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Lee MW, Cheong MA, Ng HJ, Tien SL, Lam JCM. Real-world data on the use of emicizumab in patients with haemophilia A with and without inhibitors in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:580-589. [PMID: 38920147 DOI: 10.47102/annals-acadmedsg.2023100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Emicizumab is a bispecific monoclonal antibody that mimics the function of factor VIII by binding to factor IXa and factor X to achieve haemostasis in haemophilia A. The long half-life and subcutaneous mode of administration makes emicizumab a compelling treatment option for bleeding prophylaxis. There is still limited real-world data on its use and management considerations, especially during surgical procedures. The objective of the study is to describe the real-world experience of emicizumab in a cohort of adult and paediatric haemophilia A patients in Singapore, including its use in the periprocedural setting. Method This was an observational study conducted at the 2 main haemophilia treatment centres in Singapore. All haemophilia A patients who commenced treatment with emicizumab before 1 July 2022 were recruited. Results A total of 18 patients with haemophilia A were included in this study. Ten (55.6%) patients had active inhibitors. The median annual bleeding rate for all patients before emicizumab use was 4.5 events (interquartile range [IQR] 2.8-8.3) compared with 0 events (IQR 0-0) after emicizumab was commenced (P=0). There were no adverse events of venous or arterial thrombosis, thrombotic microangiopathy, or death. A total of 6 procedures in 5 patients were performed during the study period with no major bleeding complications. Conclusion Emicizumab effectively protects against bleeding in haemophilia A patients with and without inhibitors, including in children less than 12 years old. More studies are required to address clinical nuances, such as periprocedural management and the role of immune tolerance in patients with inhibitors on emicizumab.
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Affiliation(s)
- Ming Wei Lee
- Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore
| | - May Anne Cheong
- Department of Haematology, Singapore General Hospital, Singapore
| | - Heng Joo Ng
- Department of Haematology, Singapore General Hospital, Singapore
| | - Sim Leng Tien
- Department of Haematology, Singapore General Hospital, Singapore
| | - Joyce Ching Mei Lam
- Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore
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2
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Puetz J. Emergent data influences the risk/benefit assessment of hemophilia gene therapy using recombinant adeno-associated virus. Front Med (Lausanne) 2023; 10:1256919. [PMID: 38020165 PMCID: PMC10667906 DOI: 10.3389/fmed.2023.1256919] [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: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
After decades of investigation, gene therapy has received regulatory approval to treat hemophilia. However, since gene therapy investigations were initially conceived, other avenues of treatment have revolutionized the care of hemophilia. Emergent data is showing that gene therapy may not be as beneficial as hoped and more toxic than planned. At a minimum, a reassessment of risk/benefit estimate of gene therapy for hemophilia is needed.
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Affiliation(s)
- John Puetz
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Saint Louis University School of Medicine, St. Louis, MO, United States
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3
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Nguyen NH, Jarvi NL, Balu-Iyer SV. Immunogenicity of Therapeutic Biological Modalities - Lessons from Hemophilia A Therapies. J Pharm Sci 2023; 112:2347-2370. [PMID: 37220828 DOI: 10.1016/j.xphs.2023.05.014] [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: 02/10/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
The introduction and development of biologics such as therapeutic proteins, gene-, and cell-based therapy have revolutionized the scope of treatment for many diseases. However, a significant portion of the patients develop unwanted immune reactions against these novel biological modalities, referred to as immunogenicity, and no longer benefit from the treatments. In the current review, using Hemophilia A (HA) therapy as an example, we will discuss the immunogenicity issue of multiple biological modalities. Currently, the number of therapeutic modalities that are approved or recently explored to treat HA, a hereditary bleeding disorder, is increasing rapidly. These include, but are not limited to, recombinant factor VIII proteins, PEGylated FVIII, FVIII Fc fusion protein, bispecific monoclonal antibodies, gene replacement therapy, gene editing therapy, and cell-based therapy. They offer the patients a broader range of more advanced and effective treatment options, yet immunogenicity remains the most critical complication in the management of this disorder. Recent advances in strategies to manage and mitigate immunogenicity will also be reviewed.
