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Dargaud Y, Levrero M, Bailly F, Lienhart A, Zoulim F. Liver health in hemophilia in the era of gene therapy. Thromb Res 2024; 240:109064. [PMID: 38878740 DOI: 10.1016/j.thromres.2024.109064] [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: 03/23/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 07/07/2024]
Abstract
Gene therapy for hemophilia is a groundbreaking treatment approach with promising results and potential to reduce the burden of the disease. However, uncertainties remain, particularly regarding the liver side effects of AAV gene therapy, which are more common in hemophilia A. Unlike some other diseases, such as spinal muscular atrophy, where the target cell for gene therapy is different from the one affected by side effects, hemophilia gene therapy operates within the same cellular domain-the hepatocyte. This overlap is challenging and requires a targeted strategy to mitigate the risks associated with liver injury, which often requires temporary immunosuppressive therapy. A comprehensive approach is essential to increase the efficacy of gene therapy and reduce the likelihood of hepatocyte damage. Key components of this strategy include a thorough pre-gene therapy assessment of liver health, careful post-gene therapy liver monitoring, and prompt therapeutic intervention for loss of transgene expression and liver injury. Collaboration between hematologists and hepatologists is essential to ensure a well-coordinated management plan for patients undergoing hemophilia gene therapy. This review addresses the critical aspect of hepatic comorbidities in patients with hemophilia, emphasizing the need to identify and address these issues prior to initiating gene therapy. It examines the known mechanisms of liver damage and emphasizes the importance of liver monitoring after gene therapy. In addition, the review draws insights from experiences with other AAV-based gene therapies, providing valuable lessons that can guide hemophilia centers in effectively managing liver damage associated with hemophilia gene therapy.
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Affiliation(s)
- Yesim Dargaud
- French Reference Center for Hemophilia, Clinical Haemostasis Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; Universite Claude Bernard Lyon 1 (UCLB), Lyon, France; The Lyon Hepatology Institute EVEREST, France.
| | - Massimo Levrero
- Universite Claude Bernard Lyon 1 (UCLB), Lyon, France; Department of Hepatology, Hopital Croix-Rousse, Hospices Civils de Lyon, INSERM, Lyon, France; INSERM Unit 1052, Lyon, France; The Lyon Hepatology Institute EVEREST, France
| | - François Bailly
- Department of Hepatology, Hopital Croix-Rousse, Hospices Civils de Lyon, INSERM, Lyon, France; INSERM Unit 1052, Lyon, France; The Lyon Hepatology Institute EVEREST, France
| | - Anne Lienhart
- French Reference Center for Hemophilia, Clinical Haemostasis Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fabien Zoulim
- Universite Claude Bernard Lyon 1 (UCLB), Lyon, France; Department of Hepatology, Hopital Croix-Rousse, Hospices Civils de Lyon, INSERM, Lyon, France; INSERM Unit 1052, Lyon, France; The Lyon Hepatology Institute EVEREST, France
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Wang Y, Liu Y, Du G, Liu Y, Zeng Y. Epidemiology and distribution of 207 rare diseases in China: A systematic literature review. Intractable Rare Dis Res 2024; 13:73-88. [PMID: 38836174 PMCID: PMC11145401 DOI: 10.5582/irdr.2024.01001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/16/2024] [Accepted: 04/03/2024] [Indexed: 06/06/2024] Open
Abstract
Epidemiological data on rare diseases in China are currently limited. The objective of this study was to provide a comprehensive understanding of the prevalence and incidence of rare diseases by systematically analyzing the available epidemiological data. We conducted a comprehensive search of English and Chinese databases, the Incidence and Prevalence Database, the Chinese Rare Disease Guideline, and the Taiwan Health Promotion Administration from 2010 to 2023. We identified the top diseases and regions based on epidemiological data and present the maximum, minimum, and median prevalence and incidence values in tables and forest plots. 1,264 prevalence and incidence data were retrieved from 277 studies, guidelines and official websites, covering 110 rare diseases (53.1%) and 32 regions (94.1%). In terms of geographical regions, incidence or prevalence data were available for 32 regions (94.1%), excluding Tibet Hui Autonomous Region and Macao Special Administrative Region. In terms of rate, 60 and 77 out of 207 diseases (29.0% and 37.2%) had available incidence and prevalence data, respectively. Eight diseases had an incidence rate equal to or greater than that of 1,000 patients per million. The present study provides a comprehensive epidemiological analysis and valuable insights into the prevalence and incidence of rare diseases in China. Our findings underscore the pressing need for sustained drug research and medical support for individuals and families impacted by rare diseases.
