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Meijon-Ortigueira MDM, Alvarez-Roman MT, De La Corte H, Butta N, Jimenez-Yuste V. Predicting joint involvement through tailored prophylaxis in severe haemophilia A, is it possible? Haemophilia 2024; 30:678-684. [PMID: 38575526 DOI: 10.1111/hae.15014] [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: 02/05/2024] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Tailored prophylaxis is the current treatment regimen for patients with severe haemophilia A. Recently, published guidelines describe two possible approaches, based on clinical characteristics or estimation of pharmacokinetic parameters. However, both have strengths and weaknesses, and their characteristics need to be integrated to optimize treatment appropriately. In this paper, we present a model that considers together the characteristics of prophylaxis and the relevance of each. METHODS The age at initiation of prophylaxis, number of bleeding events, treatment regimen, therapeutic adherence, FVIII trough levels, and joint status were analyzed in 59 patients followed at La Paz University Hospital between January 2000 and December 2019. RESULTS The mean duration of primary prophylaxis of 113.37 ± 57.79 months. Eighty-three percent (n = 49) had no joint status involvement at the end of follow-up (HJHS and HEAD-US = 0). The median ABR was 0.7 (IQR 0.2 -1.0) and 54.2% presented trough levels of FVIII during follow-up >1 IU/dL. 72,9% engaged in some type of physical activity and overall adherence was over 85% in all patients evaluated. The regression analysis performed, considering all these factors, showed that the initiation of prophylaxis before 21 months of age was the most relevant protective factor against the appearance of joint involvement (OR 88.33 p.031 CI 95% 1.49-5224.40) CONCLUSION: Early initiation of prophylaxis was the most relevant factor in the protection of joint status. More comprehensive analysis models adapted to the characteristics of each population, are needed to adequately individualize treatment.
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Affiliation(s)
| | | | - Hortensia De La Corte
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Nora Butta
- Department of Hematology, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Victor Jimenez-Yuste
- Department of Hematology, La Paz University Hospital-IdiPAZ, Autonomous University of Madrid, Madrid, Spain
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van Bergen EDP, van Leeuwen FHP, Foppen W, Timmer MA, Schutgens REG, Mastbergen SC, Lafeber FPJG, de Jong PA, Fischer K, van Vulpen LFD. Subclinical synovial proliferation in patients with severe haemophilia A: The value of ultrasound screening and biochemical markers. Haemophilia 2023; 29:1580-1588. [PMID: 37694775 DOI: 10.1111/hae.14861] [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: 06/14/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
AIM Subclinical bleeding and inflammation play a role in progression of haemophilic arthropathy. Synovial proliferation is predictive of joint bleeding and its early detection may guide treatment changes and prevent arthropathy progression. This study evaluated the prevalence of active and inactive subclinical synovial proliferation and investigated potential biochemical blood/urine markers to identify patients with active subclinical synovial proliferation. METHODS This cross-sectional study included patients with severe haemophilia A born 1970-2006 who were evaluated during routine clinic visits. Patients with (a history of) inhibitors or recent joint bleeding were excluded. Elbows, knees and ankles were examined for subclinical synovial proliferation by ultrasound and physical examination. Active synovial proliferation was distinguished from inactive synovial proliferation using predefined criteria. Blood/urine biochemical markers (serum osteopontin, sVCAM-1, Coll2-1, COMP, CS846, TIMP, and urinary CTX-II) were compared individually and as combined indexes between patients with and without active synovial proliferation. RESULTS This cohort consisted of 79 patients with a median age of 31 years (range 16.5-50.8 years) with 62/79 (78%) of the patients using continuous prophylaxis. The annualized joint bleeding rate over the last 5 years was .6 (.2-1.1). Active (17/79, 22%) and inactive subclinical synovial proliferation (17/79, 22%) were both prevalent in this cohort. Biochemical markers were not correlated with active subclinical synovial proliferation. CONCLUSION Subclinical synovial proliferation, both active and inactive, was prevalent in patients with severe haemophilia A with access to prophylaxis and would be overlooked without routinely performed ultrasounds. Biochemical markers were unable to identify patients with active subclinical synovial proliferation.
