1
|
Cost-effectiveness Analysis of Prophylaxis Versus On-demand Treatment for Children With Hemophilia B Without Inhibitors in China. Clin Ther 2021; 43:1536-1546. [PMID: 34392959 DOI: 10.1016/j.clinthera.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/03/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Hemophilia B (HB) is a hereditary bleeding disorder caused by a deficiency of coagulation factor IX (FIX), which represents 15% to 20% of all patients with hemophilia. Clinical studies have found significant benefits of prophylaxis treatment with FIX versus on-demand (OD) treatment. However, these benefits are associated with an increase in FIX consumption and a considerable increase in cost. Most Chinese children with HB receive OD treatment. Only a small proportion of patients with HB receive prophylaxis treatment in China. The patients with inhibitors could result in more complicated bleeding events, joint status, or treatment patterns. The objective of this study is to assess the cost-effectiveness of prophylaxis compared with OD treatment in children with HB without inhibitors from the Chinese health care perspective. METHODS A Markov model was used to analyze cost-effectiveness by comparing prophylaxis with OD treatment. The model uses a 17-year time horizon with a yearly cycle. Transition probabilities and utility weights were estimated using published studies. The cost data for patients with HB were collected from Beijing Children's Hospital and Capital Medical University. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the results. FINDINGS The model projects that prophylaxis has an incremental 1.23 quality-adjusted life-years (QALYs). The incremental cost per QALY gained for individuals with HB receiving prophylaxis was ¥155,709.80 ($23,530.36) compared with the OD group, which is under the willingness-to-pay threshold (3 times the gross domestic product per capital according to the World Health Organization recommendations) in China of ¥193,932 ($29,306.37). Moreover, 1-way sensitivity analysis found that the results were sensitive to the utility of nonarticular bleeding. The lower this parameter is, the higher the probability is of the incremental cost-effectiveness ratio for prophylaxis not being cost-effective. This finding infers that when the patients have a better QALY (higher utility) at the beginning, the cost for benefit from prophylaxis treatment is lower. The results of the probabilistic sensitivity analyses indicate that the probability of prophylaxis being cost-effective is 89.3%. IMPLICATIONS Although prophylaxis is a costly treatment, the results of this study indicate that it is cost-effective compared with OD treatment for children with HB in China.
Collapse
|
2
|
Health care resource utilization and cost burden of hemophilia B in the United States. Blood Adv 2021; 5:1954-1962. [PMID: 33830206 DOI: 10.1182/bloodadvances.2020003424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/28/2021] [Indexed: 01/12/2023] Open
Abstract
Hemophilia B is a rare congenital blood disorder characterized by factor IX deficiency. Clinical profiles of hemophilia B range from mild to severe forms of the disease. The objective of this study was to characterize the economic burden associated with differing clinical profiles of hemophilia B from a US health system perspective. Using the IBM MarketScan database (June 2011-February 2019), a claims-based algorithm was developed to identify 4 distinct profiles (mild, moderate, moderate-severe, and severe) in adult males with hemophilia B based on the frequency of hemorrhage events and factor IX replacement claims. Mean annual health care resource use (HRU) and costs were statistically compared between patients with hemophilia B (N = 454) and 1:1 demographic-matched controls (N = 454), both overall and with stratification by clinical profile. Compared with matched controls, patients with hemophilia B had a significantly higher comorbidity burden (Charlson Comorbidity Index, mean ± standard deviation [SD]: 0.9 ± 1.7 vs 0.3 ± 0.9, P < .001). Across all clinical profiles, patients with hemophilia B had significantly higher HRU vs matched controls (mean ± SD: 0.3 ± 0.6 vs 0.1 ± 0.3 inpatient admissions; 0.6 ± 1.2 vs 0.2 ± 0.6 emergency department visits; 17.7 ± 22.9 vs 8.0 ± 11.0 outpatient visits; all P < .001). Annual total health care costs per patient among patients with hemophilia B were more than 25-fold higher vs matched controls (mean ± SD: $201 635 ± $411 530 vs $7879 ± $29 040, respectively, P < .001). Annual total health care costs per patient increased with increasing severity (mean ± SD: mild, $80 811 ± $284 313; moderate, $137 455 ± $222 021; moderate-severe, $251 619 ± $576 886; severe, $632 088 ± $501 270). The findings of this study highlight the substantial burden of illness associated with hemophilia B.