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Affiliation(s)
| | | | | | - Yonghui Liu
- School of Medicine, Tongji University, Shanghai, China
| | - Ying Zeng
- School of Medicine, Tongji University, Shanghai, China
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Tran H, Yang R, Fischer K, Makris M, Konkle BA. The importance and evolution of bleeding disorder registries. Haemophilia 2024; 30 Suppl 3:21-28. [PMID: 38571362 DOI: 10.1111/hae.14993] [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: 01/11/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
Registries are excellent sources of data to address questions that are typically not evaluated in randomized clinical trials, including natural history, disease prevalence, treatment approaches and adverse events, and models of care. Global and regional registries can provide data to identify differences in outcomes and in haemophilia care between countries, economic settings, and regions, while facilitating research and data sharing. In this manuscript, we highlight five bleeding disorder registries: Country registries from Australia and China, Paediatric Network on Haemophilia Management (PedNet) data on children who have received emicizumab, data from the European Haemophilia Safety Surveillance (EUHASS) system, and data on women and girls with haemophilia from the World Federation of Haemophilia (WFH) registries. Data from these and other bleeding disorder registries have been and will continue to be used to advance patient care, understand treatment patterns and adverse reactions, and identify areas of increased need and focus.
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Affiliation(s)
- Huyen Tran
- The Alfred Hospital, Melbourne, Victoria, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Sciences, Tianjin, China
| | - Kathelijn Fischer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, Utrecht University, University Medical Center, Utrecht, Netherlands
| | - Michael Makris
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Barbara A Konkle
- Washington Center for Bleeding Disorders, University of Washington, Seattle, Washington, USA
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Huang Y, Wan C, Guan T, Xi X. Current status of treatment and disease burden of a cohort of hemophilia B in China. Front Public Health 2024; 11:1303787. [PMID: 38328542 PMCID: PMC10847226 DOI: 10.3389/fpubh.2023.1303787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/15/2023] [Indexed: 02/09/2024] Open
Abstract
Objective Hemophilia B is a rare X-chromosome linked hereditary bleeding disorder. Patients require lifelong treatment and it is costly, but there is a lack of research in China on the treatment and burden for this group. Our aim was to review the actual treatment pattern of hemophilia B patients in China, and describe the financial burden and other disease burden from the patient's perspective. Methods Using data collected by the Beijing Hemophilia Home Care Center, descriptive statistics were made on the sociodemographic characteristics and treatment of patients. The annual drug costs were calculated according to the actual factor dosage and price. Results During the study period, 29.9% of the patients only received on-demand treatment, while the rest of the patients received varying numbers of prophylaxis treatment. The total cost of clotting factors for 341 patients in one year was 16.0 million CNY ($2.5 million), with 46990.8 CNY ($7283.7) per patient. The drug cost of prophylaxis was significantly higher than that of on-demand treatment. The amount of prothrombin complex concentrates used by patients was the largest, more than 5 times of recombinant coagulation factor IX. Based on the average annual wage and average working time of Chinese employees in 2021, the average annual wage loss of HB patients reached 31544.2 CNY ($4889.4). The results of the questionnaire showed that 77.1% and 65.3% of patients had chronic pain and acute pain of different frequencies. Conclusion The level of prophylaxis for Chinese patients is low; safer and more effective recombinant drugs are not widely available. Patients also face a high burden of drug costs, as well as indirect costs that cannot be underestimated. Therefore, continued efforts are needed to improve the quality of life of patients by reducing their financial burden and promote standardized treatment.
