1
|
Sun Z, Xi Y, Liu W, Yang L, Wang X, Jin C, Jia H, Zhang L. Efficacy and safety of the B-domain-deleted TQG202 for on-demand treatment in moderate and severe haemophilia A patients: A multicentre, single-arm trial. Haemophilia 2023. [PMID: 36913439 DOI: 10.1111/hae.14777] [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: 08/11/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION On-demand treatment is the most common treatment strategy for haemophilia A in China. AIM This study aims to evaluate the efficacy and safety of a human-derived B-domain-deleted recombinant factor VIII (TQG202) in the on-demand treatment of bleeding episodes in moderate/severe haemophilia A patients. METHODS This multicentre, single-arm clinical trial enrolled moderate/severe haemophilia patients previously treated with FVIII concentrates for ≥50 exposure days (EDs) from May 2017 to October 2019. TQG202 was injected intravenously on-demand for bleeding episode management. The primary endpoints were the infusion efficiency at 15 and 60 min after the first administration and haemostatic efficacy of the first bleeding episode. Safety was also monitored. RESULTS Fifty-six participants were enrolled with a median age of 24.5 (range: 12-64) years old. The median total dose of TQG202 was 29,250 IU per participant (range: 1750-2,02,500), and the median number of administrations was 24.5 (2-116). The median infusion efficiency at 15 and 60 min after the first administration was 155.4% and 145.2%, respectively. Among the 48 first bleeding episodes evaluated, 47 (83.9%, 95% CI: 71.7%-92.4%) had a haemostatic efficacy rating of excellent or good. Eleven (19.6%) participants had treatment-related adverse events (TRAEs), but no ≥grade 3 TRAE was observed. Inhibitor development (0.6BU) was observed in one participant (1.8%) after 22 EDs, but was undetectable after 43 EDs. CONCLUSION TQG202 for on-demand treatment in moderate/severe haemophilia A shows effective control of the bleeding symptoms, with a low incidence of adverse events and inhibitors development.
Collapse
Affiliation(s)
- Zimin Sun
- Department of Hematology, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yaming Xi
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Linhua Yang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuefeng Wang
- Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, China
| | - Chenghao Jin
- Hemophilia Information Management Center of Jiangxi Province, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Haifei Jia
- R&D Institute, Chia Tai Tianqing Pharmaceutical Group Co. Ltd., Nanjing, Jiangsu, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| |
Collapse
|
2
|
Jamal M, Sathar J, Jamari J, Mohd Saffian S. A Comparison of the Incidence Rate for Joint Bleeding and FVIII Consumption between On-Demand versus Prophylaxis Factor VIII Replacement Therapy and the Direct Cost of Prophylaxis Treatment in Severe Haemophilia A Patients. Malays J Med Sci 2023; 30:129-136. [PMID: 36875203 PMCID: PMC9984116 DOI: 10.21315/mjms2023.30.1.11] [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: 09/03/2021] [Accepted: 06/11/2022] [Indexed: 03/05/2023] Open
Abstract
Background Haemophilia A is a bleeding disorder caused by inadequate clotting factor VIII (FVIII). There are two main modes of treatment approach in severe haemophilia A patients either with on-demand or prophylaxis therapy with clotting factor FVIII concentrates. In this study, a comparison was made between the bleeding incidence rate of the on-demand and prophylaxis group in severe haemophilia A patients at Ampang Hospital, Malaysia. Methods A retrospective study involving patients with severe haemophilia was conducted. The patient's self-reported bleeding frequency was retrieved from the patient's treatment folder from January to December 2019. Results Fourteen patients received on-demand therapy, while the other 24 patients received prophylaxis treatment. The total number of joint bleeds in the prophylaxis group was significantly lower compared to the on-demand group (2.79 bleeds versus 21.36 bleeds [P < 0.001]). Furthermore, the total annual usage of FVIII was higher in the prophylaxis group compared to the on-demand group (1,506 IU/kg/year [± 905.98] versus 365.26 IU/kg/year [± 223.90], P = 0.001). Conclusion Prophylaxis FVIII therapy is an effective treatment in reducing the frequency of bleeding joints. However, this treatment approach is associated with high cost due to the high consumption of FVIII.
