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Álvarez-Román MT, Nuñez Vazquez RJ, Benitez Hidalgo O, Quintana Paris L, Entrena Ureña L, Lopez Jaime FJ, la De Corte-Rodríguez H, García Dasí M, Bosch P, Mingot Castellano ME, Guerra Garaeta I, Soto-Ortega I. Humanistic burden of haemophilia A without inhibitors: A cross-sectional analysis of the HemoLIFE study. Haemophilia 2024; 30:950-958. [PMID: 38825766 DOI: 10.1111/hae.15057] [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: 10/16/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 06/04/2024]
Abstract
AIM To evaluate the impact of haemophilia A without inhibitors on humanistic outcomes in patients and caregivers. Herein, we report a cross-sectional analysis of the baseline data of persons with haemophilia (PWH) participating in the prospective study HEMOLIFE. METHODS These data are part of a prospective, observational, and multicentre study currently being conducted in 20 hospitals in Spain by haematologists. We included subjects 12 years or older diagnosed with haemophilia. The evaluations included the Maladjustment Scale, Haemophilia-Specific Quality of Life Questionnaire for Adults (HaemoQol)/HaemoQol Short Form (Children), haemophilia-specific version of the Work Productivity and Impairment Questionnaire plus the Classroom Impairment Questionnaire (WPAI+CIQ:HS), Haemophilia Activity List (HAL)/Paediatric Haemophilia Activities List (pedHAL), visual analogue scale (VAS) for evaluating pain, Coping Pain Questionnaire-Reduced (CAD-R), and Hospital Anxiety and Depression Scale (HADS). RESULTS A total of 81 PWH were recruited at 18 centres; 66 PWH were ≥18 years (i.e., adults), and PWH 15 were <18 years (i.e., paediatric patients). Out of the 79 evaluable subjects, 16 (20%) showed an impact of haemophilia on daily life, and the areas most affected were "leisure time" (58% showed maladjustment) and "work/studies" (47% showed maladjustment). Patients reported a higher impact of haemophilia on quality of life (mean [SD] of the transformed score) in the dimensions of "sport" (49.4 [28.6]), "physical health" (40.5 [25.8]) and "future" (37.7 [28.9]). In adults, according to HAL scores, greater impairment of function was observed in "lying/sitting/kneeling/standing," "function of legs" and "leisure activities and sports," with mean normalized scores of 64.7, 65.1 and 69.0, respectively. Productivity was mostly impacted by presenteeism. The pain was infrequent and moderate. According to the HADS scores, nine (11.5%) patients had clinical anxiety and depression. CONCLUSION PWH without inhibitors exhibited impairments in adjustment, quality of life and functionality, especially related to leisure and sports activities, and exhibit relevant levels of anxiety and depression.
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Affiliation(s)
| | | | - Olga Benitez Hidalgo
- Servicio de Hematología, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Quintana Paris
- Unidad de Hematología y Hemoterapia, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Laura Entrena Ureña
- Servicio de Hematología y Hemoterapia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Hortensia la De Corte-Rodríguez
- Physical and Rehabilitation Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Institute for Health Research, Madrid, Spain
| | - María García Dasí
- General Health Psychologist, Freelance Independent Consultor, Valencia, Spain
| | - Pau Bosch
- Unidad de Trombosis y Hemostasia, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - María Eva Mingot Castellano
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | | | - Inmaculada Soto-Ortega
- Sección de Hemostasia y Trombosis, Hospital Universitario Central de Asturias, Oviedo, Spain
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Madan B, Ozelo MC, Raheja P, Symington E, Quon DV, Leavitt AD, Pipe SW, Lowe G, Kenet G, Reding MT, Mason J, Wang M, von Drygalski A, Klamroth R, Shapiro S, Chambost H, Dunn AL, Oldenburg J, Chou SC, Peyvandi F, Millar CM, Osmond D, Yu H, Dashiell-Aje E, Robinson TM, Mahlangu J. Three-year outcomes of valoctocogene roxaparvovec gene therapy for hemophilia A. J Thromb Haemost 2024; 22:1880-1893. [PMID: 38614387 DOI: 10.1016/j.jtha.2024.04.001] [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: 11/03/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Valoctocogene roxaparvovec transfers a human factor (F)VIII coding sequence into hepatocytes of people with severe hemophilia A to provide bleeding protection. OBJECTIVES To present 3-year efficacy and safety in the multicenter, open-label, single-arm, phase 3 GENEr8-1 trial. METHODS GENEr8-1 enrolled 134 adult males with severe hemophilia A who were receiving FVIII prophylaxis. Efficacy endpoints included annualized bleeding rate, annualized FVIII utilization, FVIII activity (chromogenic substrate assay; imputed as 1 IU/dL at baseline and 0 IU/dL after discontinuation), and the Haemophilia-Specific Quality of Life Questionnaire for Adults. Safety was assessed by adverse events (AEs). RESULTS At week 156, 131 of 134 participants remained in the study; overall, 17 of 134 resumed prophylaxis. Mean annualized bleeding rate for treated bleeds decreased from 4.8 (SD, 6.5) bleeds/y at baseline to 0.8 (SD, 2.3; P < .0001) bleeds/y after prophylaxis (prophylaxis cessation to last follow-up) and 0.97 (SD, 3.48) bleeds/y during year 3. Annualized FVIII utilization decreased 96.8% from baseline after prophylaxis and 94.2% during year 3. At week 156, mean and median FVIII activity were 18.4 (SD, 30.8) and 8.3 IU/dL, respectively. FVIII activity decrease was lower between years 2 and 3 than between years 1 and 2. At the end of year 3, clinically meaningful improvements in the Haemophilia-Specific Quality of Life Questionnaire for Adults Total Score were observed (mean change from baseline, 6.6; 95% CI, 4.24-8.87; P < .0001). Mild alanine aminotransferase elevations remained the most common AE during year 3 (23.7% of participants). A serious AE of B-cell acute lymphoblastic leukemia was considered unrelated to treatment. CONCLUSION Hemostatic efficacy was maintained, and safety remained unchanged from previous years.
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Affiliation(s)
- Bella Madan
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' National Health Service Trust, London, United Kingdom.
| | - Margareth C Ozelo
- Hemocentro University of Campinas, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Priyanka Raheja
- Haemophilia Centre, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Emily Symington
- Haemophilia Centre, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Doris V Quon
- Orthopaedic Hemophilia Treatment Center, Los Angeles, California, USA
| | - Andrew D Leavitt
- Hemophilia Treatment Center, University of California San Francisco, San Francisco, California, USA
| | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gillian Lowe
- West Midlands Adult Haemophilia Comprehensive Care Centre, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Gili Kenet
- The National Hemophilia Center and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Tel Aviv University, Tel Aviv, Israel
| | - Mark T Reding
- Center for Bleeding and Clotting Disorders, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jane Mason
- Queensland Haemophilia Centre, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Wang
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Robert Klamroth
- Vascular Medicine and Haemostaseology, Vivantes Klinikum im Friedrichshain, Berlin, Germany; Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Susan Shapiro
- Blood Theme Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Hervé Chambost
- AP-HM, Department of Pediatric Hematology Oncology, Children Hospital La Timone & Aix Marseille University, Institut national de la santé et de la recherche médicale, Institut national de la recherche agronomique, Centre recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Amy L Dunn
- The Division of Hematology, Oncology, and Blood and Marrow Transplantation at Nationwide Children's Hospital and Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine and Center for Rare Diseases, University Hospital Bonn, Bonn, Germany
| | - Sheng-Chieh Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico and Fondazione Luigi Villa, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carolyn M Millar
- Centre for Haematology, Imperial College London, London, United Kingdom; Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Dane Osmond
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | - Hua Yu
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | | | | | - Johnny Mahlangu
- Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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Benemei S, Boni L, Castaman G. Outcome measures in hemophilia: current and future perspectives. Expert Rev Hematol 2024; 17:329-340. [PMID: 38861342 DOI: 10.1080/17474086.2024.2365929] [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: 12/20/2023] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Hemophilia can detrimentally affect patients' quality of life and likelihood of survival. In the evolving landscape of therapies, the therapeutic gain of each treatment must be understood to accurately position it in the therapeutic armamentarium. Accordingly, appropriate outcomes must be measured with appropriate tools. AREAS COVERED Our narrative review (PubMed search for 'hemophilia AND outcome' until June 2023), provides a compendium of outcome measures used in hemophilia clinical research. To define each outcome measure's relative value and applicability, several characteristics are critically discussed. EXPERT OPINION Bleeding assessment, first annual/annualized bleeding rate, remains central in evaluating the efficacy and safety of hemophilia treatments. As modern therapies improve clinical outcomes toward zero bleeding events, this endpoint may become less sensitive to detect differences between therapeutic approaches. Technological advancements necessitate the adaptation of outcome measures to address infrequent bleeding events, age-related comorbidities, and laboratory parameters with limited comparability after different treatments. Considerable effort has been dedicated to the development of tools that comprehensively assess coagulation, such as thrombin generation assays. Patient-reported outcome measures are gaining importance although limited by their subjectivity. A definitive set of research outcome measures remains elusive. Outcomes may need to be tailored to different therapeutic interventions.
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Affiliation(s)
| | - Luca Boni
- U.O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
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Feldberg G, Ricciardi JBS, Zorzi AR, Yamaguti-Hayakawa GG, Ozelo MC. Promoting pain coping skills in haemophilia: A remote intervention integrating exercise and pain education. Haemophilia 2024; 30:800-808. [PMID: 38523258 DOI: 10.1111/hae.14991] [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: 11/02/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Chronic joint pain is a significant and widespread symptom in people with haemophilia (PWH). Despite medical advancements, effective pain management remains challenging. AIM This study presents an innovative approach that integrates remote physical exercises, pain neuroscience education, and coping strategies to address chronic pain in PWH. METHODS The remote intervention consisted of sixteen 5-min videos encompassing physical exercises for chronic pain management and pain education strategies. These videos formed an 8-week remote intervention program. Clinical and physical assessments were conducted before and after the intervention. RESULTS A total of thirty-one PWHs, with a median age of 34 years (ranging from 16 to 59 years), completed the remote intervention. The study revealed significant improvements in pain intensity, disability, and physical performance among PWH with chronic pain. Enhanced functional capacity was evident in the Timed Up and Go and Single Leg Stance tests, accompanied by improved scores on the Functional Independence Score in Haemophilia (FISH). Although lacking a control group, our findings are consistent with other successful exercise and pain education programs. CONCLUSIONS This innovative intervention holds promise for managing chronic pain in PWH, underscoring patient empowerment, education, and collaboration. Notably, our study stands out by uniquely combining pain education and coping strategies, bolstering evidence for effective pain management.
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Affiliation(s)
- Glenda Feldberg
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Janaína B S Ricciardi
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Alessandro R Zorzi
- Department of Orthopedic, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil
| | - Gabriela G Yamaguti-Hayakawa
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Margareth C Ozelo
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
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Srichumpuang C, Rakmanotham A, Moonla C, Sosothikul D. Moderate- to vigorous-intensity physical activities for hemophilia A patients during low-dose pharmacokinetic-guided extended half-life factor VIII prophylaxis. Orphanet J Rare Dis 2024; 19:135. [PMID: 38532451 DOI: 10.1186/s13023-024-03092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Low-dose pharmacokinetic (PK)-guided extended half-life (EHL) factor VIII (FVIII) prophylaxis can reduce the bleeding risk in hemophilia A (HA) patients. An increase in physical activities for promoting musculoskeletal health may enhance the benefits of prophylactic therapy. OBJECTIVES To determine the clinical impact of moderate- to vigorous-intensity physical activities in HA patients during low-dose PK-guided EHL FVIII prophylaxis. PATIENTS/METHODS This prospective study enrolled patients with moderate/severe HA (baseline FVIII levels ≤ 5 IU/dL) who had received low-dose PK-guided EHL FVIII prophylaxis for ≥ 6 months. An individualized exercise protocol was introduced to each participant, targeting a 65% increase in the maximum predicted heart rate for ≥ 150 min/week, while continuing low-dose PK-guided EHL FVIII prophylaxis for 6 months. Before and after implementing the intervention, annualized bleeding rates (ABR), annualized joint bleeding rates (AJBR), Hemophilia Joint Health Scores (HJHS), skeletal muscle mass, hemophilia-specific quality-of-life (QoL) scores and annualized FVIII consumption were compared. RESULTS Of 13 participants (mean age ± standard deviation [SD]: 20.1 ± 6.8 years), ABR, AJBR, and HJHS were significantly reduced (mean differences [MD] ± SD: -5.7 ± 2.6 bleeds/year, -4.2 ± 2.6 joint bleeds/year, and -4.3 ± 3.2 marks, respectively; P < 0.05) after applying the 6-month exercise protocol. Skeletal muscle mass and QoL scores had also improved (P = 0.001), while FVIII usage had decreased (MD ± SD: -129.1 ± 208.7 IU/kg/year; P < 0.05). CONCLUSIONS The combination of moderate- to vigorous-intensity physical activities with low-dose PK-guided EHL FVIII prophylaxis improves bleeding prevention, musculoskeletal status and QoL in patients with moderate/severe HA. By minimizing FVIII consumption, this strategy helps optimize hemophilia care in countries with budget constraints. CLINICALTRIALS gov NCT05728528.