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Affiliation(s)
- Nhan H Nguyen
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA; Currently at Truvai Biosciences, Buffalo, NY, USA
| | - Nicole L Jarvi
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sathy V Balu-Iyer
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
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Tagliaferri A, Molinari AC, Peyvandi F, Coppola A, Demartis F, Biasoli C, Borchiellini A, Cultrera D, De Cristofaro R, Daniele F, Giordano P, Marchesini E, Margaglione M, Marino R, Pollio B, Radossi P, Santoro C, Santoro RC, Siragusa S, Sottilotta G, Tosetto A, Piscitelli L, Villa MR, Zanon E, Finardi A, Schiavetti I, Vaccari D, Castaman G. IDEAL study: A real-world assessment of pattern of use and clinical outcomes with recombinant coagulation factor IX albumin fusion protein (rIX-FP) in patients with haemophilia B in Italy. Haemophilia 2023; 29:135-144. [PMID: 36423202 PMCID: PMC10099489 DOI: 10.1111/hae.14689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Factor IX replacement therapy is used for treatment and prophylaxis of bleeding in haemophilia B. rIX-FP is an extended half-life albumin-fusion protein, which, in clinical studies, has demonstrated prolonged dosing intervals up to 21 days for routine prophylaxis, providing therapeutic benefit. AIMS To describe dosing frequency and consumption (primary endpoint), efficacy and safety of rIX-FP treatment during routine clinical practice in Italy. METHODS Patients with moderate/severe haemophilia B on prophylaxis with rIX-FP for ≥6 months, were enrolled in this observational study from October 2017 to February 2019 and followed-up for 2 years. Descriptive analysis included prospective and retrospective data (12 months prior to switching to rIX-FP). RESULTS Data were collected from 59 male patients (median age 30.1 years) enrolled by 23 Italian centres. Of them, 50 were on prophylaxis during the entire observation period and completed the study. The infusion frequency changed from 2-3 times/week in 86.0% of patients with previous treatment, to less than once a week in 84.0% of patients treated with rIX-FP at the 2nd-year follow-up. The annual number of infusions decreased by about 70%, whereas the mean FIX activity trough level increased from 3.8% to 14.4% (mean > 10% in all the infusion regimens). Median Annualised Bleeding Rate of .0 was achieved across all prophylaxis regimens. Subjects with zero bleedings increased from 66.0% to 78.0% with rIX-FP. CONCLUSION Treatment with rIX-FP reduced infusion frequency, while providing higher FIX trough levels with substantial benefit in terms of annualised bleeding rate and a good safety profile.
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Affiliation(s)
- Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Angelo Claudio Molinari
- Regional Reference Centre for Haemorrhagic Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Haemophilia and Thrombosis Centre, Università degli Studi di Milano, Milan, Italy
| | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Francesco Demartis
- Department of Oncology, Centre for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Chiara Biasoli
- Haemophilia and Transfusion Centre, "Bufalini" Hospital, Cesena, Italy
| | - Alessandra Borchiellini
- Regional Reference Centre for Bleeding and Thrombotic Disorders, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Dorina Cultrera
- Haemophilia Regional Reference Centre, Haematology Unit, Policlinico "G. Rodolico - S. Marco" Hospital, Catania, Italy
| | - Raimondo De Cristofaro
- Haemorrhagic and Thrombotic Disease Service, Area of Haematological and Oncological Sciences, IRCCS Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Filomena Daniele
- Haemostasis and Thrombosis Service, Ospedale Civile dell'Annunziata, Cosenza, Italy
| | - Paola Giordano
- "B. Trambusti" General and Specialised Paediatrics Unit, "Giovanni XXIII" Hospital, University of Bari, Bari, Italy
| | - Emanuela Marchesini
- Haemophilia Centre, Internal and Cardiovascular Medicine, "Santa Maria della Misericordia" University Hospital, Perugia, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Renato Marino
- Haemophilia and Thrombosis Centre, University Hospital, Bari, Italy
| | - Berardino Pollio
- Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Transfusion Medicine, "Regina Margherita" Children Hospital, Turin, Italy
| | - Paolo Radossi
- Onco-Haematology Unit, Istituto Oncologico Veneto, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | - Cristina Santoro
- Department of Haematology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Rita Carlotta Santoro
- Regional Reference Centre for Haemophilia and Coagulation Diseases, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Sergio Siragusa
- Haematology Unit, Thrombosis and Haemostasis Reference Regional Centre, University of Palermo, Palermo, Italy
| | | | - Alberto Tosetto
- Haematology Department, Haemostasis and Thrombosis Unit, San Bortolo Hospital, Vicenza, Italy
| | - Lydia Piscitelli
- SSD Congenital Haemorrhagic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Rosaria Villa
- Haemophilia and Thrombosis Centre, Haematology Unit, "Ospedale del Mare" Hospital, Naples, Italy
| | - Ezio Zanon
- Department of Medicine, Haemophilia Centre, University Hospital of Padua, Padua, Italy
| | | | - Irene Schiavetti
- Hippocrates Research, Genova, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Giancarlo Castaman
- Department of Oncology, Centre for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
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Al-Samkari H, Ozonoff A, Landschaft A, Kimia R, Harper MB, Croteau SE, Kimia AA. Utility of Blood Cultures and Empiric Antibiotics in Febrile Pediatric Hemophilia Patients With Central Venous Access Devices. Pediatr Emerg Care 2021; 37:e1531-e1534. [PMID: 32349076 DOI: 10.1097/pec.0000000000002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with hemophilia frequently require long-term central venous access devices (CVADs) for regular infusion of factor products. Hemophilia patients are not immunocompromised, but the presence and use of CVADs are associated with infections including bacteremia. Currently, the utility of blood cultures in evaluation of the febrile hemophilia patient with an indwelling CVAD is unknown, nor is optimal empiric antibiotic use. METHODS We performed a retrospective cross-sectional study of febrile immunocompetent hemophilia patients with CVADs presenting to a large academic urban pediatric emergency department from 1995 to 2017. We used a natural language processing electronic search, followed by manual chart review to construct the cohort. We analyzed rate of pathogen recovery from cultures of blood in subgroups of hemophilia patients, the pathogen profile, and the reported pathogen susceptibilities to ceftriaxone. RESULTS Natural language processing electronic search identified 181 visits for fever among hemophilia patients with indwelling CVADs of which 147 cases from 44 unique patients met study criteria. Cultures of blood were positive in 56 (38%) of 147 patients (95% confidence interval, 30%-47%). Seventeen different organisms were isolated (10 pathogens and 7 possible pathogens) with Staphylococcus aureus and coagulase-negative Staphylococcus species as the most common. Thirty-four percent of isolates were reported as susceptible to ceftriaxone. Positive blood cultures were more common in cases involving patients with inhibitors (n = 71) versus those without (n = 76), odds ratio, 7.4 (95% confidence interval, 3.5-15.9). This was observed irrespective of hemophilia type. CONCLUSIONS Febrile immunocompetent hemophilia patients with indwelling CVADs have high rates of bacteremia. Empiric antimicrobial therapy should be targeted to anticipated pathogens and take into consideration local susceptibility patterns for Staphylococcus aureus.
