not enough plasma-derived factor VIII for the planet's needs. Recombinant factor VIII products have revolutionized the treatment of patients with haemophilia A over the past 3 decades by the disappearance of transfusion-related infections and their complications. They are safer in terms of pathogens and the new long-acting factor VIII products are based on recombinant DNA technology. CONCLUSION Plasma-derived or recombinant factor VIII products must co-exist on the market for the benefit of haemophilic patients. Future solutions could be: less immunogenic factor VIII products, nonfactor replacement strategies, or bispecific antibody that mimics the function of coagulation factor VIII.
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Kim SK, Yoo KY, Lee KS, Hwang T, Choi YM, Choi EJ, Park SK. Safety and Efficacy of B-domain Deleted Third Generation Recombinant Factor VIII (GreenGene F™) in Korean Patients with Hemophilia A: Data from a Post-marketing Surveillance Study. J Korean Med Sci 2018; 33:e5. [PMID: 29215814 PMCID: PMC5729640 DOI: 10.3346/jkms.2018.33.e5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/24/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND New B-domain deleted third generation recombinant factor VIII (FVIII; GreenGene F™, beroctocog alfa) was launched in 2010. We determined safety and efficacy of GreenGene F™ during routine clinical practice in patients with hemophilia A over a period of 12 months. METHODS From July 2010 to July 2014, a total of 136 hemophilia A patients were enrolled in a post-marketing surveillance (PMS) study. Among them, 134 patients were assessed for drug safety and 114 patients were analyzed for drug efficacy. Patients with differing hemophilia A severities and medical histories were monitored during 12 months of prophylactic and/or on-demand therapy. RESULTS Among 134 patients evaluated, 85 (63.4%) had severe hemophilia. Ninety-two received a total of 1,266,077 units for prophylaxis, and 42 received 516,491 units for bleeding episodes. Three patients developed inhibitors. In 112 previously treated patients, one patient (0.9%) developed inhibitor after intensive FVIII treatment for surgery. Among 22 previously untreated patients, inhibitors were observed in 2 infants (9.1%). Overall, there were a total of 47 adverse events (other than inhibitors) of all types in 30 patients (22.4%), 11 in 10 patients (7.5%) of which were considered showing serious adverse events (SAEs); most of which were hemorrhages at different sites. None of the SAEs were judged as product related. An excellent/good efficacy rate of 91.3% for hemostasis and 89.4% for hemorrhage prevention was recorded. CONCLUSION The results of this PMS study support the use of GreenGene F™ as safe and efficacious in hemorrhage prevention and treatment of hemophilia A. These results are consistent with the findings from previously published GreenGene F™ studies.
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Affiliation(s)
- Soon Ki Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | | | - Kun Soo Lee
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
| | | | | | - Eun Jin Choi
- Department of Pediatrics, Daegu Catholic University Hospital, Daegu, Korea
| | - Sang Kyu Park
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, Korea.
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Calvez T, Chambost H, d'Oiron R, Dalibard V, Demiguel V, Doncarli A, Gruel Y, Huguenin Y, Lutz P, Rothschild C, Vinciguerra C, Goudemand J. Analyses of the FranceCoag cohort support differences in immunogenicity among one plasma-derived and two recombinant factor VIII brands in boys with severe hemophilia A. Haematologica 2017; 103:179-189. [PMID: 29025913 PMCID: PMC5777205 DOI: 10.3324/haematol.2017.174706] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/05/2017] [Indexed: 12/18/2022] Open
Abstract
Around one third of boys with severe hemophilia A develop inhibitors (neutralizing antibodies) against their therapeutic factor VIII product. This adverse effect may result in more life-threatening bleeding, disability, impaired quality of life, and costly care. We compared the incidence of inhibitors in boys treated with the three factor VIII products most used in France: one plasma-derived (Factane) and two recombinant products (Advate and Kogenate Bayer). A previously untreated cohort of patients was created in 1994 to investigate risk factors for inhibitor development. We selected boys with severe hemophilia A (factor VIII <1 IU/dL) first treated with one of the three factor VIII products studied. Details of product infusions, inhibitor assays and main fixed and time-varying inhibitor risk factors were recorded for the first 75 exposure days. Three outcomes (all inhibitors, high-titer inhibitors and subsequently treated inhibitors) were analyzed by univariate and multivariate Cox models. We studied 395 boys first treated between 2001 and 2016 (131, 137, and 127 with Factane, Advate, and Kogenate Bayer, respectively). Clinically significant inhibitors were diagnosed in 121 patients (70 high-titer). The incidence of high-titer inhibitors was significantly associated with the factor VIII product received (P=0.005): the cumulative incidence at 75 exposure days was 12.7% (95% CI: 7.7-20.6) with Factane, 20.4% (95% CI: 14.0-29.1) with Advate, and 31.6% (95% CI: 23.5-41.7) with Kogenate Bayer. The low inhibitor incidence observed with Factane is concordant with recent findings from the SIPPET randomized trial. These consistent results from observational and experimental studies should lead to improved care for previously untreated patients and cost savings for healthcare systems worldwide.