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Affiliation(s)
- Chonlatis Srichumpuang
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Integrative and Innovative Hematology/Oncology Research Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Arunothai Rakmanotham
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Integrative and Innovative Hematology/Oncology Research Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chatphatai Moonla
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Darintr Sosothikul
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- Integrative and Innovative Hematology/Oncology Research Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Maimon E, Widjajanto PH, Sitaresmi MN. Health-related quality of life of Indonesian children with hemophilia. Haemophilia 2024; 30:463-469. [PMID: 38240018 DOI: 10.1111/hae.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 10/20/2023] [Accepted: 12/30/2023] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Measuring health-related quality of life (HRQoL) in haemophilia patients provides a comprehensive patient's functional and the impact of the disease and its treatment. AIM This study aimed to assess the HRQoL of haemophilia children and related factors. METHODS We conducted a cross-sectional study from 6 April 2019 to 29 April 2019. We recruited children aged 8-16 years old who were members of the Yogyakarta Province Branch, Indonesian Haemophilia Society. Children filled in the Indonesian Haemo-QoL short-version questionnaire that consists of nine dimensions, and the score ranges from 0 to 100, in which a higher score shows a higher impartment. RESULTS Forty-four children participated in this study. The mean age was 11.99 + 2.49. The median age of the first bleeding episode was 5 years, and the median frequency of spontaneous bleeding during the previous year was 13.5. All children received antihemophilic factor (AHF) on-demand; most (81.8%) received AHF in the advanced symptoms. The mean total score of HRQoL was 42.7 ± 15.5, with the highest impairment in the family dimension, with a mean score of 68.0 ± 22.3. The severity of haemophilia was significantly correlated with the total score of HRQoL and dimensions of physical health, feeling, view, and family (effect size ranges from 0.30 to 0.42). The frequency of bleeding was significantly related to the total score of HRQoL and the feeling dimension (effect size of 0.47 and 0.34). CONCLUSION The HRQoL of our study was lower than in countries where AHF prophylactic is provided. More severe haemophilia and more frequent bleeding significantly lower HRQoL.
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Affiliation(s)
- Elsa Maimon
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Department of Child Health, Dr. Kanoejoso General Hospital, Balikpapan, Indonesia
| | - Pudjo Hagung Widjajanto
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Hay CRM, Makris M, Shima M, Nagao A, Jiménez-Yuste V, Skinner M, Kessler CM, von Mackensen S. Association of patient, treatment and disease characteristics with patient-reported outcomes: Results of the ECHO Registry. Haemophilia 2024; 30:106-115. [PMID: 38030962 DOI: 10.1111/hae.14895] [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: 07/07/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) in people living with haemophilia A (PLWHA) are often under-reported. Investigating PROs from a single study with a diverse population of PLWHA is valuable, irrespective of FVIII product or regimen. AIM To report available data from the Expanding Communications on Haemophilia A Outcomes (ECHO) registry investigating the associations of patient, treatment and disease characteristics with PROs and clinical outcomes in PLWHA. METHODS ECHO (NCT02396862), a prospective, multinational, observational registry, enrolled participants aged ≥16 years with moderate or severe haemophilia A using any product or treatment regimen. Data collection, including a variety of PRO questionnaires, was planned at baseline and annually for ≥2 years. Associations between PRO scores and patient, treatment and disease characteristics were determined by statistical analyses. RESULTS ECHO was terminated early owing to logistical constraints. Baseline data were available from 269 PLWHA from Europe, the United States and Japan. Most participants received prophylactic treatment (76.2%), with those using extended-half-life products (10.0%) reporting higher treatment satisfaction. Older age and body weight >30 kg/m2 (>BMI) were associated with poorer joint health. Older age was associated with poorer physical functioning and work productivity. Health-related quality of life and pain interference also deteriorated with age and >BMI; >BMI also increased pain severity scores. CONCLUSION ECHO captured a variety of disease characteristics, treatment patterns, PROs and clinical outcomes obtained in real-world practice with ≤1 year's follow-up. Older age, poorer joint health and >BMI adversely affected multiple aspects of participant well-being.
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Affiliation(s)
- Charles R M Hay
- Manchester University Department of Haematology, Manchester, UK
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Mark Skinner
- Institute for Policy Advancement Ltd., Washington, DC, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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O'Mahony B, Dunn AL, Leavitt AD, Peyvandi F, Ozelo MC, Mahlangu J, Peerlinck K, Wang JD, Lowe GC, Tan CW, Giermasz A, Tran H, Khoo TL, Cockrell E, Pepperell D, Chambost H, López Fernández MF, Kazmi R, Majerus E, Skinner MW, Klamroth R, Quinn J, Yu H, Wong WY, Robinson TM, Pipe SW. Health-related quality of life following valoctocogene roxaparvovec gene therapy for severe hemophilia A in the phase 3 trial GENEr8-1. J Thromb Haemost 2023; 21:3450-3462. [PMID: 37678546 DOI: 10.1016/j.jtha.2023.08.032] [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: 12/13/2022] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Severe hemophilia A (HA) negatively impacts health-related quality of life (HRQOL). OBJECTIVES We aimed to analyze HRQOL in adult men with severe HA without inhibitors after valoctocogene roxaparvovec gene transfer in the phase 3 trial GENEr8-1. METHODS Participant-reported outcomes were the hemophilia-specific quality of life questionnaire for adults (Haemo-QOL-A), the EQ-5D-5L instrument, the Hemophilia Activities List (HAL), and the Work Productivity and Activity Impairment Questionnaire: Hemophilia Specific (WPAI+CIQ:HS). Participants completed the questionnaires at baseline and through 104 weeks postinfusion with 6 × 1013 vg/kg of valoctocogene roxaparvovec. Scores were analyzed per participant characteristics and outcomes. RESULTS For 132 HIV-negative participants, mean change from baseline in Haemo-QOL-A Total Score met the anchor-based clinically important difference (CID: 5.5) by week 12; the mean (SD) increase was 7.0 (12.6) at week 104. At week 104, improvement in Consequences of Bleeding, Treatment Concern, Worry, and Role Functioning domain scores exceeded the CID (6). EQ-5D-5L Utility Index scores improved above the CID at week 52, but not at week 104. EQ-5D-5L visual analog scale and HAL scores increased from baseline to week 104. Participants reported less activity and work impairment at week 104 than baseline. Participants with problem joints had lower mean baseline Haemo-QOL-A Total and domain scores than those without them, but improved over 104 weeks, except for 11 participants with ≥3 problem joints. Participants with 0 bleeds during the baseline prophylaxis period reported Haemo-QOL-A score improvements above the CID, including in the Consequences of Bleeding domain. CONCLUSION Valoctocogene roxaparvovec provided clinically meaningful HRQOL improvement for men with severe HA.
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Affiliation(s)
- Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland; Trinity College, Dublin, Ireland.
| | - Amy L Dunn
- The Division of Hematology, Oncology, and BMT at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrew D Leavitt
- University of California San Francisco, San Francisco, California, USA
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Margareth C Ozelo
- Hemocentro UNICAMP, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Johnny Mahlangu
- Hemophilia Comprehensive Care Center, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand and NHLS, Johannesburg, South Africa
| | - Kathelijne Peerlinck
- Department of Vascular Medicine and Haemostasis and Haemophilia Centre, University Hospitals Leuven, Leuven, Belgium
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gillian C Lowe
- West Midlands Comprehensive Care Haemophilia Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Chee Wee Tan
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Adam Giermasz
- Hemophilia Treatment Center, University of California Davis, Sacramento, California, USA
| | - Huyen Tran
- Haemostasis & Thrombosis Unit, Haemophilia Treatment Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Teh-Liane Khoo
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Erin Cockrell
- Pediatric Hematology Oncology, Saint Joseph's Children's Hospital, Tampa, Florida, USA
| | - Dominic Pepperell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Hervé Chambost
- AP-HM, Department of Pediatric Hematology Oncology, Children Hospital La Timone & Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | | | - Rashid Kazmi
- Department of Haematology, Southampton University Hospital, Southampton, UK
| | - Elaine Majerus
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mark W Skinner
- Institute for Policy Advancement Ltd, Washington, DC, USA; McMaster University, Hamilton, Ontario, Canada
| | - Robert Klamroth
- Comprehensive Care Haemophilia Treatment Center, Vivantes Klinikum im Friedrichshain, Berlin, Germany; Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Germany
| | | | - Hua Yu
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc, Novato, California, USA
| | | | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
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9
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Geng BF, Feng C, Liu SG, Jiang ZL, Lin F. Haemophilia item bank based on International Classification of Functioning, Disability and Health: a systematic review. Hematology 2023; 28:2191077. [PMID: 36946880 DOI: 10.1080/16078454.2023.2191077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Haemophilia comprises a continuum of blood disorders that often include joint and muscular dysfunction, which may lead to a constellation of activity limitations and participation restrictions. However, there is scant research incorporating functional assessment scales into the common language provided by the International Classification of Functioning, Disability and Health (ICF). This study aims to identify the ICF categories to include in an item bank of functioning aspects relevant for haemophilia. DESIGN AND METHODS A systematic search was carried out in July 2021 based on the PubMed MEDLINE, CLINICAL, and Cochrane databases for qualified articles, investigating haemophilia-specific scales and the scales recommended by the World Federation of Haemophilia (WFH) linked to ICF categories between 2001 and 2021. Well-trained healthcare professionals in the haemophilia field and ICF evaluation conducted group discussions to determine the ICF items for haemophilia. RESULTS A total of 112 out of 176 items measuring function were collected for the haemophilia ICF item bank, including 32 items for body function (b), 45 items for activity and participation (d), 27 items for environmental factors (e), and 8 items for body structure(s). INTERPRETATION AND CONCLUSIONS We recommend that future haemophilia research use the haemophilia-specific ICF item bank, which could capture a whole spectrum of functional measurements and facilitate multidisciplinary and worldwide communication. This study also indicates that further development and analysis of the psychometric properties of the 112 haemophilia-related ICF items is warranted.
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Affiliation(s)
- Bao-Feng Geng
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Chun Feng
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Rehabilitation Hospital Affiliated to Tongji University, Shanghai, People's Republic of China
| | - Shou-Guo Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhong-Li Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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10
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Charafi L, Campanella L, Shay B, Rabatin A, Hughes A, Kennerly-Shah J. Expanding Pharmacy Services to the Hemophilia Treatment Center. Hosp Pharm 2023; 58:415-419. [PMID: 37711404 PMCID: PMC10498975 DOI: 10.1177/00185787231163262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Background: Hemophilia treatment centers (HTC) are multidisciplinary clinics that serve as medical homes for patients with hemophilia and other bleeding or clotting disorders. Traditionally, hemophilia treatment center teams have included hematologists, social workers, nurse coordinators, physical therapists, and in some instances, other healthcare professionals. Objective: This report describes the role of clinical pharmacy services added at 2 HTCs. Method: Retrospective review of services provided by pharmacists integrated into the care team conducted at 2 HTCs. Conclusions: Pharmacists have the knowledge and training to positively contribute to the care of hemophilia treatment center patients. Specifically, with expertise in therapeutic drug monitoring, pharmacokinetics and patient counseling, pharmacists have the ability to manage the cost of care by promoting adherence, minimizing emergency department visits, and assisting providers in formulating optimal treatment plans to improve care for this patient population.
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Affiliation(s)
| | | | - Blake Shay
- BayCare Health Systems Inc., Tampa, FL, USA
| | - Abigail Rabatin
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | | | - Julie Kennerly-Shah
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
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11
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Rasul E, Hallock R, Hellmann M, Konduros J, Pembroke L, LeCleir G, Malacan J, von Mackensen S. Gene Therapy in Hemophilia: A Transformational Patient Experience. J Patient Exp 2023; 10:23743735231193573. [PMID: 37663068 PMCID: PMC10472832 DOI: 10.1177/23743735231193573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Hemophilia is a bleeding disorder caused by a single absent/defective gene and characterized by a lack of functional clotting factors. People with hemophilia may experience joint damage, pain, and psychological impairments, all of which could contribute to reduced health-related quality of life (HRQoL). The current standard of care is clotting factor replacement, which is associated with regular infusions; therefore, alternative treatments such as gene therapy (GT) are in development. GT involves the delivery of a functional copy of the clotting factor 8/9 gene by a single infusion into the patient's cells, enabling them to produce their own clotting factor VIII/IX. The impact of treatment on patients' HRQoL can be assessed using hemophilia-specific patient-reported outcome (PRO) measures. Since these measures were designed before the advent of GT, there is a need for updated individualized PRO measures. Patient groups and regulatory authorities emphasize the need for increased patient engagement when considering clinical trial design. Here, we provide patients' perspective on undergoing GT and discuss how to capture the patient voice when measuring the therapy's transformative impact.