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Population Pharmacokinetic Analysis and Exploratory Exposure-Bleeding Rate Relationship of Emicizumab in Adult and Pediatric Persons with Hemophilia A. Clin Pharmacokinet 2021; 59:1611-1625. [PMID: 32504271 PMCID: PMC7717049 DOI: 10.1007/s40262-020-00904-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Emicizumab is a bispecific monoclonal antibody developed for routine prophylaxis of bleeding in people with hemophilia A (PwHA). This work characterizes the pharmacokinetics of emicizumab in adult and pediatric PwHA, identifies factors contributing to its between-person variabilities, compares the pharmacokinetics following different dosing regimens, and makes a descriptive assessment of the exposure–bleeding events relationship. Methods A population pharmacokinetic model was developed, using a database of 389 PwHA from five clinical studies. Potential baseline covariate effects were assessed, including body size, age, race, presence of factor VIII inhibitors, and albumin levels. Using the population pharmacokinetic model, the estimated individual average exposures over the administration period were compared across categories of annualized bleeding rate. Results A linear one-compartment model with first-order absorption and elimination processes and no lag time best described the emicizumab pharmacokinetics. Body weight, albumin levels, age, and black race were statistically correlated with primary pharmacokinetic parameters, but only body weight had an important influence on exposure. Dosing regimens of 1.5 mg/kg weekly, 3 mg/kg every 2 weeks, or 6 mg/kg every 4 weeks provided similar average concentrations at steady state. A trend for lower exposure was observed in the small proportion of PwHA having an annualized bleeding rate > 4 (11.9%), suggesting that reducing exposure to lower levels may potentially increase the bleeding risk. Conclusions Emicizumab pharmacokinetics in PwHA was described with dose-independent parameters. Body weight was an important predictor of emicizumab pharmacokinetics. All three dosing regimens are predicted to achieve similar exposure associated with clinically meaningful prevention of bleeding. Electronic supplementary material The online version of this article (10.1007/s40262-020-00904-z) contains supplementary material, which is available to authorized users.
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7
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Levy‐Mendelovich S. Emicizumab for infants and children with haemophilia A. Br J Haematol 2020; 191:145-146. [DOI: 10.1111/bjh.16965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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8
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Barg AA, Livnat T, Budnik I, Avishai E, Brutman‐Barazani T, Tamarin I, Bashari D, Misgav M, Kenet G. Emicizumab treatment and monitoring in a paediatric cohort: real‐world data. Br J Haematol 2020; 191:282-290. [DOI: 10.1111/bjh.16964] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Assaf A. Barg
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
- Amalia Biron Research Institute of Thrombosis and Hemostasis Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Tami Livnat
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
- Amalia Biron Research Institute of Thrombosis and Hemostasis Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Ivan Budnik
- Department of Pathophysiology Sechenov First Moscow State Medical University (Sechenov University) Moscow Russia
| | - Einat Avishai
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
- Amalia Biron Research Institute of Thrombosis and Hemostasis Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Tami Brutman‐Barazani
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
- Amalia Biron Research Institute of Thrombosis and Hemostasis Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Ilia Tamarin
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
| | - Dalia Bashari
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
| | - Mudi Misgav
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
| | - Gili Kenet
- National Hemophilia Center Sheba Medical Center Tel Hashomer Israel
- Amalia Biron Research Institute of Thrombosis and Hemostasis Sackler School of MedicineTel Aviv University Tel Aviv Israel
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McCary I, Guelcher C, Kuhn J, Butler R, Massey G, Guerrera MF, Ballester L, Raffini L. Real‐world use of emicizumab in patients with haemophilia A: Bleeding outcomes and surgical procedures. Haemophilia 2020; 26:631-636. [DOI: 10.1111/hae.14005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/12/2020] [Accepted: 03/30/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Isabella McCary
- The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia Pennsylvania
| | - Christine Guelcher
- Children's National Hospital George Washington University Washington District of Columbia
| | - Jan Kuhn
- Virginia Commonwealth University Richmond Virginia
| | - Regina Butler
- The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia Pennsylvania
| | - Gita Massey
- Virginia Commonwealth University Richmond Virginia
| | - Michael F. Guerrera
- Children's National Hospital George Washington University Washington District of Columbia
| | - Lance Ballester
- The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia Pennsylvania
| | - Leslie Raffini
- The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia Pennsylvania
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10
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Kim J, Park YS. Septic Arthritis and Infective Endocarditis in an Adolescent Hemophilia B Patient with an Inhibitor and a Central Venous Access Device. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jisu Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Shil Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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11