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Affiliation(s)
- Yiwen Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Chuchuan Wan
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Tao Guan
- Beijing Hemophilia Home Care Center, Beijing, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
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Guan T, Ai D, Zhao N, Liu G, Yao W, Chen Z, Li Z, Zhou Y, Wu R. Treatment-related outcome from patient report outcome (PRO) of children with severe and moderate hemophilia A in China: An analysis report of registration data from patient organization "hemophilia home care center". Haemophilia 2023; 29:1467-1474. [PMID: 37718575 DOI: 10.1111/hae.14863] [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: 02/18/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To assess current treatment-related outcomes for children with severe and moderate haemophilia A (cHA) in China. METHODS This cross-section Patient Report Outcome (PRO) report collected PRO data of severe and moderate cHAs registered in the 'Hemophilia Home Care Center' database (http://web.bjxueyou.cn) between January 2021 and November 2022. Data included records of bleeding, activities, and concentrates consumption. All patients had a confirmed diagnosis of moderate or severe haemophilia A (FVIII: C ≤ 5%) and were < 18 years old. RESULTS Among 1038 analysable cases, 9.6% of children with inhibitors had a higher rate of intracranial haemorrhage, dropout school rate, and higher FVIII consumption than children without inhibitors. Among 100 children with inhibitors, 36 patients were treated without immune tolerance induction (ITI), 14 patients with irregular treatment and 50 patients received ITI. Children with ITI had a lower ABR (2.4 (0,6.6) vs. 13.4 (9.5, 26.6), p<.001) and AJBR (0 (0, 3.1) vs. 8.9 (1.6, 19.3), p < .001) compared to those without ITI. Among 938 children without inhibitors, 28.5% received on-demand treatment and 71.5% received prophylaxis. Of 528 children with 1343.8 (1050.4, 2922.9)IU/kg/year median FVIII consumption, 43.0% received low-dose, 43.2% received intermediate-dose, and 13.8% received high-dose regimen; these children with prophylaxis had a lower ABR (3.1 (0, 10.7) vs. 12.8 (2.4, 45.5), p < .001), AJBR (0.5 (0, 3.9) vs. 3.0 (0, 12.0), p < .001) and disability rate (9.0% vs.18.5%, p = .032) compared to children who received on-demand treatment. CONCLUSION The high rate of drop-out of school and disability still present a huge gap to meet the needs in China. It is necessary to improve the level of medical accessibility and medicine affordability and strengthen the patient/parent's education in China.
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Affiliation(s)
- Tao Guan
- Beijing Hemophilia Home Care Centre, Beijing, China
| | - Di Ai
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Nan Zhao
- Beijing Hemophilia Home Care Centre, Beijing, China
| | - Guoqing Liu
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Wanru Yao
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Paediatric Research Institute, Beijing Childrenute Laborat, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Zhenping Li
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Yaohan Zhou
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
| | - Runhui Wu
- Hematology Centre, Beijing Key Laboratory of Paediatric Haematology Oncology, National Key Discipline of Paediatrics, Capital Medical University; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Childrenationrsity;, Capital Medical University, National Centre for Childrenal Univer, Beijing, China
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Central venous access devices implantation in children with severe hemophilia a: data from the children comprehensive care center of China. Heliyon 2023; 9:e13666. [PMID: 36873489 PMCID: PMC9976301 DOI: 10.1016/j.heliyon.2023.e13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Objectives To report the perioperative management experience of central venous access devices (CVAD) in Chinese children with severe hemophilia A (SHA) in China. Methods This retrospective study included SHA children who underwent Port-A-Cath or peripherally inserted central catheter (PICC) implantation between 2020/01 and 2021/07. Collected data included baseline characteristics, factor replacement regimen and CVAD-related complications. Results Nine patients had nine ports placed, and eight patients underwent 10 PICCs placement. Patients without or with low-titer inhibitor (<5 BU) received a port. The median preoperative and postoperative plasma-derived factor VIII (pd-FVIII) doses were 53.0 (44.4-61.1) and 315.9 (88.2-577.8) IU/kg. The median port duration was 189 (15-512) days, with infection incidence of 0.06 per 1000 CVAD days. Patients with high-titer inhibitors (>10 BU) received PICC. The median recombinant factor VIIa (rFVIIa) dose was 87.47 μg/kg before and for 5-7 doses after implantation over 2-3 days. The median PICC duration was 226.5 days, with infection incidence of 0.12 per 1000 catheter-days. Conclusions CVADs can be safely implanted in China. PICC implantation is a practical and safe option for SHA children with high-titer inhibitors.