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Affiliation(s)
- Enayet Rasul
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Ryan Hallock
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Magnus Hellmann
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Jay Konduros
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | - Luke Pembroke
- Patient author. Have either haemophilia A or B and have undergone gene therapy treatment
| | | | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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12
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Wilkins RA, Siddle HJ, Chapman GJ, Horn E, Walwyn R, Redmond AC. The impact of ankle haemarthropathy in patients with moderate haemophilia. Haemophilia 2023; 29:600-607. [PMID: 36528893 DOI: 10.1111/hae.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/17/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Moderate haemophilia has traditionally been associated with less complications than severe haemophilia. Changes in treatment recommendations have highlighted the burden of moderate haemophilia with a subset of patients with a severe bleeding phenotype. The ankle joint is disproportionally affected by ankle haemarthropathy however the impact has not been evaluated in moderate haemophilia, nor the effect on health related quality of life (HRQoL) or foot and ankle outcomes. AIMS To establish the impact of ankle haemarthropathy in patients with moderate haemophilia. METHODS A multicentre questionnaire study recruited patients from 11 haemophilia centres in England, Scotland and Wales. The HAEMO-QoL-A and Manchester-Oxford foot and ankle questionnaire (MOXFQ) with total and domain scores measured impact. Measures of pain and ankle haemophilia joint health (HJHS) scores were also collected. RESULTS Twenty-nine participants were recruited. HAEMO-QoL A mean (SD) total scores of 10.8 (5.2) of 100 (best health) and foot and ankle specific MOXFQ total scores of 45.5 (24.7) above zero (best outcome) indicate poor HRQoL and foot and ankle outcomes. Average ankle pain over past 6 months of (0-10) 5.5 (SD2.5) was reported and median (IQR) ankle HJHS of 3.0 (1;12.5) to 4.5 (0;9.5) for the left and right ankles. CONCLUSION HRQoL and foot and ankle specific outcomes are poor in patients with moderate haemophilia and ankle haemarthropathy, driven by chronic levels of ankle joint pain. Despite moderate haemophilia being considered less affected by haemarthrosis and haemarthropathy, patients with a bleeding or haemarthropathy phenotype are clinically similar to patients with severe haemophilia A.
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Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Horn
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Chuansumrit A, Sirachainan N, Jaovisidha S, Jiravichitchai T, Kadegasem P, Kempka K, Panuwannakorn M, Rotchanapanya W, Nuntiyakul T. Effectiveness of monthly low dose emicizumab prophylaxis without 4-week loading doses among patients with haemophilia A with and without inhibitors: A case series report. Haemophilia 2023; 29:382-385. [PMID: 36446746 DOI: 10.1111/hae.14707] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Ampaiwan Chuansumrit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphaneewan Jaovisidha
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tachit Jiravichitchai
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Praguywan Kadegasem
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ketsuda Kempka
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Monratta Panuwannakorn
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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14
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Chin B, Wee I, Syn NL, O'Neill GK, Yap ES, Koh PL. Surgery for chronic arthropathy in people with haemophilia. Cochrane Database Syst Rev 2022; 11:CD013634. [PMID: 36448638 PMCID: PMC9710191 DOI: 10.1002/14651858.cd013634.pub2] [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: 12/05/2022]
Abstract
BACKGROUND Chronic arthropathy is a potentially debilitating complication for people with haemophilia - a genetic, X-linked, recessive bleeding disorder, characterised by the absence or deficiency of a clotting factor protein. Staging classifications, such as the Arnold-Hilgartner classification for haemophilic arthropathy of the knee, radiologically reflect the extent of knee joint destruction with underlying chronic synovitis. Management of this highly morbid disease process involves intensive prophylactic measures, and chemical or radioisotope synovectomy in its early stages. However, failure of non-surgical therapy in people with progression of chronic arthropathy often prompts surgical management, including synovectomy, joint debridement, arthrodesis, and arthroplasty, depending on the type of joint and extent of the damage. To date, management of people with mild to moderate chronic arthropathy from haemophilia remains controversial; there is no agreed standard treatment. Thus, the benefits and disadvantages of non-surgical and surgical management of mild to moderate chronic arthropathy in people with haemophilia needs to be systematically reviewed. OBJECTIVES: To assess the efficacy and safety of surgery for mild to moderate chronic arthropathy in people with haemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, and two trial registers to August 2022. We also handsearched relevant journals and conference abstract books. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs comparing surgery and non-surgical interventions, for any joint with chronic arthropathy, in people with haemophilia, who were at least 12 years old. DATA COLLECTION AND ANALYSIS The review authors did not identify any trials to include in this review. MAIN RESULTS The review authors did not identify any trials to include in this review. AUTHORS' CONCLUSIONS The review authors did not identify any trials to include in this review. Due to a lack of research in this particular area, we plan to update the literature search every two years, and will update review if any new evidence is reported. There is a need for a well-designed RCT that assesses the safety and efficacy of surgical versus non-surgical interventions for chronic arthropathy in people with haemophilia.
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Affiliation(s)
- Brian Chin
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Ian Wee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Nicholas Lx Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Gavin K O'Neill
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Eng Soo Yap
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Pei Lin Koh
- Department of Paediatrics, National University Health System, Singapore, Singapore
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15
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Pascoal C, Ferreira I, Teixeira C, Almeida E, Slade A, Brasil S, Francisco R, Ligezka AN, Morava E, Plotkin H, Jaeken J, Videira PA, Barros L, dos Reis Ferreira V. Patient reported outcomes for phosphomannomutase 2 congenital disorder of glycosylation (PMM2-CDG): listening to what matters for the patients and health professionals. Orphanet J Rare Dis 2022; 17:398. [PMID: 36309700 PMCID: PMC9618201 DOI: 10.1186/s13023-022-02551-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background Congenital disorders of glycosylation (CDG) are a growing group of rare genetic disorders. The most common CDG is phosphomannomutase 2 (PMM2)-CDG which often has a severe clinical presentation and life-limiting consequences. There are no approved therapies for this condition. Also, there are no validated disease-specific quality of life (QoL) scales to assess the heterogeneous clinical burden of PMM2-CDG which presents a challenge for the assessment of the disease severity and the impact of a certain treatment on the course of the disease. Aim and methods This study aimed to identify the most impactful clinical signs and symptoms of PMM2-CDG, and specific patient and observer reported outcome measures (PROMs and ObsROMs, respectively) that can adequately measure such impact on patients’ QoL. The most burdensome signs and symptoms were identified through input from the CDG community using a survey targeting PMM2-CDG families and experts, followed by family interviews to understand the real burden of these symptoms in daily life. The list of signs and symptoms was then verified and refined by patient representatives and medical experts in the field. Finally, a literature search for PROMs and ObsROMs used in other rare or common diseases with similar signs and symptoms to those of PMM2-CDG was performed. Results Twenty-four signs/symptoms were identified as the most impactful throughout PMM2-CDG patients’ lifetime. We found 239 articles that included tools to measure those community-selected PMM2-CDG symptoms. Among them, we identified 80 QoL scales that address those signs and symptoms and, subsequently, their psychometric quality was analysed. These scales could be applied directly to the PMM2-CDG population or adapted to create the first PMM2-CDG-specific QoL questionnaire. Conclusion Identifying the impactful clinical manifestations of PMM2-CDG, along with the collection of PROMs/ObsROMs assessing QoL using a creative and community-centric methodology are the first step towards the development of a new, tailored, and specific PMM2-CDG QoL questionnaire. These findings can be used to fill a gap in PMM2-CDG clinical development. Importantly, this methodology is transferable to other CDG and rare diseases with multiple signs and symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02551-y.
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16
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Quinn J, Delaney KA, Wong WY, Miesbach W, Bullinger M. Psychometric Validation of the Haemo-QOL-A in Participants with Hemophilia A Treated with Gene Therapy. Patient Relat Outcome Meas 2022; 13:169-180. [PMID: 35879931 PMCID: PMC9307866 DOI: 10.2147/prom.s357555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The hemophilia-specific health-related quality of life (HRQOL) questionnaire (Haemo-QOL-A) is validated for detecting QOL changes following standard therapy for hemophilia A, but has not been rigorously evaluated after gene therapy. This post hoc analysis evaluated the psychometric properties of Haemo-QOL-A in adult people with severe hemophilia A (PWSHA) receiving valoctocogene roxaparvovec (AAV5-hFVIII-SQ) in 2 clinical trials (phase 1/2, NCT02576795; phase 3, NCT03370913). Patients and Methods Adult PWSHA (factor VIII levels ≤1 IU/dL) received 1 AAV5-hFVIII-SQ infusion (6×1013 vg/kg). Participants were assessed using the Haemo-QOL-A and the EuroQOL (EQ)-5D-5L and visual analog scale (VAS) questionnaires pre- and post-infusion. Psychometric analyses included convergent and discriminant validity, internal consistency, and reliability. Clinically important difference (CID) was estimated using 3-point change in EQ-5D-5L VAS as anchor. Results Haemo-QOL-A data were analyzed from 7 (phase 1/2, 3-year follow-up) and 16 participants (phase 3, 26-week analysis). Change in Haemo-QOL-A Total Scores correlated with EQ-5D-5L VAS score change at 26 weeks (Pearson’s correlation 0.77). At 26 weeks, increased Haemo-QOL-A Physical Functioning was associated with decreased EQ-5D-5L Pain and Discomfort and decreased Anxiety and Depression (Spearman’s Rank correlations −0.73 and −0.62, respectively, P <0.01). Internal consistency analysis showed good reliability for all domains (Cronbach’s alpha >0.7) except Treatment Concern (Cronbach’s alpha = 0.31). Anchor-based CID estimates were met for Haemo-QOL-A Total Score (≥5.5) and domain scores (≥6) for Consequences of Bleeding, Physical Functioning, Role Functioning, and Worry. Conclusion Our preliminary results suggest that the Haemo‐QOL‐A is a valid, reliable instrument for HRQOL assessment in PWSHA undergoing gene therapy. Future research should be undertaken to confirm these findings in a larger number of participants.
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Affiliation(s)
- Jennifer Quinn
- BioMarin Pharmaceuticals UK Ltd, London, UK
- Correspondence: Jennifer Quinn, BioMarin Pharmaceuticals UK Ltd, 10 Bloomsbury Way, London, WC1A 2SL, UK, Tel +44 7976 129 039, Email
| | | | | | - Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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17
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Palao-Ocharan P, Prior N, Pérez-Fernández E, Caminoa M, Caballero T. Psychometric study of the SF-36v2 in hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE). Orphanet J Rare Dis 2022; 17:88. [PMID: 35236380 PMCID: PMC8889710 DOI: 10.1186/s13023-022-02202-2] [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: 09/20/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The generic 36-item Short-Form Health Survey (SF-36v2) has been used to assess health related quality of life in adult patients with hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) even though it has not yet been validated for use in this specific disease. OBJECTIVE This study aims to validate the SF-36v2 for use in adult patients with C1-INH-HAE. RESULTS There was a very low item non-response rate (1-3.4%), with a high ceiling effect in 25/35 items and a low floor effect in 3/35 items. A moderate ceiling effect was observed in 5/8 dimensions of the SF-36v2, whereas no floor effect was noticed in any of the dimensions. Internal consistency was good to excellent with Cronbach's alpha coefficient ranging between 0.82 and 0.93 for the different dimensions. Construct validity was good: seven out of the 8 hypotheses defined on clinical criteria were confirmed, discriminant validity assessment showed significant differences among patients with different C1-INH-HAE severity, convergent validity showed a good correlation among the physical and mental component summaries of the SF-36v2 and the HAE-QoL total score (0.45 and 0.64 respectively, P < 0.001). Test-retest reliability was high with intraclass correlation coefficient varying from 0.758 to 0.962. The minimal clinically important difference was calculated by distribution methods and small differences in the domain scores and in the component summaries scores were shown to be meaningful. CONCLUSIONS: The psychometric properties of the SF-36v2 show it can be a useful tool to assess HRQoL in adult patients with C1-INH-HAE, although with some content validity limitation. METHODS The psychometric properties of the SF-36v2 were evaluated in an international setting based on responses from 290 adult C1-INH-HAE patients in 11 countries.
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Affiliation(s)
| | - Nieves Prior
- Allergy Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | | | | | | | - Teresa Caballero
- Allergy Department, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Biomedical Research Network On Rare Diseases (CIBERER, U754), Madrid, Spain
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18
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Real-World Rates of Bleeding, Factor VIII Use, and Quality of Life in Individuals with Severe Haemophilia A Receiving Prophylaxis in a Prospective, Noninterventional Study. J Clin Med 2021; 10:jcm10245959. [PMID: 34945255 PMCID: PMC8705574 DOI: 10.3390/jcm10245959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 01/19/2023] Open
Abstract
Regular prophylaxis with exogenous factor VIII (FVIII) is recommended for individuals with severe haemophilia A (HA), but standardised data are scarce. Here, we report real-world data from a global cohort. Participants were men ≥18 years old with severe HA (FVIII ≤ 1 IU/dL) receiving regular prophylaxis with FVIII. Participants provided 6 months of retrospective data and were prospectively followed for up to 12 months. Annualised bleeding rate (ABR) and FVIII utilisation and infusion rates were calculated. Differences between geographic regions were explored. Of 294 enrolled participants, 225 (76.5%) completed ≥6 months of prospective follow-up. Pre-baseline and on-study, the median (range) ABR values for treated bleeds were 2.00 (0–86.0) and 1.85 (0–37.8), respectively; the median (range) annualised FVIII utilisation rates were 3629.0 (1008.5–13541.7) and 3708.0 (1311.0–14633.4) IU/kg/year, respectively; and the median (range) annualised FVIII infusion rates were 120.0 (52.0–364.0) and 122.4 (38.0–363.8) infusions/year, respectively. The median (range) Haemo-QoL-A Total Score was 76.3 (9.4–100.0) (n = 289), ranging from 85.1 in Australia to 67.7 in South America. Physical Functioning was the most impacted Haemo-QoL-A domain in 4/6 geographic regions. Despite differences among sites, participants reported bleeding requiring treatment and impaired physical functioning. These real-world data illustrate shortcomings associated with FVIII prophylaxis for this global cohort of individuals with severe HA.