Collapse
|
3
|
Pasi KJ, Fischer K, Ragni M, Kulkarni R, Ozelo MC, Mahlangu J, Shapiro A, P'Ng S, Chambost H, Nolan B, Bennett C, Matsushita T, Winding B, Fruebis J, Yuan H, Rudin D, Oldenburg J. Long-term safety and sustained efficacy for up to 5 years of treatment with recombinant factor IX Fc fusion protein in subjects with haemophilia B: Results from the B-YOND extension study. Haemophilia 2020; 26:e262-e271. [PMID: 32497409 DOI: 10.1111/hae.14036] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/07/2020] [Accepted: 04/28/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Recombinant factor IX Fc fusion protein (rFIXFc) has demonstrated efficacy for treatment of haemophilia B in the Phase 3 B-LONG and Kids B-LONG studies. However, long-term rFIXFc safety and efficacy data have not yet been reported. AIM To report long-term rFIXFc safety and efficacy in subjects with haemophilia B. METHODS B-YOND (NCT01425723) was an open-label extension for eligibl previously treated subjects who completed B-LONG or Kids B-LONG. Subjects received ≥1 treatment regimen: weekly prophylaxis (WP), individualized interval prophylaxis (IP), modified prophylaxis or episodic treatment. Subjects could switch regimens at any time. The primary endpoint was inhibitor development. RESULTS Ninety-three subjects from B-LONG and 27 from Kids B-LONG (aged 3-63 years) were enrolled. Most subjects received WP (B-LONG: n = 51; Kids B-LONG: n = 23). For subjects from B-LONG, median (range) treatment duration was 4.0 (0.3-5.4) years and median (range) number of exposure days (EDs) was 146 (8-462) EDs. Corresponding values for paediatric subjects were 2.6 (0.2-3.9) years and 132 (50-256) EDs. No inhibitors were observed (0 per 1000 subject-years; 95% confidence interval, 0-8.9) and the overall rFIXFc safety profile was consistent with prior studies. Annualized bleed rates remained low and extended-dosing intervals were maintained for most subjects. Median dosing interval for the IP group was approximately 14 days for adults and adolescents (n = 31) and 10 days for paediatric subjects (n = 5). CONCLUSIONS B-YOND results confirm the long-term (up to 5 years, with cumulative duration up to 6.5 years) well-characterized safety and efficacy of rFIXFc treatment for haemophilia B.
Collapse
Affiliation(s)
- K John Pasi
- Royal London Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Margaret Ragni
- Hemophilia Center of Western Pennsylvania, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Johnny Mahlangu
- Haemophilia Comprehensive Care Centre, Faculty of Health Sciences, University of the Witwatersrand, and Charlotte Maxeke Johannesburg Academic Hospital and National Health Laboratory Service, Johannesburg, South Africa
| | - Amy Shapiro
- Indiana Hemophilia & Thrombosis Center, Inc., Indianapolis, IN, USA
| | - Stephanie P'Ng
- The Haemophilia and Haemostasis Centre, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Hervé Chambost
- Children's Hospital La Timone, and Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | | | - Carolyn Bennett
- Emory University School of Medicine, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | | | | | - Dan Rudin
- Bioverativ, a Sanofi company, Waltham, MA, USA
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| |
Collapse
|
4
|
Spronck EA, Liu YP, Lubelski J, Ehlert E, Gielen S, Montenegro-Miranda P, de Haan M, Nijmeijer B, Ferreira V, Petry H, van Deventer SJ. Enhanced Factor IX Activity following Administration of AAV5-R338L "Padua" Factor IX versus AAV5 WT Human Factor IX in NHPs. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2019; 15:221-231. [PMID: 31709273 PMCID: PMC6834974 DOI: 10.1016/j.omtm.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 10/29/2022]
Abstract