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Dunn AL, Ahuja SP, Mullins ES. Real-world experience with use of Antihemophilic Factor (Recombinant), PEGylated for prophylaxis in severe haemophilia A. Haemophilia 2018; 24:e84-e92. [DOI: 10.1111/hae.13403] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- A. L. Dunn
- Nationwide Children's Hospital and The Ohio State University School of Medicine; Columbus OH USA
| | - S. P. Ahuja
- Rainbow Babies & Children's Hospital; Cleveland OH USA
| | - E. S. Mullins
- Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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12
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Martinowitz U, Windyga J, Di Minno G, Hellmann A, Pabinger I, Enriquez M, Schwartz L, Ingerslev J, Powell J. Efficacy and safety of prophylaxis with once-weekly BAY 79–4980 compared with thrice-weekly rFVIII-FS in haemophilia A patients. Thromb Haemost 2017; 108:913-22. [DOI: 10.1160/th12-03-0188] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/22/2012] [Indexed: 02/01/2023]
Abstract
SummaryThe benefits of prophylaxis of haemophilia A patients regarding joint health and quality-of-life are well established. However, adherence to an up to every-other-day infusion regimen is a barrier to widespread adoption of prophylaxis. BAY 79–4980 is an investigational drug consisting of rFVIII-FS (sucrose-formulated recombinant FVIII) reconstituted with liposome solvent. Previous clinical studies showed extended protection from bleeding after a single injection of BAY 79–4980 (13.3 ± 6.2 days) compared with rFVIII-FS (7.2 ± 1.7 days). The effect of once-a-week prophylaxis with BAY 79–4980 (35 IU/kg) compared with three times-per-week rFVIII-FS (25 IU/kg) in previously treated, severe haemophilia A patients was evaluated in a 52-week, double-blind, two-arm, randomised, controlled study. The primary and secondary endpoints were protection from total bleeds and joint bleeds, respectively. Short- and long-term safety and tolerability of BAY 79–4980 including effects on lipid levels were assessed. A total of 139 and 131 subjects were evaluable for safety and efficacy analyses, respectively. A large difference in efficacy between treatment groups was observed with 72.1% (49/68) in the rFVIII-FS control group demonstrating <9 bleeds/year compared with 38.1% (24/63) of BAY 79–4980-treated subjects. A similar difference was seen in annualised joint bleeds, with 43 subjects (63.2%) in the control group demonstrating <5 joint bleeds/year compared with 24 subjects (38.1%) treated with BAY 79–4980. The distribution of bleeds seven days post-prophylactic treatment with BAY 79–4980 showed that 61% of bleeds occurred after day 4 post dosing. There were no safety concerns identified. The investigational treatment arm was prematurely discontinued due to failure to achieve the primary endpoint.
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13
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Khair K, Ranta S, Thomas A, Lindvall K. The impact of clinical practice on the outcome of central venous access devices in children with haemophilia. Haemophilia 2017; 23:e276-e281. [DOI: 10.1111/hae.13241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - S. Ranta
- Karolinska University Hospital; Stockholm Sweden
| | - A. Thomas
- Royal Hospital for Sick Children; Edinburgh UK
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14
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Moon HS, Huh JS, Lee OK, Kim MK. A Study of Home Therapy in Hemophilia Patients. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyeok Soo Moon
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Jae Seong Huh
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Oh Kyung Lee
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Mi Kyung Kim
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
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15
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Nijdam A, Foppen W, van der Schouw YT, Mauser-Bunschoten EP, Schutgens REG, Fischer K. Long-term effects of joint bleeding before starting prophylaxis in severe haemophilia. Haemophilia 2016; 22:852-858. [PMID: 27396935 DOI: 10.1111/hae.12959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Early initiation of prophylaxis in severe haemophilia is critical for effective prevention of arthropathy. However, the optimum time for starting prophylaxis has not been established yet. AIM This study assessed long-term effects of age at starting prophylaxis and joint bleeding before prophylaxis on haemophilic arthropathy. METHODS In patients with severe haemophilia (FVIII/IX <0.01 IU mL-1 ), born between 1965 and 2000, haemophilic arthropathy was evaluated on X-rays. Patient groups were compared by multivariable regression analysis, adjusted for bleeding phenotype and lifetime intensity of prophylaxis. RESULTS One hundred and twenty-four patients were evaluated at a median age of 22 years. When comparing patients according to age at starting prophylaxis, starting before age 6 years was significantly better than starting later (P < 0.01), but no additional benefit of starting before age 3 years was demonstrated. The number of joint bleeds before prophylaxis had a stronger association with arthropathy than age at starting prophylaxis. Starting prophylaxis before the onset of joint bleeding resulted in the best long-term outcome (P ≤ 0.02); starting after one joint bleed appeared to have acceptable long-term outcome. The difference between starting after 0-1 and 2-5 joint bleeds was notable, but statistical significance was not reached (P = 0.15). CONCLUSION Future research with more patients on early prophylaxis will have to clarify whether starting prophylaxis before joint bleeding is superior.