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19
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van Balen EC, Haverman L, Hassan S, Taal EM, Smit C, Driessens MH, Beckers EAM, Coppens M, Eikenboom J, Hooimeijer HL, Leebeek FWG, van Vulpen LFD, Schols SEM, Terwee CB, Rosendaal FR, van der Bom JG, Gouw SC. Validation of PROMIS Profile-29 in adults with hemophilia in the Netherlands. J Thromb Haemost 2021; 19:2687-2701. [PMID: 34245088 PMCID: PMC8596807 DOI: 10.1111/jth.15454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) Profile-29 questionnaire is widely used worldwide, but it has not yet been validated in the Netherlands, nor in persons with hemophilia. OBJECTIVE To validate the Dutch-Flemish version of the PROMIS-29 Profile v2.01 in adults with hemophilia. METHODS Dutch males with hemophilia (all severities) completed questionnaires that contained sociodemographic and clinical characteristics, the PROMIS-29, RAND-36, and the Hemophilia Activities List (HAL). Structural validity of each subscale was assessed with confirmatory factor analysis (CFA). Internal consistency was calculated for each subscale with sufficient model fit in CFA. Construct validity was assessed by testing hypotheses about (1) correlations of each PROMIS-29 subscale with corresponding scales of RAND-36 and domains of HAL, and (2) mean differences in T-scores between subgroups with different hemophilia severities, self-reported joint impairment, and HIV infection status. We considered ≥75% of data in accordance with the hypotheses evidence for construct validity. RESULTS In total, 770 persons with hemophilia participated in this cross-sectional study. CFA revealed sufficient structural validity for five subscales: Physical Function, Depression, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Interference. Internal consistency was high and Cronbach's alpha ranged from 0.79 for Sleep Disturbance to 0.96 for Pain Interference. Differences between clinical subgroups were in the expected direction. Construct validity was confirmed for Physical Function, Anxiety, Depression, Fatigue, Sleep Disturbance, and Pain Intensity. CONCLUSION This study revealed sufficient evidence for structural validity, internal consistency, and construct validity for most PROMIS Profile-29 subscales among people with hemophilia in the Netherlands.
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Affiliation(s)
- Erna C. van Balen
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Lotte Haverman
- Child and Adolescent Psychiatry & Psychosocial CareAmsterdam Reproduction and DevelopmentAmsterdam Public HealthEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Shermarke Hassan
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Elisabeth M. Taal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Cees Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Erik A. M. Beckers
- Department of HematologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeroen Eikenboom
- Department of Internal MedicineDivision of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Hélène L. Hooimeijer
- Department of PaediatricsUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Lize F. D. van Vulpen
- Department of Benign HematologyVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud University Medical CenterNijmegenthe Netherlands
- Hemophilia Treatment Center Nijmegen‐Eindhoven‐MaastrichtNijmegenThe Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Data ScienceAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamThe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Johanna G. van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Center for Clinical Transfusion ResearchSanquin Research/LUMCLeidenThe Netherlands
| | - Samantha C. Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Pediatric HematologyEmma Children’s HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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20
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Pasi KJ, Laffan M, Rangarajan S, Robinson TM, Mitchell N, Lester W, Symington E, Madan B, Yang X, Kim B, Pierce GF, Wong WY. Persistence of haemostatic response following gene therapy with valoctocogene roxaparvovec in severe haemophilia A. Haemophilia 2021; 27:947-956. [PMID: 34378280 PMCID: PMC9291073 DOI: 10.1111/hae.14391] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
Introduction Valoctocogene roxaparvovec is an investigational AAV5‐based factor VIII (FVIII) gene therapy that has demonstrated sustained clinical benefit in people with severe haemophilia A. Aim To report safety, tolerability, efficacy, and quality of life (QOL) among participants who received valoctocogene roxaparvovec in a phase 1/2 clinical study (NCT02576795). Methods Men ≥18 years of age with severe haemophilia A (FVIII ≤1 IU/dl) without history of FVIII inhibitors or anti‐AAV5 antibodies received a single infusion of valoctocogene roxaparvovec and were followed for 5 years (6 × 1013 vg/kg dose, n = 7) and 4 years (4 × 1013 vg/kg dose, n = 6). Results Over the past 2 years, few adverse events and no FVIII inhibitors were reported. Per chromogenic substrate (CSA) assay at years 5 and 4, four of seven and three of six participants in the 6 × 1013 and 4 × 1013 vg/kg cohorts, respectively, maintained median FVIII levels >5 IU/dl, corresponding to mild haemophilia. By regression analysis, rate of change in FVIII activity was ‐0.14 (95% confidence interval [CI]: ‐.32 to .03) IU/dl/wk in the 6 × 1013 vg/kg cohort in year 5 and ‐.06 (95% CI: ‐.14 to .01) IU/dl/wk in the 4 × 1013 vg/kg cohort in year 4. No participants resumed FVIII prophylaxis, and eight of 13 participants reported zero bleeds in the past 2 years. Improved QOL from baseline persisted in the 6 × 1013 vg/kg cohort; all six Haemo‐QOL‐A domain scores increased. For the 4 × 1013 vg/kg cohort, high baseline Haemo‐QOL‐A scores persisted. Conclusion These results demonstrate transgene expression and haemostatic response for up to 5 years in individuals with haemophilia A.
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Affiliation(s)
- K John Pasi
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
| | | | | | - Nina Mitchell
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Will Lester
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emily Symington
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bella Madan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Xinqun Yang
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Benjamin Kim
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | | | - Wing Yen Wong
- BioMarin Pharmaceutical Inc., Novato, California, USA
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21
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Abstract
Haemophilia A and B are rare congenital, recessive X-linked disorders caused by lack or deficiency of clotting factor VIII (FVIII) or IX (FIX), respectively. The severity of the disease depends on the reduction of levels of FVIII or FIX, which are determined by the type of the causative mutation in the genes encoding the factors (F8 and F9, respectively). The hallmark clinical characteristic, especially in untreated severe forms, is bleeding (spontaneous or after trauma) into major joints such as ankles, knees and elbows, which can result in the development of arthropathy. Intracranial bleeds and bleeds into internal organs may be life-threatening. The median life expectancy was ~30 years until the 1960s, but improved understanding of the disorder and development of efficacious therapy based on prophylactic replacement of the missing factor has caused a paradigm shift, and today individuals with haemophilia can look forward to a virtually normal life expectancy and quality of life. Nevertheless, the potential development of inhibitory antibodies to infused factor is still a major hurdle to overcome in a substantial proportion of patients. Finally, gene therapy for both types of haemophilia has progressed remarkably and could soon become a reality.
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22
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Aquino CC, Borg Debono V, Germini F, Pete D, Kempton CL, Young G, Sidonio R, Croteau SE, Dunn AL, Key NS, Iorio A. Outcomes for studies assessing the efficacy of hemostatic therapies in persons with congenital bleeding disorders. Haemophilia 2021; 27:211-220. [PMID: 33550614 DOI: 10.1111/hae.14247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Management strategies and hemostatic treatments to achieve control of bleeding are relevant across many disease areas. Identification of primary outcomes for studies assessing hemostatic intervention was the objective of a National Heart, Lung and Blood Institute (NHLBI) sponsored multidisciplinary initiative. The aim of this report is to summarize the evidence reviewed, and the outcomes identified by the subgroup tasked to assess outcomes for inherited bleeding disorders. METHODS The subgroup decided to focus on haemophilia, the prototypal congenital bleeding disorder and the one with the largest available body of evidence. MEDLINE, EMBASE and PsycINFO, The Cochrane Review, CINAHL, and Web of Science were searched for systematic and narrative reviews on outcomes used in haemophilia clinical trials. Three different clinical goals were identified as typical objectives of future research. RESULTS Out of 1322 unique citations, 24 reviews published in the period 2002-2019 were included. We identified 113 outcome measures, categorized in 6 domains: health-related quality of life (HRQoL), comorbidities and mortality, overall physical functioning and participation, bleeding and hemostasis, joint health, and costs and resource use. Three different clinical goals were identified as typical objectives of future research: Episodic 'on demand' replacement therapy, prevention of bleeding (Prophylaxis), and long-term and overall impact of bleeding. For each of these scenarios, specific outcomes were recommended. CONCLUSIONS Primary outcomes for clinical trials assessing the efficacy of hemostatic treatment in achieving control, prevention and limiting long-term consequences of bleeding in inherited bleeding disorders are suggested, and their strength and limitations discussed.
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Affiliation(s)
- Camila C Aquino
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada
| | - Victoria Borg Debono
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Anesthesiology, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Federico Germini
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Drashti Pete
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Christine L Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Guy Young
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Robert Sidonio
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders, Atlanta, GA, USA
| | - Stacy E Croteau
- Boston Children's Hospital, Boston Hemophilia Center, Harvard Medical School, Boston, MA, USA
| | - Amy L Dunn
- Hemophilia Treatment Center, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nigel S Key
- Division of Hematology and Blood Research Center, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Alfonso Iorio
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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23
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Hay CRM, Shima M, Makris M, Jiménez-Yuste V, Oldenburg J, Fischer K, Iorio A, Skinner MW, Santagostino E, von Mackensen S, Kessler CM. Challenges and key lessons from the design and implementation of an international haemophilia registry supported by a pharmaceutical company. Haemophilia 2020; 26:966-974. [PMID: 33094894 PMCID: PMC7894355 DOI: 10.1111/hae.14144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/19/2020] [Accepted: 08/13/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Real-world data are lacking regarding the relationship between prospectively collected patient-reported outcomes (PROs), clinical outcomes and treatment in people with haemophilia (PWH). The Expanding Communications on Hemophilia A Outcomes (ECHO) registry was designed to address this data gap, but a range of difficulties led to early study closure. AIM To describe the challenges faced and lessons learned from implementing a multinational haemophilia registry. METHODS The Expanding Communications on Hemophilia A Outcomes was planned as a five-year observational cohort study to collect data from 2000 patients in nine countries. Based on direct observations, feedback from patients enrolled in ECHO, challenges of the study design and input from study-sponsor representatives, the ECHO Steering Committee systematically identified the challenges faced and developed recommendations for overcoming or avoiding them in future studies. RESULTS The study closed after two years because few countries were activated and patient recruitment was low. This was related to multiple challenges including delayed implementation, stringent pharmacovigilance requirements, objections of investigators and patients to the burden of multiple PROs, data collection issues, lack of resources at study sites, little engagement of patients and competing clinical trials, which further limited recruitment. At study closure, 269 patients had been enrolled in four of nine participating countries. CONCLUSIONS Researchers planning studies similar to ECHO may want to consider the barriers identified in this global registry of PWH and suggestions to mitigate these limitations, such as greater patient involvement in design and analysis, clearer assessment and understanding of local infrastructure and potential changes to the administration of the study.
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Affiliation(s)
- Charles R M Hay
- Manchester University Department of Haematology, Manchester, UK
| | | | - Michael Makris
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Johannes Oldenburg
- Department of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Kathelijn Fischer
- van Creveldkliniek, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Clinical Epidemiology of Congenital Bleeding Disorders, McMaster University, Hamilton, ON, Canada
| | - Mark W Skinner
- Department of Health Research Methods, Evidence and Impact, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Institute for Policy Advancement, Ltd, Washington, DC, USA
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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24
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Mackensen S, Catalani O, Asikanius E, Paz‐Priel I, Lehle M, Trask P. Determining meaningful health‐related quality‐of‐life improvement in persons with haemophilia A using the Haemophilia Quality of Life Questionnaire for Adults (Haem‐A‐QoL). Haemophilia 2020; 26:1019-1030. [DOI: 10.1111/hae.14184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Sylvia Mackensen
- Department of Medical Psychology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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25
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Baek HJ, Park YS, Yoo KY, Cha JH, Kim YJ, Lee KS. Health-related quality of life of moderate and severe haemophilia patients: Results of the haemophilia-specific quality of life index in Korea. PLoS One 2020; 15:e0238686. [PMID: 32881977 PMCID: PMC7470394 DOI: 10.1371/journal.pone.0238686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/21/2020] [Indexed: 01/19/2023] Open
Abstract
The assessment of health-related quality of life (HRQoL) as a patient-reported outcome provides information about the patients' general well-being as well as the effects of the disease and its treatment. This study aimed to investigate HRQoL using both generic and haemophilia-specific QoL instruments and to assess the clinical factors associated with HRQoL among haemophilia patients in Korea. In this cross-sectional, multicenter, observational study, moderate-to-severe haemophilia patients aged 8-64 years were recruited between November 2012 and September 2013. The EQ-5D Questionnaire, EQ Visual Analogue Scale, and Haemophilia-Specific QoL (Haemo-QoL) Questionnaire (Haemo-QoL for 8-16 years and Haemo-A-QoL for ≥17 years) were used to assess HRQoL. A total of 605 participants with a mean age of 29.32 ± 12.62 years were enrolled. The mean Haemo-QoL scores revealed significant differences by age group (children vs. adolescent vs. adult, 26.44 ± 11.3 vs. 28.88 ± 11.1 vs. 38.43 ± 17.7, respectively, p < 0.001). "Sports and leisure," "family planning," and "view" in adults and "perceived support," "friends," and "dealing" in children and adolescents were identified as the domains with the greatest HRQoL impairments. HRQoL was significantly impaired in patients with the following clinical factors: hepatitis, haemophilia-induced disability, bleeding experiences within the last 6 months, joint bleedings within the last 6 months, and haemophilic arthropathy. According to the multivariate regression analysis, HRQoL showed a negative association with the presence of haemophilia-induced disability (β = 0.222, p < 0.0001), bleeding experiences within the last 6 months (β = 0.098, p = 0.010), and haemophilic arthropathy (β = 0.212, p < 0.0001). HRQoL decreased in patients with older age and impaired clinical conditions among moderate-to-severe haemophilia patients in Korea. These study findings may provide significant insights into the adequate haemophilia management using patient-reported measurements.