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Affiliation(s)
- Eline D P van Bergen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Flora H P van Leeuwen
- Department of Radiology & Nuclear Imaging, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology & Nuclear Imaging, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Merel A Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Roger E G Schutgens
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology & Nuclear Imaging, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Lize F D van Vulpen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Donners AAMT, van der Zwet K, Rademaker CMA, Egberts TCG, Schutgens REG, Fischer K. The efficacy of the entire-vial dosing of emicizumab: Real-world evidence on plasma concentrations, bleeds, and drug waste. Res Pract Thromb Haemost 2023; 7:100074. [PMID: 36915864 PMCID: PMC10005899 DOI: 10.1016/j.rpth.2023.100074] [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: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
Background Prophylaxis with emicizumab provides effective bleeding protection in persons with hemophilia A (PwHA) but pressures healthcare budgets. The body weight-adjusted dosing at 7-, 14-, or 28-day intervals, according to the label, often mismatches the vial content. Entire-vial dosing resulted in therapeutic concentrations according to pharmacokinetic simulations and was introduced to avoid waste. Objectives The objective of this study was to evaluate the efficacy of entire-vial dosing of emicizumab by investigating real-world evidence of plasma concentrations, bleeds, and drug waste. Methods This is a single-center, observational study with PwHA receiving emicizumab in mg/kg doses according to label but dosing interval extrapolated to the nearest vial size. Patient characteristics and bleeds were compared 1 year before starting emicizumab and during emicizumab until January 2022. Concentrations were assessed at weeks 4, 12, and annually. The mean (95% CI) annualized bleed rates were compared by using negative binomial regression. Drug waste between label-based dosing and entire-vial dosing was compared. Results A total of 112 individuals (94% severe phenotype and 9% positive FVIII inhibitors) were followed for a median of 56 weeks (interquartile range [IQR] 52-68) before and 51 weeks (IQR 29-75) after starting emicizumab. The median emicizumab dose was 5.9 (IQR 5.5-6.2) mg/kg/4 wk with median concentrations of 63 (IQR 51-80) μg/mL. The annualized bleed rate of treated bleeds before emicizumab was 3.6 (95% CI 2.9-4.4) and was 0.8 (95% CI 0.6-1.1) during emicizumab (P < .001). Drug waste was reduced by 9%. Conclusion The entire-vial dosing of emicizumab is an attractive treatment option for PwHA leading to therapeutic plasma concentrations, good bleeding control, and drug waste avoidance.
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Affiliation(s)
- Anouk A M T Donners
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Konrad van der Zwet
- Van Creveldkliniek, Center for Benign Haematology, Thrombosis and Haemostasis, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carin M A Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Roger E G Schutgens
- Van Creveldkliniek, Center for Benign Haematology, Thrombosis and Haemostasis, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, Center for Benign Haematology, Thrombosis and Haemostasis, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Meijón Ortigueira MDM, Álvarez-Román MT, De La Corte Rodríguez H, Butta Coll N, Jiménez-Yuste V. Long-term impact of primary prophylaxis on joint status in patients with severe hemophilia A. Res Pract Thromb Haemost 2023; 7:100005. [PMID: 36891521 PMCID: PMC9986103 DOI: 10.1016/j.rpth.2022.100005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/14/2022] [Accepted: 10/23/2022] [Indexed: 01/13/2023] Open
Abstract
Background Primary prophylaxis with factor VIII concentrates is the therapeutic gold standard for severe hemophilia A. Although this approach will change substantially with the use of nonsubstitutive therapies, the long-term effects of primary prophylaxis remain unclear. We present information on joint health with tailored primary prophylaxis in a consecutive series at a single center. Methods We retrospectively analyzed 60 patients who did not develop early inhibitors. The annual bleeding rate and annual joint bleeding rate, prophylaxis characteristics, physical activity, adherence, and development of inhibitors were compared between those with and without joint involvement at the end of follow-up. Joint involvement was defined as a Hemophilia Joint Health Score or Hemophilia Early Arthropathy Detection with an ultrasound score ≥1. Results Among 60 patients with median follow-up of 113 ± 6 months after starting prophylaxis, 76.7% had no joint involvement at the end of the follow-up. Those without joint involvement started prophylaxis at a younger median age (1 [IQR 1-1] year vs 3 [IQR 2-4.3] years). They also had lower annual joint bleeding rate (0.0 [IQR 0-0.2] vs 0.2 [IQR 0.1-0.5]), were more often physically active (70% vs 50%), and had lower trough factor VIII levels. Adherence to treatment was not significantly different between groups. Conclusion Initiation of primary prophylaxis at a younger age was the main factor associated with long-term preservation of joint status in patients with severe hemophilia A.