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Affiliation(s)
- A Nijdam
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands
| | - W Foppen
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - E P Mauser-Bunschoten
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands
| | - R E G Schutgens
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands
| | - K Fischer
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
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16
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Rodriguez V, Mancuso ME, Warad D, Hay CRM, DiMichele DM, Valentino L, Kenet G, Kulkarni R. Central venous access device (CVAD) complications in Haemophilia with inhibitors undergoing immune tolerance induction: Lessons from the international immune tolerance study. Haemophilia 2015; 21:e369-74. [PMID: 26178581 DOI: 10.1111/hae.12740] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Central venous access devices (CVADs) are frequently required as stable long-lasting venous access in children with haemophilia, especially those requiring immune tolerance induction (ITI) for inhibitors. CVAD infection is one of the most frequently reported catheter-related complications in this patient population. AIM Detailed review of CVAD complications from the International ITI (I-ITI) study and analysis of potential risk factors for such complications. METHODS Retrospective analysis of prospectively obtained data from the I-ITI study primarily focused on CVAD-related complications. RESULTS A total of 115 children were recruited and 183 CVADs were placed in 99 subjects resulting in 121,206 CVAD-days observed on-study. A total of 124 CVAD infections were reported in 41 of 99 (41%) subjects with an overall infection rate of 0.94 per 1000 CVAD-days (interquartile ranges 0-1.7). A similar number of infections were observed in the two treatment arms (median: 2 and 3 in high dose and low dose respectively). Infections occurred more frequently in the presence of external catheters than with fully implanted catheters (P = 0.026). Infected patients were significantly younger at the time of CVAD insertion (median age: 22 vs. 25 months, P = 0.020). Patients with Gram-positive infections were also significantly younger than those with Gram-negative infections (median age: 17 vs. 25 months, P < 0.0001). CONCLUSION CVAD infection was the most common complication observed in children with severe haemophilia and inhibitors in the frame of the I-ITI study. Younger age at CVAD insertion and external CVAD were associated with higher risk for infection. ITI outcome was unaffected by CVAD infections.
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Affiliation(s)
- V Rodriguez
- Mayo Clinic Comprehensive Hemophilia Center, Rochester, MN, USA
| | - M E Mancuso
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Warad
- Mayo Clinic Comprehensive Hemophilia Center, Rochester, MN, USA
| | - C R M Hay
- Department of Haematology, Manchester University, Manchester Royal Infirmary, Manchester, UK
| | | | - L Valentino
- Rush Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA
| | - G Kenet
- National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Hashomer, Israel
| | - R Kulkarni
- MSU Center for Bleeding and Clotting Disorders, Michigan State University, East Lansing, MI, USA
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Vepsäläinen K, Lassila R, Arola M, Lähteenmäki P, Möttönen M, Mäkipernaa A, Riikonen P. Complications associated with central venous access device in children with haemophilia: a nationwide multicentre study in Finland. Haemophilia 2015; 21:747-53. [DOI: 10.1111/hae.12665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 01/05/2023]
Affiliation(s)
- K. Vepsäläinen
- Department of Pediatrics; Kuopio University Hospital; Kuopio Finland
| | - R. Lassila
- Coagulation Disorders Unit; Department of Hematology and Cancer Center; Helsinki University Central Hospital; University of Helsinki; Helsinki Finland
| | - M. Arola
- Department of Pediatrics; Tampere University Central Hospital; Tampere Finland
| | - P. Lähteenmäki
- Department of Pediatrics and Adolescent Medicine; Turku University Central Hospital; Turku Finland
| | - M. Möttönen
- Department of Pediatrics and Adolescence; Oulu University Hospital; Oulu Finland
| | - A. Mäkipernaa
- Coagulation Disorders Unit; Department of Hematology and Cancer Center; Helsinki University Central Hospital; University of Helsinki; Helsinki Finland
- Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
| | - P. Riikonen
- Department of Pediatrics; Kuopio University Hospital; Kuopio Finland
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18
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Ljung R, Gretenkort Andersson N. The current status of prophylactic replacement therapy in children and adults with haemophilia. Br J Haematol 2015; 169:777-86. [DOI: 10.1111/bjh.13365] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences Lund-Paediatrics; Lund University; Lund Sweden
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
| | - Nadine Gretenkort Andersson
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
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19
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Harroche A, Merckx J, Salvi N, Faivre J, Jacqmarcq O, Dazet D, Makhloufi M, Clairicia M, Torchet MF, Aouba A, Rothschild C. Long-term follow-up of children with haemophilia - low incidence of infections with central venous access devices. Haemophilia 2015; 21:465-8. [DOI: 10.1111/hae.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Harroche
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - J. Merckx
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - N. Salvi
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - J. Faivre
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - O. Jacqmarcq
- Department of Anaesthesia; Universitaire Necker-Enfants Malades; Paris France
| | - D. Dazet
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - M. Makhloufi
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - M. Clairicia
- Home Care Education Centre for Children; Universitaire Necker-Enfants Malades; Paris France
| | - M.-F. Torchet
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - A. Aouba