Collapse
Affiliation(s)
- Munirah Jamal
- Centre for Medicines Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Pharmacy, Ampang Hospital, Selangor, Malaysia
| | - Jameela Sathar
- Department of Haematology, Ampang Hospital, Selangor, Malaysia
| | | | - Shamin Mohd Saffian
- Centre for Medicines Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
He X, Wang X, Dong C, Zhao M, Wu J. The long-term clinical benefits and economic costs associated with increased use of prophylaxis among patients with haemophilia A in China: Population-based predictions from 2018 to 2033. Haemophilia 2022; 28:726-736. [PMID: 35714660 DOI: 10.1111/hae.14603] [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: 01/25/2022] [Revised: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
AIM To predict the long-term benefits and economic costs of the improvements in haemophilia care in China demonstrated by increasing use of prophylaxis, compared with the current status. METHODS City-level predictions from 2018 to 2033 were conducted for five representative cities in China. The long-term clinical and economic outcomes in the scenario where haemophilia care has significantly improved and the existing scenario of haemophilia care were calculated and compared. The model input data were obtained from local records, expert interviews, published literature, and other sources. Outcome measures including number of bleeds and joint bleeds, number of target joints, disability rate, direct and indirect costs were calculated at the patient and population levels. RESULTS The long-term predictions for 2033 demonstrated significantly improved bleed control and joint outcomes due to increased use of prophylaxis. The total number of averted bleed events per patient ranged from 3.9 in Shenyang to 16.1 in Zhengzhou in 2033, and the population-level averted bleed events ranged from 1963 in Xiamen to 14,868 in Zhengzhou. The treatment improvement also leads to significant economic costs driven by increase in clotting factor costs (more than 90%). At the population level, the additional total costs were highest in Zhengzhou (CNY 177.4 million) and lowest in Shenyang (CNY 45.4 million), due to their different population sizes and various existing treatment regimens. The outpatient and hospitalization costs decreased, while the factor costs increased. CONCLUSION The long-term prophylaxis is associated with avoided bleed events and disabilities. The improved treatment regimens are also associated with a significant economic burden, driven by factor costs.
Collapse
Affiliation(s)
- Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xu Wang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Chaohui Dong
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Mingyue Zhao
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, China.,The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| |
Collapse
|
4
|
Olasupo OO, Lowe MS, Krishan A, Collins P, Iorio A, Matino D. Clotting factor concentrates for preventing bleeding and bleeding-related complications in previously treated individuals with haemophilia A or B. Cochrane Database Syst Rev 2021; 8:CD014201. [PMID: 34407214 PMCID: PMC8407508 DOI: 10.1002/14651858.cd014201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The hallmark of severe hemophilia (A or B) is recurrent bleeding into joints and soft tissues with progressive joint damage, despite on-demand treatment. Prophylaxis has long been used, but not universally adopted, because of medical, psychosocial, and cost controversies. OBJECTIVES To determine the effectiveness of clotting factor concentrate prophylaxis in managing previously-treated individuals with hemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. In addition, we searched MEDLINE and Embase and online trial registries. Most recent search of Group's Coagulopathies Trials Register: 24 February 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs evaluating people with hemophilia A or hemophilia B, who were previously treated with clotting factor concentrates to manage their hemophilia. DATA COLLECTION AND ANALYSIS Two authors independently reviewed trials for eligibility, assessed risk of bias and extracted data. The authors used the GRADE criteria to assess the certainty of the evidence. MAIN RESULTS Ten trials (including 608 participants) were eligible for inclusion. Eight of the trials (477 participants) had arms comparing two or more prophylactic regimens to one another and four of the trials (n = 258) compared prophylaxis to on-demand treatment (two trials had multiple arms and were included in both comparisons). Comparison of two or more prophylactic regimens For trials comparing one prophylaxis regimen to another, given the heterogeneity of the data, none of the data were pooled for this comparison. Considering the individual trials, three trials reported the primary outcome of joint bleeding, and none showed a dfference between dosing regimens (low-certainty evidence). For the secondary outcome of total bleeding events, prophylaxis with a twice-weekly regimen of FIX likely results in reduced total bleeds compared to a once-a-week regimen of the same dose, mean difference (MD) 11.2 (5.81 to 16.59) (one trial, 10 