Gene therapy for severe hemophilia B is advancing and offers sustained disease amelioration with a single treatment. We have reported the efficacy and safety of AMT-060, an investigational gene therapy comprising an adeno-associated virus serotype 5 capsid encapsidating the codon-optimized wild-type human factor IX (WT hFIX) gene with a liver-specific promoter, in patients with severe hemophilia B. Treatment with 2 × 1013 gc/kg AMT-060 showed sustained and durable FIX activity of 3%-13% and a substantial reduction in spontaneous bleeds without T cell-mediated hepatoxicity. To achieve higher FIX activity, we modified AMT-060 to encode the R338L "Padua" FIX variant that has increased specific activity (AMT-061). We report the safety and increased FIX activity of AMT-061 in non-human primates. Animals (n = 3/group) received intravenous AMT-060 (5 × 1012 gc/kg), AMT-061 (ranging from 5 × 1011 to 9 × 1013 gc/kg), or vehicle. Human FIX protein expression, FIX activity, and coagulation markers including D-dimer and thrombin-antithrombin complexes were measured. At equal doses, AMT-060 and AMT-061 resulted in similar human FIX protein expression, but FIX activity was 6.5-fold enhanced using AMT-061. Both vectors show similar safety and transduction profiles. Thus, AMT-061 holds great promise as a more potent FIX replacement gene therapy with a favorable safety profile.
Collapse
Affiliation(s)
- Elisabeth A Spronck
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Ying Poi Liu
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Jacek Lubelski
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Erich Ehlert
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Sander Gielen
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | | | - Martin de Haan
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Bart Nijmeijer
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Valerie Ferreira
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Harald Petry
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands
| | - Sander J van Deventer
- uniQure biopharma B.V., Paasheuvelweg 25A, 1105 BP Amsterdam, the Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| |
Collapse
|
5
|
Carroll L, Benson G, Lambert J, Benmedjahed K, Zak M, Lee XY. Real-world utilities and health-related quality-of-life data in hemophilia patients in France and the United Kingdom. Patient Prefer Adherence 2019; 13:941-957. [PMID: 31354248 PMCID: PMC6585419 DOI: 10.2147/ppa.s202773] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose: Congenital hemophilia A and B are bleeding disorders characterized by deficiency of factors VIII and IX, respectively. This study aimed to collect health-related quality-of-life (HRQoL) and health-utility data from hemophilia patients with differing disease severity. Methods: Individuals with hemophilia aged ≥12 years living in France or the UK completed a series of questionnaires, including the EQ-5D-3L and -5L and SF-36 version 2. Association with demographic and clinical variables was explored using linear regression, and health-utility comparison was completed using Pearson and intraclass correlation coefficients. Results: A total of 122 patients in France and 62 in the UK completed the survey. The combined sample primarily consisted of hemophilia A patients, mean age of 41 years, 70% had severe hemophilia, and 56% were on long-term prophylaxis. Similar HRQoL and utility scores were observed across the French and UK samples. The presence of more than two target joints, occurrence of joint surgery, and increased joint-pain frequency were independent predictors of lower SF-36 - physical health summary scores and lower health-utility scores. No statistically significant reductions in SF-36 - mental health summary scores were observed, except for participants with target joints. Strong correlations were observed between health- utility values derived from the three instruments (r=0.69-0.79). Conclusion: Results of this study reinforce the importance of appropriate treatment to limit the physical burden and long-term joint damage associated with hemophilia. Further, utility values collected here reflect real-world data, and can serve as health-state weights in future cost-utility analyses.