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
| | - C. Rothschild
- Department of Haematology; Haemophilia Care Centre; Universitaire Necker-Enfants Malades; Paris France
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20
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Nijdam A, Altisent C, Carcao MD, Cid AR, Claeyssens-Donadel S, Kurnik K, Ljung R, Nolan B, Petrini P, Platokouki H, Rafowicz A, Thomas AE, Fischer K. Bleeding before prophylaxis in severe hemophilia: paradigm shift over two decades. Haematologica 2014; 100:e84-6. [PMID: 25527565 DOI: 10.3324/haematol.2014.115709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Annelies Nijdam
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center Utrecht, Netherlands
| | | | - Manuel D Carcao
- Division of Haematology/Oncology, Department of Paediatrics and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ana R Cid
- Unidad de Hemostasia y Trombosis, Hospital Universitario la Fe, Valencia, Spain
| | | | - Karin Kurnik
- Dr. von Haunersches Children's Hospital, University of Munich, Germany
| | - Rolf Ljung
- Lund University, Department of Clinical Sciences Lund -Paediatrics and Malmö Haemostasis & Thrombosis Centre, Skåne University Hospital, Malmö, Sweden
| | - Beatrice Nolan
- Department of Haematology Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Pia Petrini
- Paediatric Department of Coagulation Disorders, Karolinska University Hospital, Stockholm, Sweden
| | - Helen Platokouki
- St. Sophia Children's Hospital, Haemophilia-Haemostasis Unit, Athens, Greece
| | - Anne Rafowicz
- Centre Régional de Traitement de l'Hémophilie et Autres Maladies Hémorragiques, Centre Hospitalier Universitaire de Bicêtre, Paris, France
| | - Angela E Thomas
- Department of Haematology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Kathelijn Fischer
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center Utrecht, Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
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21
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Giordano P, Lassandro G, Valente M, Molinari AC, Ieranò P, Coppola A. Current management of the hemophilic child: a demanding interlocutor. Quality of life and adequate cost-efficacy analysis. Pediatr Hematol Oncol 2014; 31:687-702. [PMID: 25006797 DOI: 10.3109/08880018.2014.930768] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hemophilias are the most known inherited bleeding disorders. The challenges in the management of hemophilic children are different from those in adults: prophylaxis regimen removed the hallmark of crippling disease with lifelong disabilities; individualized regimens are being implemented in order to overcome venous access problems. Presently, at least in high-income countries, advances in treatment of hemophilia resulted in continuous improvement of the patients' quality of life and life expectancy. Inhibitors remain the most severe complication of hemophilia therapy. The treatment' compliance is the key to achieve a successful management. The patient, his family, the medical and psychological team are the players of a comprehensive care system. The current management of hemophilic children is the example of huge resource investments enabling long-term benefits in particular quality of life as a primary objective of the healthcare process.
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Affiliation(s)
- Paola Giordano
- 1Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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22
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Yeoh ZH, Furmedge J, Ekert J, Crameri J, Curtis N, Barnes C. Central venous access device-related infections in patients with haemophilia. J Paediatr Child Health 2013; 49:242-5. [PMID: 23438133 DOI: 10.1111/jpc.12112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/29/2022]
Abstract
AIMS Fully implantable central venous access devices (CVADs) can offer long-term reliable venous access to facilitate regular factor replacement therapy in haemophilia. However, CVAD-related infection remains a major deterrent to the optimal use of CVAD in this population. This report represents the first review of CVAD use in haemophilia in Australia and aims to examine the rate of complications including CVAD-related infections. METHODS A retrospective review of medical records was conducted of all haemophilic patients with fully implantable CVADs at the Royal Children's Hospital (RCH), Melbourne, between 1 June 1992 and 30 June 2009. CVAD-related bloodstream infection was defined based on the guidelines from the Centre of Disease Control and Victoria National Nosocomial Infection Surveillance. To further enhance identification of CVAD-related infection in this study, a third criterion of 'suspected infection' was added by the authors. RESULTS Eighty-one CVADs in 56 patients were managed at the RCH during this time period resulting in a combined study period of 94 756 CVAD days. Median age at first CVAD insertion = 2.16 years (range 0.66 to 13.98 years). CVADs were inserted predominantly due to difficult venous access and prophylaxis initiation (70.4%). Median life-span of a CVAD was 1227 days, equivalent to 3.36 years (n = 50; range 0.22 to 9.44 years). Fifty-seven CVAD-related infections occurred in 37 CVADs (46.3%) in 29 patients (51.8%). Overall incidence of confirmed CVAD-related bloodstream infection = 0.42 per 1000 CVAD days (95% confidence interval (CI): 0.31 to 0.58 per 1000 CVAD days) and indicate better performance compared with the published benchmark of 0.66 per 1000 CVAD days (0.44 to 0.97 per 1000 CVAD days). The incidence of both confirmed (criteria 1, 2) and suspected (criterion 3) CVAD-related infection is 0.60 per 1000 CVAD days (95% CI: 0.46 to 0.78), which is comparable to the international benchmark. The majority of CVAD-related infections (73.7%) were successfully treated with intravenous antimicrobials without necessitating CVAD removal. Klebsiella pneumoniae was the most common organism found in positive blood cultures. CONCLUSION CVAD-related infection in this Australian population was comparable to rates described in the medical literature. Ongoing surveillance for infection rates is important to provide an up-to-date assessment of risks associated with CVAD use in this population.