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Chen R, Gultyaev D, Lister J, Han R, Hu N, Malacan J, Solms A, Vashi P, O'Hara J, Hu S. Pharmacokinetic parameter driven outcomes model predicts a reduction in bleeding events associated with BAY 81-8973 versus antihemophilic factor (recombinant) plasma/albumin-free method in a Chinese healthcare setting. BMC Med Res Methodol 2022; 22:215. [PMID: 35931967 PMCID: PMC9356410 DOI: 10.1186/s12874-022-01659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Long-term prophylactic therapy is considered the standard of care for hemophilia A patients. This study models the long-term clinical and cost outcomes of two factor VIII (FVIII) products using a pharmacokinetic (PK) simulation model in a Chinese population. Methods Head-to-head PK profile data of BAY 81–8973 (KOVALTRY®) and antihemophilic factor (recombinant) plasma/albumin-free method (rAHF-PFM, ADVATE®) were applied to a two-state (alive and dead) Markov model to simulate blood FVIII concentrations at a steady state in prophylactically-treated patients with hemophilia A. Worsening of the Pettersson score was simulated and decline was associated with the probability of having orthopaedic surgery. The only difference between the compounds was FVIII concentration at a given time; each subject was treated with 25 IU/kg every 3 days. The model used a lifetime horizon, with cycle lengths of 1 year. Results Cumulative bleeding events, joint bleeding events, and major bleeding events were reduced by 19.3% for BAY 81–8973 compared to rAHF-PFM. Hospitalizations and hospitalization days were also reduced by 19.3% for BAY 81–8973 compared to rAHF-PFM. BAY 81–8973 resulted in both cost savings and a gain in quality adjusted life years (QALYs) compared to rAHF-PFM. Conclusion Based on modeled head-to-head comparisons, differences in PK-properties between BAY 81–8973 and rAHF-PFM result in a reduced number of bleeding events, leading to reduced costs and increased quality of life for BAY 81–8973. These results should be used to inform clinical practice in China when caring for patients with severe hemophilia A. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01659-w.
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Affiliation(s)
- Rong Chen
- Hematology Department, Chengdu Third People's Hospital, Chengdu, China
| | | | | | - Rong Han
- Medical Affairs, Pharmaceuticals, Bayer Healthcare Company. Ltd, Beijing, China
| | - Nan Hu
- Medical Affairs, Pharmaceuticals, Bayer Healthcare Company. Ltd, Beijing, China
| | - Jean Malacan
- Global Market Access Hematology, Bayer Consumer Care AG, Peter Merian-Strasse 84, CH-4002, Basel, Switzerland.
| | | | - Parth Vashi
- Formerly at US Data Generation and Observational Studies, Bayer Corporation, Whippany, NJ, USA
| | | | - Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
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Wu R, Wang X, Zhao X, Cheng Y, Zhou Z, Sun J, Xu M, Li W, Xiao J, Yang F, Chen Y, Xu W, Huang J, Ma C, Gai W, Xie L, Yang R. Efficacy, safety and pharmacokinetics of recombinant human coagulation factor VIII (omfiloctocog alfa) in previously treated Chinese children with severe hemophilia A. Haemophilia 2022; 28:e199-e208. [PMID: 35802040 DOI: 10.1111/hae.14622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Omfiloctocog alfa, the first China-developed recombinant factor VIII (FVIII), demonstrated efficacy and safety of prophylaxis in previously treated patients (PTPs) aged ≥12 years with severe hemophilia A in China. AIMS To investigate efficacy, safety and pharmacokinetics (PK) of omfiloctocog alfa in pediatric PTPs with severe hemophilia A in China. METHODS PTPs (>50 exposure days [ED] for Chinese patients aged <6 years; >150 EDs for patients aged 6-12 years) were treated with omfiloctocog alfa at 25-50 IU/kg every other day or three times per week for 24 weeks. PK was evaluated after single injection of 50 IU/kg. The primary efficacy endpoint was annualized bleeding rate (ABR). RESULTS A total of 69 patients were enrolled (<6 years, n = 35; 6-12 years, n = 34) and mean exposure to omfiloctocog alfa was 78.9 days. Mean half-life was 6.7 and 10.2 h in children < 6 years and 6-12 years, respectively. Estimated mean ABRs of all patients were 4.05 for overall bleeding episodes and 1.38 for spontaneous bleeding episodes. Of 127 bleeding episodes, the success rate was 92.1%. 39.7% patients did not experience any bleeding episodes and the mean weekly dose of FVIII was 109.1 IU/kg for these patients. 83% bleeding episodes were controlled with ≤2 injections. Adverse reactions occurred in 2.9% of the patients. One 2-year-old patient developed inhibitors after 12 EDs and it resolved with omfiloctocog alfa immune tolerance induction. CONCLUSION Omfiloctocog alfa was efficacious and well tolerated for the prevention and treatment of bleeding in Chinese pediatric PTPs with severe hemophilia A.