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Affiliation(s)
- Thierry Calvez
- Sorbonne Universités, UPMC Paris 06, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), France
| | - Hervé Chambost
- Service d'Hématologie Oncologie Pédiatrique, La Timone, APHM, Marseille, France.,Aix Marseille University, INSERM, INRA, NORT, Marseille, France
| | - Roseline d'Oiron
- Centre Régional de Traitement de l'Hémophilie, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, APHP, Le Kremlin Bicêtre, France
| | - Vincent Dalibard
- Département d'Hématologie et de Transfusion, Centre Hospitalier Universitaire de Lille, Université Lille 2, EA 2693, Faculté de Médecine, France
| | - Virginie Demiguel
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Alexandra Doncarli
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Yves Gruel
- Centre Régional de Traitement de l'Hémophilie, Laboratoire d'Hématologie, UMR CNRS 7292, Université François Rabelais, Tours, France
| | - Yoann Huguenin
- Service d'Hématologie, Hôpital Pellegrin Tripode, Bordeaux, France
| | - Patrice Lutz
- Unité Pédiatrique d'Hématologie Oncologie, Hôpital Hautepierre, Strasbourg, France
| | - Chantal Rothschild
- Centre Régional de Traitement de l'Hémophilie, Hôpital Necker, APHP, Paris, France
| | - Christine Vinciguerra
- Service d'Hématologie Biologique, Hospices Civils de Lyon, EA 4609, Université de Lyon, France
| | - Jenny Goudemand
- Département d'Hématologie et de Transfusion, Centre Hospitalier Universitaire de Lille, Université Lille 2, EA 2693, Faculté de Médecine, France.,Institut Pasteur de Lille, EGID, Inserm UMR 1011, Université Lille 2, France
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Afonja O, Kozak R, Petraro P, Michaels LA, Mathew P, Lemm G, Kessler C. Baby hamster kidney cell-derived recombinant factor VIII: a quarter century of learning and clinical experience. Expert Rev Hematol 2016; 9:1151-1164. [PMID: 27841041 DOI: 10.1080/17474086.2017.1259559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Management and care of individuals with hemophilia A advanced immensely with the introduction of recombinant factor VIII (rFVIII) replacement products. This review provides a historical overview of rFVIII development with a focus on Bayer's rFVIII (with albumin) and sucrose-formulated rFVIII (rFVIII-FS), the only rFVIII products cloned in baby hamster kidney (BHK) cells with >25 years of proven safety and efficacy. Areas covered: We review the advances in rFVIII technology and the efficacy and safety data for BHK-derived rFVIII/rFVIII-FS from clinical trials, investigator-initiated studies, and observational studies. Innovative products with new treatment potentials (eg, BAY 81-8973 and BAY 94-9027) built on this established safety and efficacy profile are also briefly discussed. The literature search strategy included targeted searches (PubMed) with manual article selection and other product-specific searches. Expert commentary: Development of rFVIII products and related improvements in viral safety and manufacturing efficiency have guaranteed an adequate supply of factor products worldwide and increased prophylaxis use. The net effects have been joint health preservation, reduction in morbidity and mortality, and quality-of-life enhancements. Current treatment challenges include lack of adherence to prophylaxis and inhibitor development; extended-half-life rFVIII products and non-FVIII replacement therapies in development may help overcome these challenges.
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Affiliation(s)
| | | | | | | | - Prasad Mathew
- a Bayer , Whippany , NJ , USA.,c Department of Pediatric Hematology/Oncology , University of New Mexico , Albuquerque , NM , USA
| | | | - Craig Kessler
- e Department of Medicine and Pathology , Georgetown University Medical Center , Washington , DC , USA
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