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Affiliation(s)
- Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Shil Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | | | - Jin-Hye Cha
- Pfizer Pharmaceuticals Korea Ltd., Seoul, South Korea
| | - Young-Joo Kim
- Pfizer Pharmaceuticals Korea Ltd., Seoul, South Korea
| | - Kun Soo Lee
- Department of Pediatrics, Kyungpook National University Medical School, Kyungpook National University Hospital, Daegu, South Korea
- * E-mail:
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26
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Neuner B, von Mackensen S, Kiesau B, Krampe H, McCarthy WJ, Reinke S, Kowalski D, Shneyder M, Clausnizer H, Rocke A, Junker R, Nowak-Göttl U. Cross-Sectional and Longitudinal Construct Validity of the Generic KINDL-A(dult)B(rief) Questionnaire in Adults with Thrombophilia or with Hereditary and Acquired Bleeding Disorders. Acta Haematol 2020; 144:166-175. [PMID: 32506056 DOI: 10.1159/000507602] [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: 08/09/2019] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS The newly adapted generic KINDL-A(dult)B(rief) questionnaire showed satisfactory cross-sectional psychometric properties in adults with bleeding disorders or thrombophilia. This investigation aimed to evaluate its cross-sectional and longitudinal construct validity. METHODS After ethical committee approval and written informed consent, 335 patients (mean age 51.8 ± 16.6 years, 60% women) with either predominant thrombophilia (n = 260) or predominant bleeding disorders (n = 75) participated. At baseline, patients answered the KINDL-AB, the MOS 36-item Short-Form Health Survey (SF-36), and the EQ-5D-3L. A subgroup of 117 patients repeated the questionnaire after a median follow-up of 2.6 years (range: 0.4-3.5). A priori hypotheses were evaluated regarding convergent correlations between KINDL-AB overall well-being and specific subscales, EQ-5D-3L index values (EQ-IV), EQ-5D visual analog scale (EQ-VAS), and SF-36 subscales. RESULTS Contrary to hypothesis, baseline correlations between the KINDL-AB and EQ-IV/EQ-VAS were all moderate while, as hypothesized, several KINDL-AB subscales and SF-36 subscales correlated strongly. At follow-up, no significant changes in all three instruments occurred. Correlations between instruments over the follow-up were mostly moderate and partially strong. Contrary to hypothesis but consistent with no significant changes in health-related quality of life, convergent correlations between changes in KINDL-AB overall well-being, physical and psychological well-being, and EQ-IV/EQ-VAS were all weak. CONCLUSIONS While repeated measures of KINDL-AB showed moderate to strong correlations, changes in KINDL-AB overall well-being and subscales correlated more weakly than expected with changes involving two established instruments of generic health status.
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Affiliation(s)
- Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Sylvia von Mackensen
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bettina Kiesau
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - William J McCarthy
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Center for Cancer Prevention and Control Research, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Sarah Reinke
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
- Department of Pediatric Oncology and Hematology, University Childrens' Hospital, Münster, Germany
| | - Dorothee Kowalski
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
| | - Maria Shneyder
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
| | - Hartmut Clausnizer
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
| | - Angela Rocke
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
| | - Ralf Junker
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany
| | - Ulrike Nowak-Göttl
- Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany,
- Department of Pediatric Oncology and Hematology, University Childrens' Hospital, Münster, Germany,
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27
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Lalezari S, Acquadro M, de Bock E, Lambert J, Simpson ML. Comparing Physician and Patient Perspectives on Prophylactic Treatment with BAY 94-9027 for Severe Haemophilia A: A Post Hoc Analysis. Adv Ther 2020; 37:2763-2776. [PMID: 32410165 PMCID: PMC7467448 DOI: 10.1007/s12325-020-01374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/02/2022]
Abstract
Introduction BAY 94-9027 is a newly developed extended half-life product to treat haemophilia, allowing for fewer injections than with standard products. This post hoc analysis aimed to compare physicians’ and patients’ opinions on BAY 94-9027 prophylaxis, and explore how qualitative interview data is aligned with the data from the Haemophilia-specific Quality of Life questionnaire for Adults (Haemo-QoL-A). Methods Exploratory qualitative interviews were conducted with physicians and patients by phone upon the exit of patients from the PROTECT VIII extension phase following a semi-directed guide. In this post hoc analysis, all transcripts were reviewed and reported concepts were compared to assess the level of concordance between physicians and patients. These qualitative data were compared with the Haemo-QoL-A mean global and subscale scores at baseline and end of main phase (36 weeks later). Results Ten physicians and 16 patients (mean age 47 years) from Israel, the Netherlands and the USA were interviewed. Significant improvements were reported by all physicians from baseline [e.g. lower frequency of bleeds (80%), improvement in emotional functioning (90%)], which is in concordance with patients’ reports. The improved confidence reported by physicians cascaded to greater participation in various activities, resulting in a better perceived emotional state and a significant improvement on the Haemo-QoL-A emotional impact subscale score (p = 0.04) between baseline and end of main phase. Most physicians (80%) reported improvement in bleed frequency, as patients did (88%). Improvement in physical functioning or mobility was not consistently reported in this 8-month study. Conclusion Interviewed physicians and patients generally agreed on the beneficial impact of BAY 94-9027, specifically regarding the increased level of self-confidence in patients and its subsequent positive impact on patients’ lives. These findings supported the observed improvement on the Haemo-QoL-A emotional impact subscale. Overall, this study highlights the concordance between physician and patient perspective on the positive experience with BAY 94-9027.
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Affiliation(s)
- Shadan Lalezari
- National Hemophilia Center, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | | | - Mindy L Simpson
- Rush Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA.
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28
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Chai-Adisaksopha C, Skinner MW, Curtis R, Frick N, Nichol MB, Noone D, O'Mahony B, Page D, Stonebraker J, Thabane L, Crowther MA, Iorio A. Exploring regional variations in the cross-cultural, international implementation of the Patient Reported Outcomes Burdens and Experience (PROBE) study. Haemophilia 2019; 25:365-372. [PMID: 30861270 DOI: 10.1111/hae.13703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/22/2018] [Accepted: 01/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Patient Reported Outcomes Burdens and Experience (PROBE) study has developed and validated the PROBE questionnaire for assessing patient-reported outcomes in people with haemophilia and participants without bleeding disorders. OBJECTIVE To explore the regional variations in the international implementation of the PROBE questionnaire. METHODS Data were collected from participants in four regions (Western Pacific, South America, North America and Europe). Participants were able to choose English or translated versions of the PROBE questionnaire into their first language. We used analysis of variance methods and multivariable regression to determine the relative contribution of the variance explained by region controlling for haemophilia diagnosis, age group and levels of educations. We also explored interactions between region and the other components. RESULTS We used 862 questionnaires from 14 countries. Mean age of participants was 40.03 years (standard deviation 13.89), and 73.67% were male. After adjusting, region contributed 0.44%-7.98% of the variance component in subitem scores and 0.26% in the PROBE score. Years of education contributed 0.34% in the PROBE score. Age and haemophilia diagnosis contributed 3.42% and 22.42% of the PROBE score. CONCLUSIONS The results demonstrate that the PROBE questionnaire is valid to implement for assessing health status among patients with haemophilia and participants without bleeding disorders across regions.
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Affiliation(s)
- Chatree Chai-Adisaksopha
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark W Skinner
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Institute for Policy Advancement Ltd, Washington, District of Columbia
| | | | - Neil Frick
- National Hemophilia Foundation, New York, New York
| | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| | | | - Brian O'Mahony
- Irish Haemophilia Society, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Jeffrey Stonebraker
- Poole College of Management, North Carolina State University, Raleigh, North Carolina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Mark A Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alfonso Iorio
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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29
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Wharfe G, Buchner-Daley L, Gibson T, Hilliard P, Usuba K, Abad A, Boma-Fischer L, Bouskill V, Floros G, Lillicrap D, Lowe Y, Lowe D, Palmer-Mitchell N, Rand ML, Teitel J, Tuttle A, Watson A, White R, Young NL, Blanchette VS. The Jamaican Haemophilia Registry: Describing the burden of disease. Haemophilia 2018; 24:e179-e186. [PMID: 29855125 DOI: 10.1111/hae.13517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Jamaica has an estimated 200 persons with haemophilia (PWH), who face significant constraints in access to specialized haemophilia care, including access to clotting factor concentrates. AIM The aim of this paper is to establish the current burden of disease in PWH in Jamaica. METHODS PWH were enrolled through the University Hospital of the West Indies, Jamaica. The impact of haemophilia was assessed using a comprehensive battery of heath outcome measures that included the following: laboratory, clinical information and validated outcome measures of joint structure and function, activity, and health-related quality of life (HRQoL) to provide a health profile of the Jamaican haemophilia population. RESULTS In all, 45 PWH were registered (mean age: 29, range: 0.17-69 years), including 13 children (<18 years of age) and 32 adults. In this sample, 41 had haemophilia A (30 severe) and 4 had haemophilia B (3 severe); 10 patients with haemophilia A were inhibitor positive. The results indicate that adults with haemophilia in Jamaica have significant joint damage: mean Haemophilia Joint Health Score (HJHS) = 42.1 (SD = 17.3); moderate activity levels - mean Haemophilia Activities List (HAL) score = 64.8 (SD = 17.8); and low HRQoL scores - mean Haemo-QoL-A score = 62.3 (SD = 19.4). Results for children are also reported but should be interpreted with caution due to the small sample size. CONCLUSIONS There is a very high burden of disease in PWH in Jamaica. The health profiles reported in this paper are an essential first step in advocating for a multidisciplinary Comprehensive Care Program for assessment and care of PWH in Jamaica.
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Affiliation(s)
- G Wharfe
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - L Buchner-Daley
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - T Gibson
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - P Hilliard
- Department of Rehabilitation, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Usuba
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,School of Rural and Northern Health and ECHO Research Centre, Laurentian University, Sudbury, ON, Canada
| | - A Abad
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Boma-Fischer
- Department of Hematology, Comprehensive Care Hemophilia Program, St. Michael's Hospital, Toronto, ON, Canada
| | - V Bouskill
- Department of Nursing, The Hospital for Sick Children, Toronto, ON, Canada
| | - G Floros
- Department of Hematology, Comprehensive Care Hemophilia Program, St. Michael's Hospital, Toronto, ON, Canada
| | - D Lillicrap
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Y Lowe
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - D Lowe
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - N Palmer-Mitchell
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - M L Rand
- Departments of Laboratory Medicine & Pathobiology, Biochemistry and Paediatrics, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Research Institute, The Hospital for Sick Children, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Teitel
- Department of Hematology, Comprehensive Care Hemophilia Program, St. Michael's Hospital, Toronto, ON, Canada
| | - A Tuttle
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - A Watson
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - R White
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - N L Young
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,School of Rural and Northern Health and ECHO Research Centre, Laurentian University, Sudbury, ON, Canada
| | - V S Blanchette
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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30
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Manco-Johnson MJ, Lundin B, Funk S, Peterfy C, Raunig D, Werk M, Kempton CL, Reding MT, Goranov S, Gercheva L, Rusen L, Uscatescu V, Pierdominici M, Engelen S, Pocoski J, Walker D, Hong W. Effect of late prophylaxis in hemophilia on joint status: a randomized trial. J Thromb Haemost 2017; 15:2115-2124. [PMID: 28836341 DOI: 10.1111/jth.13811] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 11/29/2022]
Abstract
Essentials High-quality data are lacking on use of prophylaxis in adults with hemophilia and arthropathy. SPINART was a 3-year randomized clinical trial of late/tertiary prophylaxis vs on-demand therapy. Prophylaxis improved function, quality of life, activity and pain but not joint structure by MRI. Prophylaxis improves function but must start before joint bleeding onset to prevent arthropathy. SUMMARY Background Limited data exist on the impact of prophylaxis on adults with severe hemophilia A and pre-existing joint disease. Objectives To describe 3-year bleeding, joint health and structure, health-related quality-of-life (HRQoL) and other outcomes from the open-label, randomized, multinational SPINART study. Patients/Methods Males aged 12-50 years with severe hemophilia A, ≥ 150 factor VIII exposure days, no inhibitors and no prophylaxis for > 12 consecutive months in the past 5 years were randomized to sucrose-formulated recombinant FVIII prophylaxis or on-demand therapy (OD). Data collected included total and joint bleeding events (BEs), joint structure (magnetic resonance imaging [MRI]), joint health (Colorado Adult Joint Assessment Scale [CAJAS]), HRQoL, pain, healthcare resource utilization (HRU), activity, and treatment satisfaction. Results Following 3 years of prophylaxis, adults maintained excellent adherence, with a 94% reduction in BEs despite severe pre-existing arthropathy; 35.7% and 76.2% of prophylaxis participants were bleed-free or had fewer than two BEs per year, respectively. As compared with OD, prophylaxis was associated with improved CAJAS scores (least squares [LS] mean, - 0.31 [n = 42] versus + 0.63 [n = 42]) and HAEMO-QoL-A scores (LS mean, + 3.98 [n = 41] versus - 6.00 [n = 42]), less chronic pain (50% decrease), and approximately two-fold less HRU; activity, Euro QoL-5D-3L (EQ-5D-3L) scores and satisfaction scores also favored prophylaxis. However, MRI score changes were not different for prophylaxis versus OD (LS mean, + 0.79 [n = 41] versus + 0.96 [n = 38]). Conclusions Over a period of 3 years, prophylaxis versus OD in adults with severe hemophilia A and arthropathy led to decreased bleeding, pain, and HRU, better joint health, activity, satisfaction, and HRQoL, but no reduction in structural arthropathy progression, suggesting that pre-existing joint arthropathy may be irreversible.