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Affiliation(s)
- Runhui Wu
- Beijing, Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoling Wang
- Beijing, Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xielan Zhao
- Xiangya Hospital Central South University, Hunan, People's Republic of China
| | - Yanli Cheng
- Shanxi Provincial Children's Hospital, Shanxi, People's Republic of China
| | - Zeping Zhou
- The Second Affiliated Hospital of Kunming Medical University, Yunnan, People's Republic of China
| | - Jing Sun
- Nanfang Hospital Affiliated to Southern Medical University, Guangdong, People's Republic of China
| | - Ming Xu
- Chengdu Women's & Children's Central Hospital, Sichuan, People's Republic of China
| | - Wenqian Li
- Qinghai Provincial People's Hospital, Qinghai, People's Republic of China
| | - Jianwen Xiao
- The Affiliated Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fenge Yang
- Fujian Medical University Union Hospital, Fujian, People's Republic of China
| | - Yun Chen
- Jinan Central Hospital, Shandong, People's Republic of China
| | - Weiqun Xu
- The Affiliated Children's Hospital of Zhejiang Medical University, Zhejiang, People's Republic of China
| | - Jing Huang
- The Affiliated Hospital of Guizhou Medical University, Guangdong, People's Republic of China
| | - Chuanrong Ma
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing, People's Republic of China
| | - Wenlin Gai
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing, People's Republic of China
| | - Liangzhi Xie
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing, People's Republic of China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
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Zhang W, Xie S, Xue F, Liu W, Chen L, Zhang L, Wu J, Yang R. Health-related quality of life among adults with haemophilia in China: A comparison with age-matched general population. Haemophilia 2022; 28:776-783. [PMID: 35751903 DOI: 10.1111/hae.14615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/22/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Evaluating health-related quality of life (HRQoL) is vital for informing the improvement of the overall health of people with haemophilia (PwH). While there is lacking such data in China and comparisons with the general population. AIM To evaluate the HRQoL and its associated factors among adults with haemophilia, and compare it with a sample of the general population in China. METHODS PwH were recruited in this study using telephone-based interviews. Demographic and clinical characteristics were first collected. HRQoL was then evaluated using the self-reported Short Form 6-dimensions version 2 (SF-6Dv2) instrument. An age and gender-matched sample of the general population in China was also included as the comparator group. Linear regression was used to assess the association between the SF-6Dv2 utility value and the demographic and clinical variables of the patients. RESULTS This study included 206 PwH (mean [SD] age: 41.36 [14.48] years) and 206 respondents from the general population. PwH reported worse levels in physical functioning, role limitation, social functioning, and mental health dimensions on SF-6Dv2 than the general respondents. The mean (SD) utility of patients was .650 (.251), which was significantly lower than the general respondents (.786 [.183], P < .001). Being a student, having a higher monthly income, absence of comorbidities, having no target joints and requiring no treatment are independent predictors of a higher HRQoL for PwH. CONCLUSION This study provides the first practical evidence of a significantly lower level of HRQoL in PwH than in the general population in China.
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Affiliation(s)
- Wenhui Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Lingling Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
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Escuriola Ettingshausen C, Yang R, Wu W, Meeks SL. Inhibitors: Diagnostic challenges, unknowns of inhibitor development, treatment of bleeding and surgery, and insights into diagnosis and treatment in China. Haemophilia 2022; 28 Suppl 4:111-118. [PMID: 35521731 DOI: 10.1111/hae.14553] [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: 01/07/2022] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Factor (F) VIII inhibitors develop in around 30% of previously untreated patients (PUPs) with severe haemophilia, to a lesser extend in moderate and mild haemophilia A and in up to 10% in severe haemophilia B. Diagnostic challenges and questions remain including access to high quality testing, the role for functional inhibitor testing and binding antibody testing, and the adaptations needed in the presence of non-factor replacement therapy. Despite significant gains in knowledge there are still many unanswered questions underlying the immunologic mechanisms of inhibitor development and tolerance. Therapeutic options include eradication of inhibitors using immune tolerance induction therapy (ITI), prophylaxis with bypassing agents (i.e., recombinant activated factor VII /rFVIIa or activated prothrombin complex concentrate/aPCC) or non-factor replacement therapies (e.g., emicizumab) and treatment of bleeds or coverage of surgeries/invasive procedure. Recently a haemophilia centre capacity building program was launched in China to further develop the infrastructure and support needed to improve the diagnosis of haemophilia, detection of inhibitors, and continue to improve the care of patients with haemophilia and inhibitors.
