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Schmidt DE, Truedsson Å, Strålfors A, Hojbjerg JA, Soutari N, Holmström M, Ranta S, Letelier A, Bowyer A, Ljung R, Antovic J, Bruzelius M. Clinical Implications of Discrepancy between One-Stage Clotting and Chromogenic Factor IX Activity in Hemophilia B. Thromb Haemost 2024; 124:32-39. [PMID: 37494968 DOI: 10.1055/a-2142-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Discrepancy in factor IX activity (FIX:C) between one-stage assay (OSA) and chromogenic substrate assay (CSA) in patients with hemophilia B (PwHB) introduces challenges for clinical management. AIM To study the differences in FIX:C using OSA and CSA in moderate and mild hemophilia B (HB), their impact on classification of severity, and correlation with genotype. METHODS Single-center study including 21 genotyped and clinically characterized PwHB. FIX:C by OSA was measured using ActinFSL (Siemens) and CSA by Biophen (Hyphen). In addition, in vitro experiments with wild-type FIX were performed. Reproducibility of CSA was assessed between three European coagulation laboratories. RESULTS FIX:C by CSA was consistently lower than by OSA, with 10/17 PwHB having a more severe hemophilia type by CSA. OSA displayed a more accurate description of the clinical bleeding severity, compared with CSA. A twofold difference between OSA:CSA FIX:C was present in 12/17 PwHB; all patients had genetic missense variants in the FIX serine protease domain. Discrepancy was also observed with diluted normal plasma, most significant for values below 0.10 IU/mL. Assessment of samples with low FIX:C showed excellent reproducibility of the CSA results between the laboratories. CONCLUSION FIX:C was consistently higher by OSA compared with the CSA. Assessing FIX:C by CSA alone would have led to diagnosis of a more severe hemophilia type in a significant proportion of patients. Our study suggests using both OSA and CSA FIX:C together with genotyping to classify HB severity and provide essential information for clinical management.
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Affiliation(s)
- David E Schmidt
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Coagulation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Truedsson
- Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Annelie Strålfors
- Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johanne Andersen Hojbjerg
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nida Soutari
- Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Holmström
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Susanna Ranta
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Coagulation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Letelier
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Annette Bowyer
- Department of Coagulation, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Rolf Ljung
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jovan Antovic
- Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Maria Bruzelius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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Bowyer AE, Gosselin RC. Factor VIII and Factor IX Activity Measurements for Hemophilia Diagnosis and Related Treatments. Semin Thromb Hemost 2023; 49:609-620. [PMID: 36473488 PMCID: PMC10421651 DOI: 10.1055/s-0042-1758870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accurate measurement of clotting factors VIII (FVIII) or IX (FIX) is vital for comprehensive diagnosis and management of patients with hemophilia A or B. The one-stage activated partial thromboplastin time (aPTT)-based clotting assay is the most commonly used method worldwide for testing FVIII or FIX activities. Alternatively, FVIII and FIX chromogenic substrate assays, which assess the activation of factor X, are available in some specialized laboratories. The choice of reagent or methodology can strongly influence the resulting activity. Variation between one-stage FVIII or FIX activities has been reported in the measurement of some standard and extended half-life factor replacement therapies and gene therapy for hemophilia B using different aPTT reagents. Discrepancy between one-stage and chromogenic reagents has been demonstrated in some patients with mild hemophilia A or B, the measurement of some standard and extended half-life factor replacement therapies, and the transgene expression of hemophilia A and B patients who have received gene therapy. Finally, the measurement of bispecific antibody therapy in patients with hemophilia A has highlighted differences between chromogenic assays. It is imperative that hemostasis laboratories evaluate how suitable their routine assays are for the accurate measurement of the various hemophilia treatment therapies.