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Affiliation(s)
| | - B Lundin
- Lund University and Skåne University Hospital, Lund, Sweden
| | - S Funk
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, FL, USA
| | - D Raunig
- ICON Medical Imaging, Warrington, PA, USA
| | - M Werk
- Martin-Luther-Krankenhaus, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - M T Reding
- University of Minnesota, Minneapolis, MN, USA
| | - S Goranov
- UMHAT Sveti Georgi and Medical University, Plovdiv, Bulgaria
| | | | - L Rusen
- S. C. SANADOR SRL, Bucharest, Romania
| | - V Uscatescu
- Institutul Clinic Fundeni, Bucharest, Romania
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31
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Varaklioti A, Kontodimopoulos N, Niakas D, Kouramba A, Katsarou O. Health-Related Quality of Life and Association With Arthropathy in Greek Patients with Hemophilia. Clin Appl Thromb Hemost 2017; 24:815-821. [PMID: 28992766 PMCID: PMC6714871 DOI: 10.1177/1076029617733041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Health-related quality of life (HRQoL) is increasingly implicated in contemporary hemophilia management. This study focuses on the assessment of HRQoL in Greek patients with hemophilia and the comparison with normative data from the general population, as well as on the extent arthropathy may affect the patients’ HRQoL. One hundred and nine adult patients completed the Greek social functioning (SF-36) and Haem-A-QoL questionnaires. Arthropathy was assessed by both the World Federation of Hemophilia clinical score and Pettersson radiological score. The most impaired domains of Haem-A-QoL were sports/leisure (SL) and physical health (PH; mean scores 61.2 and 42.2, respectively). The patients experienced statistically significant lower mean scores in all SF-36 domains than the normative sample, especially in role physical (RPH), bodily pain (BP), and general health (GH) subscales. Among Haem-A-QoL subscales, SL and PH were found strongly associated with severity of arthropathy using both orthopedic scores (P < .001), and maintained the statistical significance after adjustment for age (P < .05). A poor orthopedic status was also negatively associated with certain SF-36 subscales. However, none of these correlations remained after adjustment with age. Compared to normative data from Greece, patients with hemophilia showed deterioration in all HRQoL subscales, with a more pronounced effect in RPH, BP, and GH subscales. Health-related quality of life was strongly influenced by arthropathy, mainly in the physical aspects of HRQoL. The use of the disease-specific Haem-A-QoL tool can capture additional associations between HRQoL and hemophilic arthropathy.
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Affiliation(s)
- Agoritsa Varaklioti
- 1 Blood Center and National Centre for Congenital Bleeding Disorders, Laiko General Hospital, Athens, Greece.,2 Faculty of Social Sciences, Department of Health Management, Hellenic Open University, Patras, Greece
| | - Nick Kontodimopoulos
- 2 Faculty of Social Sciences, Department of Health Management, Hellenic Open University, Patras, Greece
| | - Dimitris Niakas
- 2 Faculty of Social Sciences, Department of Health Management, Hellenic Open University, Patras, Greece.,3 Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Kouramba
- 1 Blood Center and National Centre for Congenital Bleeding Disorders, Laiko General Hospital, Athens, Greece
| | - Olga Katsarou
- 1 Blood Center and National Centre for Congenital Bleeding Disorders, Laiko General Hospital, Athens, Greece
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32
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Limperg PF, Haverman L, Maurice-Stam H, Coppens M, Valk C, Kruip MJHA, Eikenboom J, Peters M, Grootenhuis MA. Health-related quality of life, developmental milestones, and self-esteem in young adults with bleeding disorders. Qual Life Res 2017; 27:159-171. [PMID: 28900823 PMCID: PMC5770500 DOI: 10.1007/s11136-017-1696-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Abstract
Background The treatment of bleeding disorders improved in the last decades. However, the effect of growing up with bleeding disorders on developmental, emotional, and social aspects is understudied. Therefore, this study assesses HRQOL, developmental milestones, and self-esteem in Dutch young adults (YA) with bleeding disorders compared to peers. Methods Ninety-five YA (18–30 years) with bleeding disorders (78 men; mean 24.7 years, SD 3.5) and 17 women (mean 25.1 years, SD 3.8) participated and completed the Pediatric Quality of Life Inventory Young Adult version, the Course of Life Questionnaire, and the Rosenberg Self-Esteem Scale. Differences between patients with bleeding disorders and their peers, and between hemophilia severity groups, were tested using Mann–Whitney U tests. Results YA men with bleeding disorders report a slightly lower HRQOL on the total scale, physical functioning, and school/work functioning in comparison to healthy peers (small effect sizes). YA men with severe hemophilia report more problems on the physical functioning scale than non-severe hemophilia. YA men with bleeding disorders achieved more psychosexual developmental milestones than peers, but show a delay in ‘paid jobs, during middle and/or high school.’ A somewhat lower self-esteem was found in YA men with bleeding disorders in comparison to peers (small effect size). For YA women with bleeding disorders, no differences were found on any of the outcomes in comparison to peers. Conclusion This study demonstrates some impairments in HRQOL and self-esteem in YA men with bleeding disorders. By monitoring HRQOL, problems can be identified early, especially with regard to their physical and professional/school functioning.
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Affiliation(s)
- P F Limperg
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - L Haverman
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M Coppens
- Department of Vascular Medicine, Hemophilia Comprehensive Care Treatment Center, AMC, Amsterdam, The Netherlands
| | - C Valk
- Department of Vascular Medicine, Hemophilia Comprehensive Care Treatment Center, AMC, Amsterdam, The Netherlands
| | - M J H A Kruip
- Department of Hematology, Hemophilia Comprehensive Care Treatment Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Eikenboom
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - M Peters
- Department of Pediatric-Hematology, Emma Children's Hospital and Hemophilia Comprehensive Care Treatment Center, AMC, Amsterdam, The Netherlands
| | - M A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, AMC, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
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33
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Sun HL, McIntosh KA, Squire SJ, Yang M, Bartholomew C, Gue DS, Camp PG, Jackson SC. Patient powered prophylaxis: A 12-month study of individualized prophylaxis in adults with severe haemophilia A. Haemophilia 2017; 23:877-883. [PMID: 28851133 DOI: 10.1111/hae.13319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adults with severe haemophilia A (SHA) may experience breakthrough bleeds despite standard weight-based FVIII prophylaxis three times weekly. Individualized prophylaxis has evolved to optimize patient outcomes. AIMS This study aimed to evaluate the impact of a standardized approach to individualized prophylaxis on annualized bleeding rates (ABR), factor utilization, physical activity and quality of life in adults with SHA. METHODS In this prospective cohort study, patients with baseline FVIII:C <2% and ABR >3 on weight-based prophylaxis received a standardized approach to individualized prophylaxis. Changes in ABR, annualized FVIII consumption and adherence from the 12-month prestudy and 12-month intervention period were compared. Changes in Haemo-QoL-A total score, Physical Functioning (PF) subscale and physical activity level measured by accelerometry were also examined. RESULTS Eighteen patients participated (median age 26 years). Individualized prophylaxis decreased total bleeds in the population by 69% and traumatic bleeds by 73%. The median ABR decreased from 7.5 to 2 (P<.001). Annualized factor consumption increased by 7.3%, as a result of 66% reduction in factor utilization for treatment of bleeds and 25% increase in factor utilization for prophylaxis. Adherence scores for frequency and dosing did not change. There was a significant increase in the Haemo-QoL-A total score (P=.02) and PF score (P=.01) from baseline to 4 months but no change in physical activity. CONCLUSION Patients with SHA who switched from standard to individualized prophylaxis show reduced ABR and increased FVIII consumption, and also improved their health-related quality of life. The mechanism is independent of adherence to prescribed prophylactic regimen.
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Affiliation(s)
- Haowei Linda Sun
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada.,Division of Hematology, Department of Medicine, University of British Columbia (UBC) and St. Paul's Hospital, Vancouver, BC, Canada
| | - Kam A McIntosh
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Sandra J Squire
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Ming Yang
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Claude Bartholomew
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Deb S Gue
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pat G Camp
- Centre for Heart Lung Innovation, Vancouver, BC, Canada.,UBC Department of Physical Therapy, Vancouver, BC, Canada
| | - Shannon C Jackson
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada.,Division of Hematology, Department of Medicine, University of British Columbia (UBC) and St. Paul's Hospital, Vancouver, BC, Canada
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34
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Limperg P, Terwee C, Young N, Price V, Gouw S, Peters M, Grootenhuis M, Blanchette V, Haverman L. Health-related quality of life questionnaires in individuals with haemophilia: a systematic review of their measurement properties. Haemophilia 2017; 23:497-510. [DOI: 10.1111/hae.13197] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 01/29/2023]
Affiliation(s)
- P.F. Limperg
- Psychosocial Department; Emma Children's Hospital; AMC; Amsterdam the Netherlands
| | - C.B. Terwee
- Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | - N.L. Young
- School of Rural and Northern Health; Laurentian University; Sudbury Ontario Canada
| | - V.E. Price
- Division of Pediatric Hematology/Oncology; Department of Pediatrics; IWK Health Centre; Dalhousie University; Halifax Nova Scotia Canada
| | - S.C. Gouw
- Department of Pediatric-Hematology; Emma Children's Hospital and Hemophilia Comprehensive Care Treatment Center; AMC; Amsterdam the Netherlands
| | - M. Peters
- Department of Pediatric-Hematology; Emma Children's Hospital and Hemophilia Comprehensive Care Treatment Center; AMC; Amsterdam the Netherlands
| | - M.A. Grootenhuis
- Psychosocial Department; Emma Children's Hospital; AMC; Amsterdam the Netherlands
| | - V. Blanchette
- Department of Pediatrics; University of Toronto; Division of Hematology/Oncology; The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - L. Haverman
- Psychosocial Department; Emma Children's Hospital; AMC; Amsterdam the Netherlands
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35
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Salomon T, Chaves DG, Brener S, Martins PRJ, Mambrini JVM, Peixoto SV. Determining the health-related quality of life in individuals with haemophilia in developing economies: results from the Brazilian population. Haemophilia 2016; 23:42-49. [PMID: 27928900 DOI: 10.1111/hae.13130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Several studies show the negative impact of haemophilia in health-related quality of life (HRQOL). This issue is not well explored in developing countries. OBJECTIVES This cross-sectional study aimed to evaluate the HRQOL and its associated factors in patients with haemophilia A/B in Brazil. Data were collected by questionnaire and in medical records, including a Portuguese version of Haem-A-Qol. RESULTS Brazilian patients were invited to the study and 175 participants (147 haemophilics A and 28 haemophilics B) were included. The total score of the Haem-A-QoL had a median of 36.96 (range of 0-100), with worse performance in 'sport and leisure' and best on 'relationships' fields. HRQOL was worst among the older participants, the less educated, non-white, non-working, who were hospitalized in the last year, who did not have a single medical consultation and among those with the highest number of affected joints. Moreover, patients with hepatitis B had a significantly worse HRQOL in the domain 'sports and leisure', also observed in married patients. Otherwise, married individuals reported better HRQOL on 'dealing with the disease' domain. Patients with haemophilia B reported worse HRQOL in the domain 'self-perception'. CONCLUSION The results obtained could be helpful in guidance of haemophilia treatment which is determinant to improve HRQoL of the most vulnerable groups of patients. This work also reinforced the relevance of joint bleeds in all aspects of HRQoL in haemophilic patients. The use of prophylactic factor concentrates and multidisciplinary treatments could contribute to improve the quality of life in haemophilia.