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Affiliation(s)
- Zhi Han Yeoh
- Henry Ekert Haemophilia Treatment Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
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23
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Josephson N. The hemophilias and their clinical management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2013; 2013:261-267. [PMID: 24319189 DOI: 10.1182/asheducation-2013.1.261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Outcomes for patients with hemophilia have improved dramatically over the past 50 years. With the increased availability of safe clotting factor concentrates, the primary focus in clinical management is now the prevention of long-term complications, most notably the debilitating hemophilic arthropathy that is associated with severe disease. This article reviews evidence-based approaches for managing both children and adults with hemophilia. Definitive evidence of improved clinical results from primary prophylaxis started in young patients with severe hemophilia A and a minimal bleeding history is presented. Furthermore, recent studies showing benefits for initiating prophylaxis in older adolescents and adults with established joint disease are examined. Inhibitors to factor VIII are the most problematic complication of factor replacement therapy. Patient-specific and treatment-related factors that contribute to the risk of inhibitor formation are discussed and controversies and clinical evidence related to approaches for tolerance induction are reviewed.
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Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A. Guidelines for the management of hemophilia. Haemophilia 2012; 19:e1-47. [PMID: 22776238 DOI: 10.1111/j.1365-2516.2012.02909.x] [Citation(s) in RCA: 1274] [Impact Index Per Article: 106.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 01/23/2023]
Affiliation(s)
- A. Srivastava
- Department of Hematology; Christian Medical College; Vellore; India
| | - A. K. Brewer
- Department of Oral Surgery; The Royal Infirmary; Glasgow; Scotland
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek and Department of Hematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill; NC; USA
| | - S. Kitchen
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - A. Llinas
- Department of Orthopaedics and Traumatology; Fundación Santa Fe University Hospital Fundación Cosme y Damián and Universidad de los Andes and Universidad del Rosario; Bogotá; Colombia
| | - C. A. Ludlam
- Comprehensive Care Haemophilia and Thrombosis Centre; Royal Infirmary; Edinburgh; UK
| | - J. N. Mahlangu
- Haemophilia Comprehensive Care Centre; Johannesburg Hospital and Department of Molecular Medicine and Haematology; Faculty of Health Sciences; National Health Laboratory Services and University of the Witwatersrand; Johannesburg; South Africa
| | - K. Mulder
- Bleeding Disorders Clinic; Health Sciences Center; Winnipeg; Canada
| | - M. C. Poon
- Departments of Medicine; Pediatrics and Oncology, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary, Foothills Hospital and Calgary Health Region; Calgary; Canada
| | - A. Street
- Haematology; Alfred Hospital; Melbourne; Victoria; Australia
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25
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COPPOLA A, FRANCHINI M, MAKRIS M, SANTAGOSTINO E, DI MINNO G, MANNUCCI PM. Thrombotic adverse events to coagulation factor concentrates for treatment of patients with haemophilia and von Willebrand disease: a systematic review of prospective studies. Haemophilia 2012; 18:e173-87. [DOI: 10.1111/j.1365-2516.2012.02758.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gringeri A, Muça-Perja M, Mangiafico L, von Mackensen S. Pharmacotherapy of haemophilia A. Expert Opin Biol Ther 2011; 11:1039-53. [PMID: 21682657 DOI: 10.1517/14712598.2011.570006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Haemophilia A is due to factor VIII (FVIII) deficiency. The main treatment is replacement therapy with FVIII concentrates. However, these concentrates carried a high risk of blood-borne viral infections and still have a high risk of inducing anti-FVIII inhibitors. AREAS COVERED An overview of products available and therapeutic options for haemophilia A management in order to help in decision making. A literature search using Medline with the keywords: 'haemophilia', 'factor VIII', 'therapy', 'inhibitor', 'concentrate', 'bleeding', 'prophylaxis', 'on demand', 'plasma-derived', 'recombinant', 'coagulation factors', 'immunotolerance' was performed. The years 1960 - 2010 are included. EXPERT OPINION Progress in management of patients with haemophilia A has allowed increased life expectancy and quality of life. There is evidence that prophylaxis prevents or, at least, slows down arthropathy development when started early in childhood. FVIII concentrates have achieved high levels of blood-borne pathogen safety. However, treatment is frequently complicated by development of FVIII-neutralizing inhibitors, which prevent control of bleeding and predispose to a high morbidity and mortality risk. Bypassing agents are effective in bleeding treatment in a high percentage of cases. Prophylaxis with bypassing agents and their use in combination are offering opportunities in management of inhibitor patients. More evidence is necessary to understand how to prevent and manage this complication.