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Affiliation(s)
- Annette E. Bowyer
- Department of Coagulation, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Robert C. Gosselin
- Hemostasis and Thrombosis Center, University of California, Davis Health System, Sacramento, California
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Atsou S, Furlan F, Duchemin J, Ellouze S, Sourdeau É, Launois A, Roussel-Robert V, Stieltjes N, Combe S, Fontenay M, Curis E, Jourdi G. Pharmacodynamics of eftrenonacog-alfa (rFIX-Fc) in severe hemophilia B patients: A real-life study. Eur J Pharmacol 2020; 891:173764. [PMID: 33249076 DOI: 10.1016/j.ejphar.2020.173764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/26/2023]
Abstract
Eftrenonacog-alfa is a recombinant factor IX-Fc fusion protein increasingly prescribed in hemophilia B patients. We aimed to assess its pharmacodynamics (PD) in real-life setting via FIX activity measurement and thrombin generation assay (TGA). Sixty samples from 15 severe hemophilia B treated patients were collected at different time points. FIX activity was measured using product-specific one-stage clotting assay (reference method) and two chromogenic assays (CSA) (Biophen FIX and Rox FIX). TGA was triggered with 1 pM tissue factor. Five parameters were analyzed: lag time (LT), time to peak (TTP), peak height (PH), endogenous thrombin potential (ETP), and velocity. PD models were built to characterize their relationships with FIX activity, using mixed effects models. Mean trough FIX level was estimated at 4.64 (±1.50) IU/dl with a recovery at 0.78 (±0.16) IU/dl per 1 IU/kg injected dose. FIX activity ranged between 1 and 86 IU/dl with 21.5 IU/dl median value. Biophen FIX and Rox FIX allowed reliable measurements except in samples with FIX <20 IU/dl in which values were underestimated (delta >30%). PD models revealed that velocity was the most sensitive TGA parameter to FIX activity followed by PH, ETP, TTP and finally LT. Following FIX activity peak after eftrenonacog-alfa injection, velocity decreased first, followed by PH then ETP. Both CSA failed to accurately measure FIX in severe hemophilia B patients receiving eftrenonacog-alfa throughout the measuring range. TGA could be an additional valuable tool to evaluate hemostasis balance in treated patients.
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Affiliation(s)
- Senade Atsou
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Fiona Furlan
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Jérôme Duchemin
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Syrine Ellouze
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Élise Sourdeau
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Amélie Launois
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Valérie Roussel-Robert
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Natalie Stieltjes
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Sophie Combe
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Michaela Fontenay
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France; Université de Paris, Faculté de Santé, F-75006, Paris, France
| | - Emmanuel Curis
- Laboratoire de Biomathématiques, EA 7537, Faculté de Pharmacie, Université de Paris, France; Service de Biostatistiques et Informatique Médicale SBIM, Hôpital Saint Louis, AP-HP, Paris, France
| | - Georges Jourdi
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France; Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR-S1140, F-75006, Paris, France.
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Nederlof A, Kitchen S, Meijer P, Cnossen M, Ali Pour N, Kershaw G, Jennings I, Walker I, de Maat MPM. Performance of factor IX extended half-life product measurements in external quality control assessment programs. J Thromb Haemost 2020; 18:1874-1883. [PMID: 32311825 PMCID: PMC7496271 DOI: 10.1111/jth.14847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with hemophilia B are increasingly treated with extended half-life (EHL) factor IX (FIX) concentrates. For the laboratory, introduction of these EHL concentrates presents a major challenge. To understand the variation in FIX activity levels, all available diagnostic assays need to be directly compared. METHODS The ECAT, UKNEQAS, and RCPAQAP have collaboratively performed a global survey to evaluate the quality of FIX measurements using FIX deficient plasma samples spiked with recombinant FIX (rFIX), rFIXFP, rFIXFc, and N9-GP to levels at typical FIX trough (6 IU/dL) and peak levels (60 IU/dL). Participants were asked to use their routine protocols, using one-stage assays (OSA) or chromogenic assays (CA). RESULTS In samples spiked with 6 IU/dL product, median (25%-75% range) FIX activity levels (OSA), were 8.0 IU/dL (7.0-9.2) for rFIX, 6.0 IU/dL (4.0-7.1) for rFIXFP, 6.6 IU/dL (5.5-8.0) for rFIXFc, and 4.9 IU/dL (3.5-8.4) for N9-GP. In samples spiked with 60 IU/dL, FIX activity levels measured (using OSA) was 63.0 IU/dL (59.9-67.0) for rFIX, 42.5 IU/dL (28.2-47.0) for rFIXFP, 50.0 IU/dL (45.0-55.0) for rFIXFc, and 34.0 IU/dL (24.8-67.5) for N9-GP. Considerable differences were observed between reagents for all samples. With CA, there was also quite some variation, but no differences between reagents. CONCLUSION Large variation is observed in the measurement of FIX activity levels after administration of rFIX and EHL FIX products. For N9-GP, most silica-based assays show especially high levels. It is essential to standardize and improve reliability of measurements of these concentrates as diagnosis and treatment monitoring is based on these results.