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Affiliation(s)
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wenman Wu
- Department of Laboratory Medicine, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shannon L Meeks
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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Huang Z, Nicholas S, Yang Y, Chen X, Maitland E, Ma Y, Shi X. Medical costs and hospital utilization for hemophilia A and B urban inpatients in China: a national cross-sectional study. BMC Health Serv Res 2022; 22:230. [PMID: 35183186 PMCID: PMC8858491 DOI: 10.1186/s12913-022-07626-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 02/11/2022] [Indexed: 12/31/2022] Open
Abstract
Background Hemophilia care in mainland China has been greatly improved since the establishment of the Hemophilia Treatment Center Collaborative Network of China (HTCCNC), and most of drugs for hemophilia have been covered by basic medical insurance schemes. This study assesses whether medical costs and hospital utilization disparities exist between hemophilia A and hemophilia B urban inpatients in China and, second, whether the prescription of coagulation factor concentrates for hemophilia A and hemophilia B inpatients was optimal, from the third payer perspective. Methods We conducted a retrospective nationwide analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) schemes from 2010 to 2016. Univariate analysis and multiple regression analysis based on a generalized linear model were conducted. Result A total of 487 urban inpatients who had hemophilia were identified, including 407 inpatients with hemophilia A and 80 inpatients with hemophilia B. Total medical cost for hemophilia B inpatients was significantly higher than for hemophilia A inpatients (USD 2912.81 versus USD 1225.60, P < 0.05), and hemophilia B inpatients had a significantly longer length of hospital stay than hemophilia A inpatients (9.00 versus 7.00, P < 0.05). Total medical costs were mostly allocated to coagulation factor products (76.86-86.68%), with coagulation factor cost of hemophilia B significantly higher than hemophilia A (P < 0.05). Both hemophilia cohorts utilized greatest amount of plasma-derived Factor VIII, followed by recombinant Factor VIII and prothrombin complex concentrates. Conclusions Patients with hemophilia B experienced significantly higher inpatient cost, coagulation factor cost and longer length of hospital stay than patients with hemophilia A. Our findings revealed the suboptimal use of coagulation factor concentrate drugs and a higher drug cost burden incurred by hemophilia B than hemophilia A inpatients. Our results call for efforts to strengthen drug regulatory management for hemophilia and to optimize medical insurance schemes according to hemophilia types.
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Xue F, Zhao X, Sun J, Zeng X, Yang F, Xu M, Yu Z, Gu W, Feng Y, Li W, Zheng C, Bi H, Xie L, Gai W, Yang R. Pharmacokinetic, efficacy and safety evaluation of B-domain-deleted recombinant FVIII (SCT800) for prophylactic treatment in adolescent and adult patients with severe haemophilia A. Haemophilia 2021; 27:814-822. [PMID: 34089210 DOI: 10.1111/hae.14350] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION SCT800 is a recombinant human B-domain-deleted coagulation factor VIII (BDDrFVIII) developed in China. AIM To evaluate the repeat pharmacokinetics (PKs), efficacy, and safety of SCT800 in previously treated Chinese adolescent and adult patients with severe haemophilia A. METHODS A phase III, multicentre, prospective, open-label, single-arm trial was conducted at 12 medical centres. Subjects received treatment for 24 weeks. PKs were assessed at the initial and repeated dosing 24 weeks later. The primary endpoint was annualized bleeding rate (ABR). Breakthrough bleeding episodes and inhibitor development were assessed. RESULTS A total of 71 of 73 patients completed the study, and 18 were enrolled for the repeat PK investigation. Total exposure was 5643 exposure days. Overall, SCT800 showed comparable repeat PK profiles. The total ABR was 2.82 (95% confidence interval 2.01-3.96). During prophylaxis, 43.8% of patients had no bleeding episodes. The majority (89.4%) of bleeding episodes were controlled with 1-2 injections of SCT800, the success rate (defined as 'excellent' or 'good' haemostatic response) for the treatment of bleeding episodes was 92.6%. The incidence of treatment-related adverse events was 53.4%. Drug-related AE incidence was 4.1%. The observed AEs were similar to those of other coagulation factor VIII, but lower in frequency. No subject developed an inhibitor, and no other safety concerns were identified. CONCLUSIONS SCT800 has robust PK characteristics, and is safe and efficacious for the prophylaxis and treatment of bleeding episodes in previously treated adolescent and adult patients with severe haemophilia A.