participants, low-certainty evidence). Transient low-titer anti-FVIII inhibitors were reported in one of the trials. Blood-transmitted infections were not identified. Other adverse events reported include hypersensitivity, oedema, and weight gain. These were, however, rare and unrelated to study drugs (very low-certainty evidence). Comparison of prophylactic and on-demand regimens Four of the trials (258 participants) had arms that compared prophylaxis to on-demand treatment. Prophylaxis may result in a large decrease in the number of joint bleeds compared to on-demand treatment, MD -30.34 (95% CI -46.95 to -13.73) (two trials, 164 participants, low-certainty evidence). One of these trials (84 participants) also reported the long-term effects of prophylaxis versus on-demand therapy showing improved joint function, quality of life, and pain; but no differences between groups in joint structure when assessed by magnetic resonance imaging (MRI). In one trial (84 participants) validated measures for joint health and pain assessment showed that prophylaxis likely improves joint health compared to an on-demand regimen with an estimated change difference of 0.94 points (95% CI 0.23 to 1.65) and improves total pain scores, MD -17.20 (95% CI -27.48 to -6.92 (moderate-certainty evidence). Two trials (131 participants) reported that prophylaxis likely results in a slight increase in adverse events, risk ratio 1.71 (1.24 to 2.37) (moderate-certainty evidence). No inhibitor development and blood-transmitted infections were identified. Overall, the certainty of the body of evidence was judged to be low because of different types of bias that could have altered the effect. AUTHORS' CONCLUSIONS: There is evidence from RCTs that prophylaxis, as compared to on-demand treatment, may reduce bleeding frequency in previously-treated people with hemophilia. Prophylaxis may also improve joint function, pain and quality of life, even though this does not translate into a detectable improvement of articular damage when assessed by MRI. When comparing two different prophylaxis regimens, no significant differences in terms of protection from bleeding were found. Dose optimization could, however, result in improved efficacy. Given the heterogeneity of the data, pooled estimates were not obtained for most comparisons. Well-designed RCTs and prospective observational controlled studies with standardised definitions and measurements are needed to establish the optimal and most cost-effective treatment regimens.
Collapse
Affiliation(s)
- Omotola O Olasupo
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Megan S Lowe
- Department of Health Sciences, McMaster University, Hamilton, Canada
| | - Ashma Krishan
- School of Health Sciences, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Peter Collins
- Arthur Bloom Haemophilia Centre, Heath Park, School of Medicine, Cardiff University, Cardiff, UK
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Davide Matino
- Department of Internal Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
5
|
Sun J, Zhou X, Hu N. Factor VIII replacement prophylaxis in patients with hemophilia A transitioning to adults: a systematic literature review. Orphanet J Rare Dis 2021; 16:287. [PMID: 34174912 PMCID: PMC8236177 DOI: 10.1186/s13023-021-01919-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the advantages of prophylactic treatment for hemophilia, patients tend to discontinue or not adhere to it because of several challenges such as long-term use, high cost, young patients transitioning to adolescents, and switch to self-infusion or self-care. The goal of this systematic literature review is to emphasize adherence to and efficiency of prophylactic treatment in adults. METHODS A literature review was conducted in PubMed, Embase, and Cochrane databases until April 2021 according to PRISMA guidelines, and the protocol was registered with PROSPERO (CRD42020220085). Studies evaluating the efficacy of prophylaxis in enhancing the quality of life were included. RESULTS A total of 31 articles involving 2379 patients with hemophilia were included in this systematic review. Of these, 26 studies were observational, questionnaire-based studies, and 5 were randomized controlled trials. The majority of studies reported lower annualized bleeding rates in patients receiving prophylaxis compared with those receiving on-demand treatment or those who discontinued prophylaxis. Standard-dose prophylaxis was reported to be effective in most of the studies. In developing countries like China, data suggest that low doses were administered because of limited available resources. However, standard dose or individualized prophylaxis should be provided to prevent joint damage in the long term. Compared with adults, greater adherence to treatment was observed in patients aged < 16 years. CONCLUSION This systematic review emphasizes the importance of adherence to prophylaxis among young adults transitioning from childhood. In countries like China, low-dose prophylaxis can help in preventing joint bleeds in the short term, but in the long term, standard-dose therapy has shown high adherence among young adults and better joint health, in turn improving the quality of life.