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Affiliation(s)
- Angelique Nederlof
- Department of HaematologyErasmus University Medical Centre RotterdamRotterdamthe Netherlands
- Department of Paediatric HaematologyErasmus University Medical CentreSophia Children’s HospitalRotterdamthe Netherlands
| | | | | | - Marjon Cnossen
- Department of Paediatric HaematologyErasmus University Medical CentreSophia Children’s HospitalRotterdamthe Netherlands
| | | | - Geoffrey Kershaw
- Institute of HaematologyRoyal Prince Alfred HospitalSydneyAustralia
| | | | | | - Moniek P. M. de Maat
- Department of HaematologyErasmus University Medical Centre RotterdamRotterdamthe Netherlands
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5
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Sinegre T, Trayaud A, Tardieu M, Fourneyron V, Talon L, Berger MG, Tillier M, Senectaire S, Gembara P, Barbin AL, Vaissade A, Lebreton A. Measurements of eftrenonacog alfa by 19 different combinations reagents/instrument: A single-centre study. Haemophilia 2020; 26:543-552. [PMID: 32314511 DOI: 10.1111/hae.14003] [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: 01/31/2020] [Revised: 03/19/2020] [Accepted: 03/30/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Recombinant factor IX Fc fusion protein (rFIXFc) is an extended half-life concentrate for the treatment of haemophilia B (HB). rFIXFc activity monitoring is crucial in several clinical situations. However, differences were observed between one-stage clotting (OSC) and chromogenic assays, but not for all factor IX (FIX) concentrations. AIMS To compare rFIXFc measurements obtained using different instruments and common OSC and chromogenic asssays. METHODS FIX:C measurements were performed in rFIXFc-spiked plasma aliquots (targeted FIX levels of 1.5, 1, 0.5, 0.2, 0.05, 0.02 and 0.01 IU/mL) and plasma samples collected from two patients with HB at various time points after rFIXFc infusion, using three instruments (STA-R MAX, ACLTOP700 and CS2100i) and common clotting and chromogenic FIX:C assays. RESULTS The same reagent could give different FIX:C measurements when adapted to different instruments. Moreover, the same reagent/instrument combination could give different results depending of the FIX concentration. For OSC assays, only STA-Cephascreen on STA-R MAX and CS2100i, SynthAFax on ACLTOP 700 and Actin on CS2100i provided acceptable recoveries for all rFIXFc concentrations. The chromogenic assays ROX-FIX and Biophen FIX:C underestimated rFIXFc for concentrations lower than 0.05 and 0.2 IU/mL, respectively. CONCLUSIONS Our study demonstrates that the same reagent adapted to different instruments could lead to different rFIXFc values. As rFIXFc under/overestimation could be associated with inappropriate treatment or biased calculation of pharmacokinetic parameters, the reagent/instrument combination used by haemostasis laboratories should be considered and regularly evaluated by external quality assessment programmes.