Collapse
Affiliation(s)
| | - Gary Benson
- Northern Ireland Haemophilia Comprehensive Care Centre and Thrombosis Unit, Belfast City Hospital
, Belfast, UK
| | - Jérémy Lambert
- Patient-Centered Outcomes, Mapi, an ICON plc company, Lyon, France
| | | | - Marek Zak
- Global Development, Medical & Science, Biopharm, Novo Nordisk, Søborg, Denmark
| | - Xin Ying Lee
- Global Biopharm Patient Access, Novo Nordisk, Søborg, Denmark
- Correspondence: Xin Ying Lee Global Biopharm Patient Access, Novo Nordisk, 108 Vandtårnsvej, Søborg, DenmarkTel +45 30 777 030 Email
| |
Collapse
|
6
|
Mahlangu JN. Updates in clinical trial data of extended half-life recombinant factor IX products for the treatment of haemophilia B. Ther Adv Hematol 2018; 9:335-346. [PMID: 30364483 PMCID: PMC6196631 DOI: 10.1177/2040620718802606] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022] Open
Abstract
Whilst the global prevalence of haemophilia B is less than that of haemophilia A, rapid and remarkable innovations have been made in the development of haemophilia B therapies in the last decade. The most recent developments are the evolution of extended half-life haemophilia B replacement therapies which are designed to reduce the treatment burden associated with prophylactic infusion of factor IX (FIX) to prevent bleeding in haemophilia B participants. Clinical development programmes have culminated in the completion of three phase III studies on extended half-life (EHL) recombinant FIX (rFIX) products and subsequent approval and registration of these in many countries around the world. Current data from the three EHL rFIX clinical studies indicate that these products have acceptable safety profiles with no allergic reactions, thromboembolic phenomena or neutralizing antibodies when given to previously treated adolescent and adults for the prevention of bleeds, for the treatment of bleeds and in the perisurgical haemostasis use. Studies in previously untreated paediatric participants are currently ongoing. The EHL rFIX products have the potential impact to reduce the treatment burden associated with prophylactic infusion of replacement FIX, to treat and prevent bleeds in participants with haemophilia B and to improve the participant's health-related quality of life. The impact of EHL rFIX is likely to be modified by current development of other haemophilia B therapy such as antitissue factor pathway inhibitors and haemophilia B gene therapy. In this review, we aim to provide an update on the safety and efficacy data from the three EHL rFIX clinical studies and to consider their roles in the face of novel haemophilia B therapy currently evolving.
Collapse
Affiliation(s)
- Johnny N. Mahlangu
- Haemophilia Comprehensive Care Centre, Charlotte Maxeke Johannesburg Academic Hospital, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, 7 York Road, Parktown, Johannesburg 2193, South Africa
| |
Collapse
|
7
|
Abstract
INTRODUCTION The health benefits of prophylactic dosing regimens for clotting factor therapy in patients with hemophilia include reduced joint damage and improved quality of life; as such, prophylaxis is recommended in treatment guidelines. However, many patients with hemophilia B are treated on demand, and prophylaxis has been utilized less frequently than in hemophilia A. Areas covered: This review discusses the opportunities and evidence for prophylaxis in hemophilia B, in the context of treatment guidelines and with regard to factor IX (FIX) replacement therapies, including long-acting recombinant FIX (rFIX). Expert commentary: Long-acting rFIX concentrates may increase uptake of and adherence to prophylaxis regimens through attainment of higher trough levels with longer dosing intervals. In this new era of hemophilia B treatment, physicians may be able to achieve better clinical outcomes for their patients and reconsider treatment goals. Maintaining higher FIX trough levels will undoubtedly have long-term benefits for patients, such as preserving joint function. The long-acting rFIX concentrates support robust prophylaxis regimens and offer physician's flexibility in treating patients to best suit their needs, whether to enable an active lifestyle, to achieve higher trough levels for better bleed protection, or simply to decrease the burden of treatment by reducing injection frequency.