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Affiliation(s)
- T Salomon
- Programa de Pós-Graduação em Saúde Coletiva - Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil.,Grupo de Qualidade de Vida em Hematologia e Hemoterapia, Belo Horizonte, Minas Gerais, Brazil
| | - D G Chaves
- Grupo de Qualidade de Vida em Hematologia e Hemoterapia, Belo Horizonte, Minas Gerais, Brazil.,Fundação Hemominas, Belo Horizonte, Minas Gerais, Brazil
| | - S Brener
- Grupo de Qualidade de Vida em Hematologia e Hemoterapia, Belo Horizonte, Minas Gerais, Brazil.,Fundação Hemominas, Belo Horizonte, Minas Gerais, Brazil
| | - P R J Martins
- Grupo de Qualidade de Vida em Hematologia e Hemoterapia, Belo Horizonte, Minas Gerais, Brazil.,Fundação Hemominas, Belo Horizonte, Minas Gerais, Brazil
| | - J V M Mambrini
- Fiocruz Minas - Centro de Pesquisas René Rachou, Belo Horizonte, Minas Gerais, Brazil
| | - S V Peixoto
- Programa de Pós-Graduação em Saúde Coletiva - Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil.,Grupo de Qualidade de Vida em Hematologia e Hemoterapia, Belo Horizonte, Minas Gerais, Brazil.,Fiocruz Minas - Centro de Pesquisas René Rachou, Belo Horizonte, Minas Gerais, Brazil.,Escola de Enfermagem - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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36
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Tran DQ, Barry V, Antun A, Ribeiro M, Stein S, Kempton CL. Physician trust and depression influence adherence to factor replacement: a single-centre cross-sectional study. Haemophilia 2016; 23:98-104. [PMID: 27686244 DOI: 10.1111/hae.13078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Poor adherence to factor replacement therapy among patients with haemophilia can lead to joint bleeding and eventual disability. AIM The aim of this study was to determine patient-related characteristics associated with adherence to factor replacement in adults with haemophilia. METHODS Adults with haemophilia were recruited to participate in this cross-sectional study. Adherence was measured using either the Validated Hemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro or the VERITAS-PRN questionnaire. Simple and multiple regression analyses that controlled for confounding were performed to determine the association between patient-related characteristics and adherence to factor replacement therapy. RESULTS Of the 99 subjects enrolled, all were men; 91% had haemophilia A and 78% had severe disease. Age ranged from 18 to 62 years. Most (95%) had functional health literacy; but only 23% were numerate. Mean adherence scores were 45.6 (SD 18) and 51.0 (SD 15) for those on a prophylactic and those on an episodic regimen, respectively, with a lower score indicating better adherence. On multivariable analysis, being on any chronic medication, longer duration followed at our haemophilia treatment centre, higher physician trust and better quality of life were associated with higher adherence. A history of depression was associated with lower adherence. CONCLUSION Two potentially modifiable characteristics, physician trust and depression, were identified as motivator and barrier to adherence to factor replacement therapy. Promoting a high level of trust between the patient and the healthcare team as well as identifying and treating depression may impact adherence to factor replacement therapy and accordingly reduce joint destruction.
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Affiliation(s)
- D Q Tran
- Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - V Barry
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - A Antun
- Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA
| | - M Ribeiro
- Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA
| | - S Stein
- Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA
| | - C L Kempton
- Department of Hematology and Oncology, Emory University, School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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37
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Recht M, Konkle BA, Jackson S, Neufeld EJ, Rockwood K, Pipe S. Recognizing the need for personalization of haemophilia patient‐reported outcomes in the prophylaxis era. Haemophilia 2016; 22:825-832. [PMID: 27581872 DOI: 10.1111/hae.13066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 01/19/2023]
Affiliation(s)
- M. Recht
- The Hemophilia Center Oregon Health & Science University Portland OR USA
| | - B. A. Konkle
- Division of Hematology Bloodworks NW and Department of Medicine University of Washington Seattle WA USA
| | - S. Jackson
- Division of Hematology Department of Medicine University of British Columbia Vancouver BC Canada
| | - E. J. Neufeld
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Boston Hemophilia Center Boston MA USA
| | - K. Rockwood
- Division of Geriatric Medicine Dalhousie University Halifax Nova Scotia Canada
| | - S. Pipe
- Departments of Pediatrics and Pathology University of Michigan Ann Arbor MI USA
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38
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Crivianu-Gaita V, Rivard GE, Carcao M, Teitel J, St-Louis J, Blanchette V, Pullenayegum E, Abad A, Feldman BM. Pilot study of once-a-day prophylaxis for youth and young adults with severe haemophilia A. Haemophilia 2016; 22:e401-5. [PMID: 27481574 DOI: 10.1111/hae.13058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Standard prophylaxis has been shown to be an effective treatment for severe haemophilia A. According to pharmacokinetic principles, daily factor infusions of smaller doses can maintain similar trough factor VIII (FVIII) levels, and perhaps the same protection as standard prophylaxis. AIM This multicentre study examined the feasibility of daily prophylaxis for youth and young adults with severe haemophilia A in Montreal and Toronto. METHODS Bleeding rates, joint status, quality of life and physical activity were monitored for 14 patients during this study. At baseline, subjects continued their regular treatment regimen and switched to daily prophylaxis after 4 months; nine had begun daily prophylaxis before enrolment. Additional visits occurred at 8 and 12 months which included a physical examination, inhibitor testing, HJHS and FISH assessments, the CHO-KLAT/Haemo-QoL-A and PDPAR. Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication ver.II and perceived difficulty questions at the end of study. RESULTS AND CONCLUSIONS There were no significant changes in quality of life except for concerns with the demanding daily infusion schedule. The number of bleeds did not statistically differ from the initial 4 months of the study to the last 8 months. Monthly bleeding rates from the year prior to the study and during the intervention phase were not statistically different. It was also found that daily prophylaxis used 24% less FVIII compared to standard prophylaxis. Taking all of this into account, we have found that providing daily prophylaxis is feasible and that it is feasible to prospectively study daily prophylaxis in youth and young adults.
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Affiliation(s)
- V Crivianu-Gaita
- Department of Chemistry, University of Toronto, Toronto, ON, Canada
| | - G E Rivard
- Division of Haematology/Oncology, Department of Paediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - M Carcao
- Division of Haematology/Oncology, Department of Paediatrics and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Teitel
- Division of Hematology and Oncology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - J St-Louis
- Hematology and Oncology Service, CHU Sainte-Justine, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - V Blanchette
- Department of Pediatrics, University of Toronto, Pediatric Comprehensive Care Hemophilia Program, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - E Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - A Abad
- Child Health Evaluative Sciences, The Hospital for Sick Children, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - B M Feldman
- Department of Pediatrics, Faculty of Medicine and the Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Child Health Evaluative Sciences, Toronto, ON, Canada. .,Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.
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39
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Remor E. Psychometric field testing of the HemoLatin-QoL questionnaire. Haemophilia 2016; 22:e390-400. [PMID: 27481399 DOI: 10.1111/hae.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The present work aims to describe the psychometric field testing of the Latin American Hemophilia-Specific Quality of Life Assessment Measure for Adults (the HemoLatin-QoL questionnaire) in 306 adults (age range 16-80) with haemophilia living in seven Latin American countries (i.e. Argentina, Brasil, Chile, Nicaragua, Panama, Uruguay and Venezuela). METHODS The HemoLatin-QoL questionnaire is a patient-reported outcomes instrument that evaluates relevant health-related quality-of-life domains for haemophilia, selected by an exploratory qualitative study with patients, and taking into account healthcare specialists in haemophilia also. Psychometric examination involved the assessment of the data quality, scaling assumptions, reliability (internal consistency and test-retest) and evidences for validity (dimensionality, convergent and external-related clinical criterion). RESULTS A 27-item version with a six-factor structure (e.g. physical functioning, pain, emotional functioning, social functioning, mental health, environment conditions) was psychometrically tested using exploratory factor analysis. The instrument and its subscales fulfilled the construct (dimensionality, convergent and criterion-related) validity hypotheses. The criteria for adequate internal consistency and test-retest reliability of the HemoLatin-QoL instrument were also met. CONCLUSION The HemoLatin-QoL showed acceptable psychometric properties with respect to responses from haemophilia patients. The questionnaire is now available for adult assessment and is ready for use in research in Latin America.
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Affiliation(s)
- E Remor
- Institute of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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St-Louis J, Urajnik DJ, Ménard F, Cloutier S, Klaassen RJ, Ritchie B, Rivard GE, Warner M, Blanchette V, Young NL. Generic and disease-specific quality of life among youth and young men with Hemophilia in Canada. BMC HEMATOLOGY 2016; 16:13. [PMID: 27158500 PMCID: PMC4858890 DOI: 10.1186/s12878-016-0052-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/27/2016] [Indexed: 11/20/2022]
Abstract
Background This study was undertaken to explore the longitudinal patterns of health-related quality of life (HRQoL) among youth and young adults with Hemophilia A (HA) over a 3-year period. This report presents the baseline characteristics of the study cohort. Methods Males, 14 to 29 years of age, with predominantly severe HA were recruited from six treatment centres in Canada. Subjects completed a comprehensive survey. HRQoL was measured using: the CHO-KLAT2.0 (youth), Haemo-QoL-A (young adults) and the SF-36v2 (all). Results 13 youth (mean age = 15.7, range = 12.9-17.9 years) and 33 young adults (mean age = 23.6; range = 18.4 -28.7 years) with moderate (7 %) and severe (93 %) HA were enrolled. All were on a prophylactic regimen with antihemophilic factor (Helixate FS®) during the study. The youth had minimal joint damage (mean HJHS = 5.2) compared to young adults (mean HJHS = 13.3). The mean HRQoL scores for youth were: 79.2 (SD = 11.9) for the CHO-KLAT, and 53.0 (5.5) and 52.3 (6.8) for the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores respectively. The mean HRQoL scores for young adults were: 85.8 (9.5) for the Haemo-Qol-A, and 50.8 (6.4) and 50.9 (8.8) for PCS and MCS respectively. PCS and MCS scores were comparable to published Canadian norms, however significant differences were found for the domains of Physical Functioning and Bodily Pain. The disease-specific HRQoL scores were weakly correlated with the PCS for youth (CHO-KLAT vs. PCS r = 0.28, p = 0.35); and moderately correlated for the MCS (r = 0.39, p = 0.19). Haemo-QoL-A scores for young adults were strongly correlated with the PCS (r = 0.53, p = 0.001); and weakly correlated with the MCS (r = 0.26, p = 0.13). Joint status as assessed by HJHS was correlated with PCS scores. A history of lifelong prophylaxis resulted in better PCS but worse MCS scores. Conclusion Despite having hemophilia, the youth in this cohort have minimal joint disease and good HRQoL. The young adults demonstrated more joint disease and slightly worse HRQoL in the domains of physical functioning and pain. The data presented here provide new information to inform the selection of Health Related Quality of Life (HRQoL) instruments for use in future clinical trials involving persons with hemophilia. Trial registration ClinicalTrials.gov : NCT01034904. Study funded by CSL Behring Canada. Electronic supplementary material The online version of this article (doi:10.1186/s12878-016-0052-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J St-Louis
- CHU Sainte-Justine, Montréal, Canada ; Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - F Ménard
- CHU Sainte-Justine, Montréal, Canada
| | - S Cloutier
- Hôpital de l'Enfant-Jésus, Quebec city, Canada
| | - R J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - B Ritchie
- University of Alberta, Edmonton, Canada
| | | | - M Warner
- McGill University Health Centre, Montréal, Canada
| | - V Blanchette
- University of Toronto, Toronto, Canada ; Hospital for Sick Children, Toronto, Canada
| | - N L Young
- Laurentian University, Sudbury, Canada ; Hospital for Sick Children, Toronto, Canada
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Psychometric Field Study of Hereditary Angioedema Quality of Life Questionnaire for Adults: HAE-QoL. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:464-473.e4. [PMID: 26969268 DOI: 10.1016/j.jaip.2015.12.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) may affect health-related quality of life (HRQoL). A specific HRQoL questionnaire for adult patients with C1-INH-HAE, the HAE-QoL, has recently been developed in Spain. OBJECTIVE The objective of this study was to perform a cross-cultural validation and psychometric study of the HAE-QoL in an international setting. METHODS Cross-cultural adaptation of the Spanish HAE-QoL draft version and an international rating phase with experts were performed. The resultant version of the HAE-QoL, a clinical questionnaire, and Short Form 36-item Health Survey Version 2.0 (SF-36v2) were pilot tested internationally. Item reduction was based on both descriptive and exploratory factor analysis. Psychometric properties were assessed. RESULTS Cross-cultural adaptation of the HAE-QoL was performed in 18 countries. The draft version of the HAE-QoL was pilot tested in 332 patients, and accurate data were obtained from 290 patients from 11 countries. The reduction process resulted in a new version with 25 items and 7 dimensions (treatment difficulties, physical functioning and health, disease-related stigma, emotional role and social functioning, concern about offspring, perceived control over illness, and mental health). Strong psychometric properties were observed (Cronbach's α 0.92; test-retest reliability 0.87). Convergent validity showed mild to moderate correlations with SF-36v2 physical and mental component summaries (0.45 and 0.64, respectively) and with SF-36v2 dimensions (P < .004). HAE-QoL scores discriminated significantly among severity groups (median: asymptomatic 133.5 vs severe 84.0; P < .001); between patients with and without long-term prophylaxis (median: 101 vs 90; P = .001); and between patients with and without psychiatric and/or psychological care (median: 74 vs 103; P ≤ .001). CONCLUSIONS The HAE-QoL, currently available in 18 languages, showed good reliability and validity evidence.