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Affiliation(s)
- Thomas Sinegre
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,INRA UMR 1019, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Adeline Trayaud
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maryse Tardieu
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Virginie Fourneyron
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurie Talon
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc G Berger
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maxence Tillier
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Stéphanie Senectaire
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Piotr Gembara
- Centre de Ressources et Compétences des Maladies Hémorragiques Constitutionnelles, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne-Lise Barbin
- Centre de Ressources et Compétences des Maladies Hémorragiques Constitutionnelles, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Vaissade
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Lebreton
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,INRA UMR 1019, Université Clermont Auvergne, Clermont-Ferrand, France.,Centre de Ressources et Compétences des Maladies Hémorragiques Constitutionnelles, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Jeanpierre E, Pouplard C, Lasne D, Le Cam Duchez V, Eschwege V, Flaujac C, Galinat H, Harzallah I, Proulle V, Smahi M, Sobas F, Stepina N, Toulon P, Voisin S, Ternisien C, Nougier C. Factor VIII and IX assays for post-infusion monitoring in hemophilia patients: Guidelines from the French BIMHO group (GFHT). Eur J Haematol 2020; 105:103-115. [PMID: 32277501 DOI: 10.1111/ejh.13423] [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: 01/12/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/24/2023]
Abstract
Replacement therapy with plasma-derived or recombinant FVIII and FIX (pdFVIII/pdFIX or rFVIII/rFIX) concentrates is the standard of treatment in patients with haemophilia A and B, respectively. Measurement of factor VIII (FVIII:C) or factor IX (FIX:C) levels can be done by one-stage clotting assay (OSA) or chromogenic substrate assay (CSA). The French study group on the Biology of Hemorrhagic Diseases (a collaborative group of the GFHT and MHEMO network) presents a literature review and proposals for the monitoring of FVIII:C and FIX:C levels in treated haemophilia A and B patients, respectively. The use of CSA is recommended for the monitoring of patients treated with pdFVIII or rFVIII including extended half-life (EHL) rFVIII. Except for rFVIII-Fc, great caution is required when measuring FVIII:C levels by OSA in patients substituted by EHL-rFVIII. The OSA is recommended for the monitoring of patients treated with pdFIX or rFIX. Large discordances in the FIX:C levels measured for extended half-life rFIX (EHL-rFIX), depending on the method and reagents used, must lead to great attention when OSA is used for measuring FIX:C levels in patients substituted by EHL-rFIX. Data of most of recent studies, obtained with spiked plasmas, deserve to be confirmed in plasma samples of treated patients.
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Affiliation(s)
- Emmanuelle Jeanpierre
- CHU Lille, Institut d'Hématologie Transfusion, Institut Pasteur de Lille, UMR1011-EGID, Lille, 59000, France
| | - Claire Pouplard
- Service d'Hématologie Hémostase, Hôpital Trousseau, CHU de Tours, EA 7501, Université Francois Rabelais, Tours, France
| | - Dominique Lasne
- Laboratoire d'Hématologie Générale, Hôpital Necker AP-HP, Université Paris Sud Saclay, INSERM U1176, Paris, Le Kremlin-Bicêtre, France
| | | | | | - Claire Flaujac
- Laboratoire d'Hématologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Hubert Galinat
- Labortaoire d'Hématologie, Hôpital La Cavale Blanche, CHU de Brest, France
| | - Ines Harzallah
- Service d'Hématologie Hémostase, Groupe Hospitalier Régional de Mulhouse et Sud Alsace, France
| | - Valérie Proulle
- Service d'Hématologie Biologique, CHU Bicètre, AP-HP, Université Paris Sud Saclay, INSERM U1176, Le Kremlin-Bicêtre, France
| | - Motalib Smahi
- Service d'Hématologie Hémostase, Hôpital Simone Veil, Eaubonne, France
| | - Frédéric Sobas
- Service d'Hématologie Hémostase, Hospices Civils de Lyon, Bron, France
| | | | - Pierre Toulon
- Service d'Hématologie Biologique, Hôpital Pasteur, CHU Nice, France