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Affiliation(s)
| | | | | | - Nora Butta Coll
- Department of Hematology, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Víctor Jiménez-Yuste
- Department of Hematology, La Paz University Hospital-IdiPAZ, Autonoma University, Madrid, Spain
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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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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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Hoefnagels JW, Schrijvers LH, Fischer K. Adherence to prophylaxis and bleeding in children: Significant drop during puberty but no correlation with bleeding. Haemophilia 2020; 26:e240-e243. [PMID: 32478933 DOI: 10.1111/hae.14051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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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: 7] [Impact Index Per Article: 1.8] [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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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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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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12
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Na JH, Yoo KY, Kim JY, Park SK, Kim SK, Choi EJ. Educational Interventions to Enhance Adherence to Prophylactic Treatment in Korean Hemophilia Patients. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.1.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Ji Hyun Na
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | | | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sang Kyu Park
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Ki Kim
- Department of Pediatrics,Inha University College of Medicine, Incheon, Korea
| | - Eun Jin Choi
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
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13
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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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14
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Schrijvers LH, Beijlevelt-van der Zande M, Peters M, Lock J, Cnossen MH, Schuurmans MJ, Fischer K. Adherence to prophylaxis and bleeding outcome in haemophilia: a multicentre study. Br J Haematol 2016; 174:454-60. [PMID: 27098446 DOI: 10.1111/bjh.14072] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/29/2016] [Indexed: 12/20/2022]
Abstract
Prevention of bleeding and joint damage in severe haemophilia is dependent on adherence to prophylactic replacement therapy. The aim of this study was to assess adherence to prophylaxis, including associations with age, bleeding and clotting factor consumption (CFC). In three Dutch haemophilia centres, semi-structured interviews about adherence to prophylaxis in the previous 2 weeks were conducted with patients or parents of a child with haemophilia. Patients were classified, according to pre-specified definitions, as adherent, sub-optimally adherent or non-adherent based on missing, timing, and dose of infusions. Association of annual bleeding rates, mean CFC, person performing the infusion (parents verus patients) with adherence categories were analysed. Overall, 241 patients with haemophilia using prophylaxis were studied. Parents were more adherent (66%; n = 48/73) than patients (43%; n = 72/168). Sub-optimal adherence occurred in 29% of parents and 37% of patients and was characterized by changes in timing of infusion (mostly from morning to evening), while missing <6% of infusions. Non-adherence occurred less often: in 5% of parents and 20% of patients. Reduced adherence was associated with lower CFC, but not with joint bleeding. In conclusion, non-adherence in haemophilia was relatively rare, yet 1/3 of patients struggled to administer prophylaxis at the appropriate time of day.
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Affiliation(s)
| | | | - Marjolein Peters
- Haemophilia Treatment Centre, Emma Children's' Hospital- Academical Medical Centre, Amsterdam, the Netherlands
| | - Janske Lock
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marieke J Schuurmans
- Nursing Science, Faculty of Health Care, University of Applied Science, Utrecht, the Netherlands.,Nursing Science, University Medical Centre, Utrecht, the Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Centre, Utrecht, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
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