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DUNN AL. Pathophysiology, diagnosis and prevention of arthropathy in patients with haemophilia. Haemophilia 2011; 17:571-8. [DOI: 10.1111/j.1365-2516.2010.02472.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coppola A, Di Capua M, Di Minno MND, Di Palo M, Marrone E, Ieranò P, Arturo C, Tufano A, Cerbone AM. Treatment of hemophilia: a review of current advances and ongoing issues. J Blood Med 2010; 1:183-95. [PMID: 22282697 PMCID: PMC3262316 DOI: 10.2147/jbm.s6885] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Indexed: 01/27/2023] Open
Abstract
Replacement of the congenitally deficient factor VIII or IX through plasma-derived or recombinant concentrates is the mainstay of treatment for hemophilia. Concentrate infusions when hemorrhages occur typically in joint and muscles (on-demand treatment) is able to resolve bleeding, but does not prevent the progressive joint deterioration leading to crippling hemophilic arthropathy. Therefore, primary prophylaxis, ie, regular infusion of concentrates started after the first joint bleed and/or before the age of two years, is now recognized as first-line treatment in children with severe hemophilia. Secondary prophylaxis, whenever started, aims to avoid (or delay) the progression of arthropathy and improve patient quality of life. Interestingly, recent data suggest a role for early prophylaxis also in preventing development of inhibitors, the most serious complication of treatment in hemophilia, in which multiple genetic and environmental factors may be involved. Treatment of bleeds in patients with inhibitors requires bypassing agents (activated prothrombin complex concentrates, recombinant factor VIIa). However, eradication of inhibitors by induction of immune tolerance should be the first choice for patients with recent onset inhibitors. The wide availability of safe factor concentrates and programs for comprehensive care has now resulted in highly satisfactory treatment of hemophilia patients in developed countries. Unfortunately, this is not true for more than two-thirds of persons with hemophilia, who live in developing countries.
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Affiliation(s)
- Antonio Coppola
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
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29
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Coppola A, Di Minno MND, Santagostino E. Optimizing management of immune tolerance induction in patients with severe haemophilia A and inhibitors: towards evidence-based approaches. Br J Haematol 2010; 150:515-28. [DOI: 10.1111/j.1365-2141.2010.08263.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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30
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Coppola A, Franchini M, Di Palo M, Marrone E, Di Perna C, Tagliaferri A. Enabling normal psychophysical development in children with hemophilia: the choice for prophylaxis. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/phe.10.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hemophilia A and B, the congenital deficiencies of coagulation factors VIII and IX, are characterized by recurrent joint and muscle bleeding episodes and progressive musculoskeletal damage (hemophilic arthropathy). Primary prophylaxis – that is, the regular infusion of factor concentrates after the first hemarthrosis and/or before 2 years of age – is now recognized as the first-choice treatment for children with severe hemophilia. Preventing bleeding from an early age enables avoidance of the clinical impact of hemophilic arthropathy and the consequences regarding psychosocial development and quality of life for these children. Interestingly, recent data suggest a role for early prophylaxis in also preventing inhibitor development, the most serious complication of treatment in hemophilia. Secondary prophylaxis, initiated after 2 years of age or after two or more joint bleeds, aims to avoid (or delay) the progression of arthropathy. In addition, better outcomes and better quality of life have been reported with earlier treatment. This review summarizes the evidence, current clinical strategies and open issues regarding prophylxis in children with hemophilia.
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Affiliation(s)
- Antonio Coppola
- Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Via S. Pansini, 5-80131 Naples, Italy
| | - Massimo Franchini
- Immunohematology & Transfusion Center, Department of Pathology & Laboratory Medicine, University Hospital, Parma, Italy
| | - Mariagiovanna Di Palo
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Emiliana Marrone
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Caterina Di Perna
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy
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CARCAO M, CHAMBOST H, LJUNG R. Devising a best practice approach to prophylaxis in boys with severe haemophilia: evaluation of current treatment strategies. Haemophilia 2010; 16 Suppl 2:4-9. [DOI: 10.1111/j.1365-2516.2009.02196.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Franchini M, Lippi G. Factor V Leiden and hemophilia. Thromb Res 2010; 125:119-23. [DOI: 10.1016/j.thromres.2009.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/02/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
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Abstract
Surgery in infants and young children with haemophilia, when preceded by accurate diagnosis and accompanied by safe and effective factor prophylaxis, is not associated with a significant risk of haemorrhage. Haemophilic newborns undergoing circumcision or major surgery prior to diagnosis and in the absence of appropriate haemostatic prophylaxis remain as a concern. Inhibitor development has replaced haemorrhage as the major surgical complication in the developed world, largely because of the intensity of treatment used to secure haemostasis. For that reason only, essential surgery should be performed. Intracranial haemorrhage (ICH) during the neonatal period affects 3.5-4.0% of all haemophilia boys in countries with a good standard of health care, which is considerably (40-80 times) higher than expected in the normal population. Because of the high frequency of sporadic cases, ICH in the neonatal period can only be partially prevented by improved carrier diagnosis and counselling. Infections and thrombosis are the major serious complications of central venous lines. Large differences are seen in the frequency of these complications, the most plausible explanations are probably related to the protocol used for device care, the quality of education and the compliance of the users, an issue addressed in an on-going study.
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Affiliation(s)
- R Ljung
- Departments of Paediatric, Lund University, University Hospital, Malmö, Sweden.
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35
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Park Y. Availability of peripheral inserted central catheters in severe hemophilia patients with inhibitors. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.12.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Youngshil Park
- Department of Pediatrics, East-West Neo Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
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