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Sommer JM, Sadeghi-Khomami A, Barnowski C, Wikén M, Willemze AJ. Real-world assay variability between laboratories in monitoring of recombinant factor IX Fc fusion protein activity in plasma samples. Int J Lab Hematol 2020; 42:350-358. [PMID: 32202380 PMCID: PMC7318191 DOI: 10.1111/ijlh.13189] [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: 11/13/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023]
Abstract
Introduction Monitoring of factor IX (FIX) replacement therapy in haemophilia B relies on accurate coagulation assays. However, considerable interlaboratory variability has been reported for one‐stage clotting (OSC) assays. This study aimed to evaluate the real‐world, interlaboratory variability of routine FIX activity assays used in clinical haemostasis laboratories for the measurement of recombinant FIX Fc fusion protein (rFIXFc) activity. Methods Human FIX‐depleted plasma was spiked with rFIXFc at 0.80, 0.20 or 0.05 IU/mL based on label potency. Participating laboratories tested samples using their own routine OSC or chromogenic substrate (CS) assay protocols, reagents and FIX plasma standards. Laboratories could perform more than one measurement and method, and were not fully blinded to nominal activity values. Results A total of 142 laboratories contributed OSC results from 175 sample kits using 11 different activated partial thromboplastin time (aPTT) reagents. The median recovered FIX activity for the 0.80, 0.20 and 0.05 IU/mL samples was 0.72 IU/mL, 0.21 IU/mL and 0.060 IU/mL, respectively. Across all OSC reagents, interlaboratory variability (% CV) per aPTT reagent ranged from 9.4% to 32.1%, 8.2% to 32.6% and 12.2% to 42.0% at the 0.80, 0.20 and 0.05 IU/mL levels, respectively. CS results showed excellent median recoveries at all nominal levels (87.5% to 115.0%; n = 11) with low interlaboratory variability (CV 3.6% to 15.4%). Conclusion This large, real‐world data set indicates that rFIXFc activity in plasma samples can be accurately measured with the majority of routine OSC and CS assay methods. Given the variation in FIX assay procedures between sites, it is important that individual laboratories qualify their in‐house methods for monitoring of rFIXFc activity.
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8
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Williams SC, Gray E. Activity measurements of dalcinonacog alfa. Haemophilia 2020; 26:346-353. [PMID: 32142203 PMCID: PMC7891335 DOI: 10.1111/hae.13949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/03/2020] [Accepted: 02/10/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Many recombinant and modified FIX products have been, and continue to be, developed with the aim of improving treatment for patients with haemophilia B. One such new product is dalcinonacog alfa, a recombinant FIX with modifications to provide improved features such as subcutaneous administration. AIM In view of previously observed assay discrepancies with modified FIX therapeutics, the aim of this study was to assess potential discrepancies in potency measurement of dalcinonacog alfa between and within different assay methods. METHODS Potency of dalcinonacog alfa was measured against the 5th International Standard (IS) for FIX Concentrate and the 4th IS for FIX Plasma by One-Stage Clotting Assay, using 9 different APTT reagents and 2 commercially available FIX chromogenic kits. Plasma-derived concentrate and recombinant FIX samples were also included for comparison in every assay. RESULTS Substantial discrepancies were observed when assaying dalcinonacog alfa using the one-stage clotting assay against both standards. No statistically valid results were obtained when testing dalcinonacog alfa using either chromogenic kit. Increasing the incubation time with the activation reagent in both chromogenic kits resulted in valid assays and increased the potency to become more in line with potencies by one-stage clotting assays. Increasing the incubation time in the chromogenic kits had no effect on the potencies of the plasma-derived or recombinant samples. However, incubation time influenced in the one-stage clotting assay using Dapttin. CONCLUSIONS Within and between assay method discrepancy was found when assaying dalcinonacog alfa. Methods for potency labelling and clinical monitoring should be given careful consideration.