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Affiliation(s)
- Feng Xue
- State Key Laboratory of Experimental Hematology, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Hematology & Blood Diseases Hospital, Tianjin, China
| | - Xielan Zhao
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Nanfang Medial University, Guangzhou, China
| | - Xiaojing Zeng
- Department of Hematology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Fenge Yang
- Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ming Xu
- Pediatric Hematology& Oncology, Chengdu Women's & Children's Central Hospital, Chengdu, China
| | - Ziqiang Yu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiying Gu
- Department of Hematology, The First People's Hospital of Changzhou, Changzhou, China
| | - Ying Feng
- Department of Hematology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenqian Li
- Department of Hematology & Rheumatology, Qinghai Provincial People's Hospital, Qinghai, China
| | - Changcheng Zheng
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Hui Bi
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liangzhi Xie
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing, China
| | - Wenlin Gai
- Beijing Engineering Research Center of Protein and Antibody, Sinocelltech Ltd., Beijing, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Hematology & Blood Diseases Hospital, Tianjin, China
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13
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Dou X, Liu W, Poon MC, Zhang X, Wu J, Zeng X, Wu R, Hu Q, Li C, Wang X, Song X, Chen L, Zhang L, Xue F, Yang R. Patients with haemophilia A with inhibitors in China: a national real-world analysis and follow-up. Br J Haematol 2021; 192:900-908. [PMID: 33534930 DOI: 10.1111/bjh.17322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022]
Abstract
The development of alloantibodies (inhibitors) against coagulation factor VIII (FVIII) is the most serious complication of FVIII replacement therapy in patients with haemophilia A (HA). We carried out a nationwide study focussing on patients with HA with inhibitors in China to evaluate the condition and management of this population. The study retrospectively analysed patient characteristics, clinical history, manifestation, treatment strategy as well as individual haemophilia care of 493 patients with inhibitors (466 with severe HA and 27 with non-severe HA) registered all over China. The median (interquartile range) age at diagnosis of FVIII inhibitors was 13 (5-28) years in patients with severe HA and 24 (10·5-39·5) years in patients with non-severe HA. Most patients (85%) had high-titre inhibitors. Prothrombin complex concentrate and recombinant activated coagulation factor VII were used respectively in 76·2% and 29·2% of patients for acute bleeding. Only 22·3% of patients underwent immune tolerance induction (ITI) treatment, of whom 64·9% achieved negative inhibitor titre. In patients who did not undergo ITI, the inhibitors turned negative in 17·7%, and patients with low peak inhibitor titre were more likely to acquire negative titre spontaneously (odds ratio 11·524, 95% confidence interval 5·222-25·432; P = 0·000). We recorded that 3·2% of the patients died from haemophilia-related life-threatening bleeding.
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Affiliation(s)
- Xueqing Dou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, University of Calgary, Cumming School of Medicine and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | | | - Jingsheng Wu
- First Affiliated Hospital, Chinese University of Science and Technology, Hefei, China
| | - Xiaojing Zeng
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Runhui Wu
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qun Hu
- Department of Pediatric Hematology, Tongji Hospital of Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China
| | - Chengping Li
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaomin Wang
- Xinjiang Uygur Autonomous Region People's Hospital, Urumchi, China
| | - Xuewen Song
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Lingling Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, CAMS Center for Stem Cell Medicine, PUMC Department of Stem Cell and Regenerative Medicine, Tianjin, China
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