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Ragni MV, DiMichele DM, Hay CM, Malec LM, Seaman CD, Li J, Yabes JG, Butenas S, Brummel-Ziedins K. Thrombin generation and bleeding in haemophilia inhibitor patients during immune tolerance induction. Haemophilia 2015; 22:240-247. [PMID: 26517283 DOI: 10.1111/hae.12830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inhibitor formation complicates haemophilia treatment and requires immune tolerance induction to rid inhibitors over 5 BU. In the prospective, randomized International Immune Tolerance Study, immune tolerance induction was equally effective with high-dose (HD) (200 IU kg-1 day-1 ) and low-dose (LD) (50 IU kg-1 3× per week) factor VIII, but haemorrhages were twofold higher in the LD arm. This finding was unexpected as inhibitors neutralize FVIII activity. We hypothesized that the thrombin generation assay (TGA), a global measure of clot formation, might predict bleeding better than FVIII levels. METHODS We evaluated TGA using relipidated tissue factor (TF) on 83 thawed, recalcified corn trypsin inhibitor/citrate plasma samples from 31 subjects (17 HD, 14 LD) who participated on the ITI study, and who had sufficient sample available and appropriate informed consent. RESULTS There were no significant differences in peak thrombin, estimated thrombin potential, maximum rate or lag time between HD and LD arms; between pre-, during and post-ITI time points, or after FVIII spiking. In 19 subjects (12 HD, 7 LD) with anti-FVIII<1.0 BU, the prevalence of non-neutralizing antibody (NNA) and neutralizing antibody (NA) was 89.5% (17/19), and the latter strongly correlated with anti-VIII titer, r = 0.73 [95% CI: 0.55, 0.88]. CONCLUSION In haemophilia inhibitor patients, thrombin generation is present, but does not predict bleeding risk. Following tolerance induction, NNA remains detectable in the majority.
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Affiliation(s)
- M V Ragni
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
| | - D M DiMichele
- Division of Blood Diseases and Resources, National Heart Blood Lung Institute, Bethesda, MD, USA
| | - C M Hay
- Department of Hematology, Manchester University Royal Infirmary, Manchester, UK
| | - L M Malec
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - C D Seaman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
| | - J Li
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J G Yabes
- Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Butenas
- Department of Biochemistry, University of Vermont, Colchester, VT, USA
| | - K Brummel-Ziedins
- Department of Biochemistry, University of Vermont, Colchester, VT, USA
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Oladapo AO, Epstein JD, Williams E, Ito D, Gringeri A, Valentino LA. Health-related quality of life assessment in haemophilia patients on prophylaxis therapy: a systematic review of results from prospective clinical trials. Haemophilia 2015; 21:e344-58. [DOI: 10.1111/hae.12759] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2015] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | - D. Ito
- Baxalta US Inc; Cambridge MA USA
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Boehlen F, Graf L, Berntorp E. Outcome measures in haemophilia: a systematic review. Eur J Haematol 2015; 76:2-15. [PMID: 24957102 DOI: 10.1111/ejh.12369] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 01/03/2023]
Abstract
Haemophilia A and B are hereditary X-linked disorders due to deficiency (or absence) of coagulation factor VIII or IX, respectively. Bleeding risk is related to the severity of factor deficiency. Repeated joint bleeding can lead to a severe haemophilic arthropathy resulting in disabilities. Outcome measurements in persons with haemophilia (PWH) have been limited to laboratory evaluation (factor VIII or IX levels) and clinical outcomes (such as bleeding frequency), morbidity (for example linked with arthropathy) and mortality. Due to the new standard of care of PWH, there is a need to consider other outcome measures, such as the early detection and quantification of joint disease, health-related quality of life (QoL) and economic or cost-utility analyses. To investigate this, we performed a 10-yr systematic overview of outcome measures in haemophilia. Only clinical trials including at least 20 patients with haemophilia A or B were included. To facilitate the search strategy, eight issues of outcome measures were selected: physical scores, imaging technique scores, functional scores, QoL measurement, mortality, bleeding frequency, cost and outcome and bone mineral density. The results of these will be discussed. Clearly defined outcomes in haemophilia care are important for many reasons, to evaluate new treatments, to justify treatment strategies, to allow a good follow-up, to perform studies and to allocate resources. The use of such scoring systems is clearly recommended by experts in haemophilia care. However, most centres do not perform such scores outside clinical trials due to reasons such as lack of time and resources.
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Affiliation(s)
- Françoise Boehlen
- Division of Angiology and Haemostasis, University Hospitals and School of Medicine, Geneva, Switzerland
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Tagliaferri A, Feola G, Molinari AC, Santoro C, Rivolta GF, Cultrera DB, Gagliano F, Zanon E, Mancuso ME, Valdré L, Mameli L, Amoresano S, Mathew P, Coppola A. Benefits of prophylaxis versus on-demand treatment in adolescents and adults with severe haemophilia A: the POTTER study. Thromb Haemost 2015; 114:35-45. [PMID: 25855376 DOI: 10.1160/th14-05-0407] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/01/2015] [Indexed: 11/05/2022]
Abstract
Rigorous evidence is lacking on long-term outcomes of factor VIII (FVIII) prophylaxis initiated in adolescent or adult patients with severe haemophilia A. The prospective, open-label Prophylaxis versus On-demand Therapy Through Economic Report (POTTER) study (ClinicalTrials.gov NCT01159587) compared long-term late secondary prophylaxis (recombinant FVIII-FS 20-30 IU/kg thrice weekly) with on-demand treatment in patients aged 12 to 55 years with severe haemophilia A. The annual number of joint bleeding episodes (primary endpoint), total bleeding episodes, orthopaedic and radiologic (Pettersson) scores, health-related quality of life (HRQoL), pharmacoeconomic impact, and safety were evaluated over a > 5-year period (2004-2010). Fifty-eight patients were enrolled at 11 centres in Italy; 53 (27 prophylaxis, 26 on demand) were evaluated and stratified into 2 age subgroups (12-25 and 26-55 years). Patients receiving prophylaxis experienced a significantly lower number of joint bleeding episodes vs the on-demand group (annualised bleeding rate, 1.97 vs 16.80 and 2.46 vs 16.71 in younger and older patients, respectively; p=0.0043). Results were similar for total bleeding episodes. Prophylaxis was associated with significantly fewer target joints (p< 0.001), better orthopaedic (p=0.0019) and Pettersson (p=0.0177) scores, better HRQoL, and fewer days of everyday activities lost (p< 0.0001) but required significantly higher FVIII product consumption. The POTTER study is the first prospective, controlled trial documenting long-term benefits of late secondary prophylaxis in adolescents and adults with severe haemophilia A. The benefits of reduced bleeding frequency, improved joint status, and HRQoL may offset the higher FVIII consumption and costs.
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Affiliation(s)
- Annarita Tagliaferri
- Annarita Tagliaferri, MD, Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Via Gramsci, 14-43126, Parma, Italy, Tel.: +39 0521 703971, Fax: +39 0521 704332, E-mail:
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Pocoski J, Benjamin K, Michaels LA, Flood E, Sasane R. An overview of current trends and gaps in patient-reported outcome measures used in haemophilia. Eur J Haematol 2015; 93 Suppl 75:1-8. [PMID: 24966140 DOI: 10.1111/ejh.12323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM This review summarises the importance, recent progress and issues in measuring patient-reported outcomes (PROs) in haemophilia research. METHODS A critical review of recent advances and trends in measuring haemophilia-related PROs was conducted, using current regulatory guidelines and methodological recommendations to evaluate these instruments. RESULTS Although regulators, payers and policymakers increasingly consider the patient's perspective to be important in treatment decision-making, to date, few haemophilia intervention studies have meaningfully applied PRO endpoints. Condition-specific PRO instruments have been developed, but most are not fully validated; sensitivity to subgroup differences and changes over time is unclear. Generic PROs and instruments developed for other conditions have been used to measure health-related quality of life (HRQL) in haemophilia patients, but little evidence of their validity for this purpose exists. Haemophilia presents a number of challenges to developing valid, reliable and responsive PRO instruments, including the rarity of the disorder; necessitating research in multiple counties to attain sufficient sample size; the chronic nature of the condition; acute exacerbations of illness; age and geographical region variations with respect to treatment; differences in treatment regimens, range of disease severity and phenotypes; and changes in patients' perceived health status over time. Given that haemophilia begins at birth, the illness has an impact on the lives of caregivers, although the extent of the impact is largely unknown. CONCLUSIONS Patient perspectives are crucial to understanding the best and most cost-effective haemophilia treatment approaches. More research is needed on the ability of current disease-specific and generic PRO instruments to capture responsiveness to treatments over time and subgroup differences in outcomes. Inclusion of PROs in clinical trials is necessary to answer these questions.
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García-Dasí M, Aznar JA, Jiménez-Yuste V, Altisent C, Bonanad S, Mingot E, Lucía F, Giménez F, López MF, Marco P, Pérez R, Fernández MÁ, Paloma MJ, Galmes B, Herrero S, García-Talavera JA. Adherence to prophylaxis and quality of life in children and adolescents with severe haemophilia A. Haemophilia 2015; 21:458-64. [PMID: 25649244 DOI: 10.1111/hae.12618] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/30/2022]
Abstract
Treatment adherence in adolescents with chronic diseases is around 50%, and failure is more common in preventive therapy. In haemophilia, contradictory results are reported by the published studies. The objective of this study was to evaluate adherence with factor VIII (FVIII) prophylaxis in Spanish patients with severe haemophilia A between age 6 and 20 years. Data were collected retrosp-ectively in the previous 2 years. The primary endpoint was the absolute adherence index (AAI), and the endpoints were related to clinical status, age, prophylaxis regimen, responsibility for factor administration and quality of life (QoL), assessed by the Haemo-QoL questionnaires. A total of 78 patients from 14 Spanish hospitals were recruited. Adherence ranged between -64.4 and 66.7 (mean -3.08). No differences were observed between children and adolescents (7.11 vs. 6.39; P = 0.809). A statistically significant association (P < 0.010) between infra adherent group and target joint was found, as was a statistically significant difference (P < 0.010) between the number of bleeding episodes experienced by the adherent group (mean 1.4) and by infra adherents (mean 4.5). There was no significant difference between AAI and prophylactic regimen (6.35 vs. 6.96, P = 0.848), neither between AAI and the person responsible for factor administration (5.57 vs. 8.79, P = 0.326). The Haemo-QoL scores (8-12 years) were related to adherence level (P < 0.05). Adherence was approximately ideal and patients perceived a high QoL. Because of the repercussions for compliance, it is essential to work during puberty on emotional and self-acceptance aspects of the disease, as well as coping, and the patient's family, school and health team relationships.
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Affiliation(s)
- M García-Dasí
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J A Aznar
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - C Altisent
- Hospital Vall d'Hebron, Barcelona, Spain
| | - S Bonanad
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - E Mingot
- Hospital Carlos Haya, Málaga, Spain
| | - F Lucía
- Hospital Miguel Servet, Zaragoza, Spain
| | - F Giménez
- Hospital Torrecárdenas, Almería, Spain
| | | | - P Marco
- Hospital General de Alicante, Alicante, Spain
| | - R Pérez
- Hospital Virgen del Rocío, Sevilla, Spain
| | | | - M J Paloma
- Hospital Virgen del Camino, Pamplona, Spain
| | - B Galmes
- Hospital Son Espases, Mallorca, Spain
| | - S Herrero
- Hospital General de Guadalajara, Guadalajara, Spain
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Stemberger M, Seybold U, Eberle J, Denk G, Kolligs F, Kaspar M, Guba M, Pichler M, Spannagl M. Haemophilia-related outcome after liver transplantation and treatment with sofosbuvir/ribavirin in a HCV-HIV coinfected man with liver failure and hepatocellular carcinoma. Haemophilia 2015; 21:e131-e133. [PMID: 25622556 DOI: 10.1111/hae.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M Stemberger
- Haemostaseologie, Medizinische Klinik und Poliklinik IV, Klinikum der LMU, Munich, Germany
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Grosse SD, Chaugule SS, Hay JW. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:267-83. [PMID: 25585817 DOI: 10.1586/14737167.2015.1001372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost-effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost-effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mail Stop E-64, Atlanta, GA 30333, USA
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Psychometric properties of the Greek Haem-A-QoL for measuring quality of life in Greek haemophilia patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:968081. [PMID: 24895637 PMCID: PMC4026943 DOI: 10.1155/2014/968081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/01/2014] [Indexed: 11/18/2022]
Abstract
Background and Objectives. Health Related Quality of Life (HRQoL) is an important health outcome measure in haemophilia. The aim of this study was to assess the psychometric properties of the Greek version of Haem-A-QoL, a disease-specific questionnaire for haemophiliacs. Methods. Haem-A-QoL and SF-36 were administered to 118 adult haemophilia patients. Hypothesized scale structure, internal consistency (Cronbach's α), and test-retest reliability, as well as various types of construct validity were evaluated. Results. Scale structure of Haem-A-QoL was confirmed, with good item convergence (87%) and discrimination (80.6%) rates. Cronbach's α was >0.70 for all but one dimension (dealing) and test-retest reliability was significantly high. The strength of Spearman's correlations between Haem-A-QoL and SF-36 scales ranged from 0.25 to 0.75 (P < 0.01). Multiple stepwise linear regression analysis revealed that all but one Haem-A-QoL dimensions were important predictors of SF-36 scales. Known-groups comparisons yielded consistent support of the instruments' construct validity and significant relationships were identified for age, educational level, haemophilia type, disease severity, and viral infections. Conclusion. Overall, the psychometric properties of the Greek version of Haem-A-QoL, resulting from this first time administration of the instrument to Greek adult haemophiliacs, confirmed it as a reliable and valid questionnaire for assessing haemophilia-specific HRQoL in Greece.
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