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Affiliation(s)
- Stella C Williams
- The National Institute for Biological Standards and Control, Potter Bar, UK
| | - Elaine Gray
- The National Institute for Biological Standards and Control, Potter Bar, UK
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Suzuki A, Suzuki N, Kanematsu T, Shinohara S, Arai N, Kikuchi R, Matsushita T. Performance evaluation of Revohem™FVIII chromogenic and Revohem™FIX chromogenic in the CS‐5100 autoanalyser. Int J Lab Hematol 2019; 41:664-670. [DOI: 10.1111/ijlh.13083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Atsuo Suzuki
- Department of Medical Technique Nagoya University Hospital Nagoya Japan
| | - Nobuaki Suzuki
- Department of Transfusion Medicine Nagoya University Hospital Nagoya Japan
| | - Takeshi Kanematsu
- Department of Laboratory Medicine Nagoya University Hospital Nagoya Japan
| | | | | | - Ryosuke Kikuchi
- Department of Medical Technique Nagoya University Hospital Nagoya Japan
| | - Tadashi Matsushita
- Department of Transfusion Medicine Nagoya University Hospital Nagoya Japan
- Department of Laboratory Medicine Nagoya University Hospital Nagoya Japan
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10
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Genc S, Aydin AF, Karaca E, Ömer B. The comparison of CS-2500 and BCS XP coagulation analyzers for Factor VIII and Factor IX one-stage clotting assays. Int J Lab Hematol 2019; 41:e124-e127. [PMID: 31034727 DOI: 10.1111/ijlh.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sema Genc
- Istanbul Faculty of Medicine, Department of Biochemistry, Istanbul University, Istanbul, Turkey
| | - Abdurrahman Fatih Aydin
- Istanbul Faculty of Medicine, Department of Biochemistry, Istanbul University, Istanbul, Turkey
| | - Ece Karaca
- Istanbul Faculty of Medicine, Department of Biochemistry, Istanbul University, Istanbul, Turkey
| | - Beyhan Ömer
- Istanbul Faculty of Medicine, Department of Biochemistry, Istanbul University, Istanbul, Turkey
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Escuriola Ettingshausen C, Hegemann I, Simpson ML, Cuker A, Kulkarni R, Pruthi RK, Garly M, Meldgaard RM, Persson P, Klamroth R. Favorable pharmacokinetics in hemophilia B for nonacog beta pegol versus recombinant factor IX-Fc fusion protein: A randomized trial. Res Pract Thromb Haemost 2019; 3:268-276. [PMID: 31011711 PMCID: PMC6462750 DOI: 10.1002/rth2.12192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/09/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Nonacog beta pegol (N9-GP) and recombinant factor IX-Fc fusion protein (rFIXFc) are extended half-life rFIX compounds. We report the first single-dose pharmacokinetic trial of N9-GP and rFIXFc. PATIENTS/METHODS Paradigm 7 was a multicenter, open-label, randomized, crossover trial in previously treated (>150 exposure days) adults with congenital hemophilia B (FIX activity ≤2%). Patients received single intravenous injections (50 IU/kg) of N9-GP and rFIXFc with at least 21 days between doses. Plasma FIX activity, predose, and at serial time points up to 240 hours postdose, was measured using validated one-stage clotting assays (SynthAFax for N9-GP; Actin FSL for rFIXFc) and a chromogenic assay (ROX factor IX) with normal human plasma as calibrator. The primary endpoint was area under the FIX activity-time curve from 0 to infinity, dose-normalized to 50 IU/kg (AUC0-inf,norm). RESULTS Fifteen patients received study treatment. Based on FIX activity results from the one-stage clotting assays, estimated AUC0-inf,norm was significantly greater for N9-GP than rFIXFc (ratio: 4.39; P < 0.0001, based on a two-sided test on 5% significance level). In addition, N9-GP had a longer terminal half-life, two times higher incremental recovery at 30 minutes and maximum FIX activity (dose-normalized to 50 IU/kg) and six times higher FIX activity at 168 hours than rFIXFc. These findings were largely comparable with the chromogenic assay data and are consistent with published data for each compound. CONCLUSIONS In this comparison, N9-GP demonstrated favorable pharmacokinetic characteristics versus rFIXFc, helping clinicians to understand differences between N9-GP and rFIXFc. REGISTRATION This trial is registered with clinicaltrials.gov (NCT03075670) and the European Clinical Trials Database (EudraCT: 2016-001149-25).
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Affiliation(s)
| | - Inga Hegemann
- Division of HaematologyZürich University HospitalZürichSwitzerland
| | - Mindy L. Simpson
- Pediatric Hematology/OncologyRush University Medical CenterChicagoILUSA
| | - Adam Cuker
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Roshni Kulkarni
- Department of Pediatrics and Human DevelopmentMichigan State UniversityEast LansingMIUSA
| | | | | | | | | | - Robert Klamroth
- Department for Internal MedicineVascular Medicine and HaemostaseologyVivantes KlinikumBerlinGermany
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