Collapse
Affiliation(s)
- Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Xuan Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Nan Hu
- Medical Affairs, Pharmaceuticals, Bayer Healthcare Company Ltd, Beijing, 100020, China
| |
Collapse
|
6
|
Liu Y, Chen L, Li K, Shi M, Poon M. Severe haemophilia A children on low‐dose tertiary prophylaxis showed less joint deterioration and better maintenance of functional independence than children on on‐demand treatment: A 6‐year follow‐up study. Haemophilia 2020; 26:779-785. [PMID: 32700412 DOI: 10.1111/hae.14016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ying Liu
- Department of Physical Medicine and Rehabilitation Peking Union Medical College Hospital Chinese Academy of Medical Science Beijing China
| | - Lixia Chen
- Department of Physical Medicine and Rehabilitation Peking Union Medical College Hospital Chinese Academy of Medical Science Beijing China
| | - Kuixing Li
- Department of Hematology Peking Union Medical College Hospital, Chinese Academy of Medical Science Beijing China
| | - Mingnan Shi
- Department of Physical Medicine and Rehabilitation Peking Union Medical College Hospital Chinese Academy of Medical Science Beijing China
| | - Man‐Chiu Poon
- Departments of Medicine, Pediatric and Oncology Foothills Medical Center University of Calgary Cumming School of Medicine Calgary AB Canada
| |
Collapse
|
7
|
Yang R, Sun J, Zhao Y, Wang X, Wu D, Tseneklidou-Stoeter D, Wu J, Church N. Efficacy and safety of prophylaxis with BAY 81-8973 in Chinese patients with severe haemophilia A enrolled in the LEOPOLD II trial. Haemophilia 2019; 25:e153-e158. [PMID: 30993836 PMCID: PMC6850381 DOI: 10.1111/hae.13751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 11/27/2022]
Abstract
Introduction BAY 81‐8973 (Kovaltry®) is a full‐length, unmodified recombinant human factor VIII approved in China for prophylaxis and on‐demand treatment in patients with haemophilia A. Limited access to FVIII prophylaxis in China has historically led to this population being undertreated. This subanalysis of LEOPOLD II investigated whether the efficacy and safety of BAY 81‐8973 varied between Chinese and non‐Chinese patients. Aim To evaluate BAY 81‐8973 efficacy and safety in Chinese patients. Methods LEOPOLD II enrolled males aged 12‒65 years with severe haemophilia A who were receiving on‐demand treatment. Patients were randomly assigned to receive BAY 81‐8973 as low‐dose prophylaxis (20‒30 IU/kg twice‐weekly), high‐dose prophylaxis (30‒40 IU/kg 3 times weekly) or on‐demand for 1 year. Results Data were available from 23 Chinese and 57 non‐Chinese patients; Chinese patients had a higher prestudy bleeding rate and were more likely to have target joints than non‐Chinese patients. 74% of patients were assigned to prophylaxis. Annualized bleeding rates (ABRs) in Chinese and non‐Chinese patients receiving prophylaxis were significantly lower compared to patients treated on‐demand. Median ABRs for all bleeds in the last 6 months of the study were 2.0 and 1.0 for Chinese and non‐Chinese patients, respectively, in the combined prophylaxis groups, and 61.3 and 58.5 in the on‐demand group. A treatment‐related adverse event occurred in 1 Chinese patient; no patients developed FVIII inhibitors. Conclusion BAY 81‐8973 prophylaxis was efficacious and well tolerated in Chinese patients with severe haemophilia A, with ABRs comparable to those in non‐Chinese patients receiving prophylaxis.
Collapse
Affiliation(s)
- Renchi Yang
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jing Sun
- Hematology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | | | - Depei Wu
- First Affiliated Hospital of Suzhou University, Suzhou, China
| | | | | | | |
Collapse
|