Collapse
Affiliation(s)
- Giancarlo Castaman
- a Center for Bleeding Disorders , Careggi University Hospital , Florence , Italy
| |
Collapse
|
8
|
Miesbach W, Sawyer EK. Practical Implications of Factor IX Gene Transfer for Individuals with Hemophilia B: A Clinical Perspective. HUM GENE THER CL DEV 2018; 29:80-89. [PMID: 29624465 DOI: 10.1089/humc.2017.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gene therapy for severe hemophilia is on the cusp of entering clinical practice. However, there is limited clinical experience in this area given that gene transfer is a relatively recent technology. Therefore, this clinical perspective article will review the evidence supporting gene therapy in this field, examine ways to open a dialogue about gene therapy with patients in the clinic setting, and present a case of a participant in a recent clinical trial of gene therapy for hemophilia. Clinical trials in hemophilia using adeno-associated virus (AAV) vectors to transfer functional factor IX (FIX) have reported increases in FIX activity to functional levels, reduced bleed frequency, and a lessening or abrogation of the need for costly FIX replacement. The safety profile of AAV-mediated gene therapy also appears positive, with manageable, asymptomatic increases in liver enzymes being the most commonly described adverse event. Examining a clinical case in hemophilia B more closely, gene transfer decreased annualized bleeds from six (unknown or spontaneous) bleeds before treatment to three (spontaneous) bleeds after treatment alongside a 55% reduction in FIX replacement. The participant experienced an increase in traumatic bleeds after treatment, which appears to reflect increased physical activity and early prophylaxis discontinuation. After the gene transfer, the participant considered his hemophilia to be "cured," which emphasizes the need to manage patient expectations, particularly regarding activity levels and bleed risk in the immediate post-treatment period. Gene therapy for hemophilia has the potential to transform the lives of affected individuals and is likely to create a new class of hemophilia patient who has shifted from a severe to a mild phenotype. Despite having a mild phenotype, these individuals may retain a legacy of increased bleed risk and joint damage from their years with severe hemophilia and will need different clinical management compared to a more typical individual with mild hemophilia.
Collapse
|
9
|
The impact of extended half-life versus conventional factor product on hemophilia caregiver burden. Qual Life Res 2018; 27:1335-1345. [PMID: 29392598 PMCID: PMC5891570 DOI: 10.1007/s11136-018-1792-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Extended half-life factor products have reduced annualized bleeding rates in hemophilia patients. The impact of extended half-life versus conventional factor products on hemophilia caregiver burden has not been investigated. This study aimed to evaluate caregiver burden in extended half-life versus conventional factor products for hemophilia A and B. METHODS This cross-sectional web-based study of caregivers of people with hemophilia A or B was recruited from a panel research company and by word of mouth. Participants completed the Hemophilia Caregiver Impact measure, the PedsQL Family Impact Module (PedsQL), and the Work Productivity and Activity Impairment Questionnaire (WPAI). We also collected demographic, insurance coverage, and medical information related to the hemophilia patient(s). Burden differences were assessed using linear regression and matched cohort analyses. RESULTS The sample (n = 448) included 49 people who were caring for people on extended half-life factor products. Worse caregiver burden was associated with more infusions per week and more bleeds in the past 6 months. Regression analyses suggested that caring for someone who is on a extended half-life factor product is associated with lower emotional impact (β = - 0.11, p < 0.05, Adjusted R2 = 0.06), and shows a trend association with lower practical impact (β = - 0.09, p < 0.10, Adjusted R2 = 0.05). The matched cohort analysis also revealed that people on extended half-life factor product had lower Emotional Impact and Practical Impact scores (t = - 2.95 and - 2.94, respectively, p < 0.05 in both cases). No differences were detected on the PedsQL or the WPAI. CONCLUSION The reduced required frequency of factor product infusions of extended half-life factor products appears to reduce the emotional distress and practical burden of caregiving. Future work should evaluate the longitudinal impact.
Collapse
|
10
|
Chen CX, Baker JR, Nichol MB. Economic Burden of Illness among Persons with Hemophilia B from HUGS Vb: Examining the Association of Severity and Treatment Regimens with Costs and Annual Bleed Rates. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1074-1082. [PMID: 28964439 DOI: 10.1016/j.jval.2017.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 03/03/2017] [Accepted: 04/20/2017] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine US societal burden of illness, including direct and indirect costs and annual bleed rate (ABR), for persons with hemophilia B (HB), a rare and debilitating genetic disorder, and to examine associations of hemophilia severity and treatment regimens with costs and ABR. METHODS From 2009 to 2014, the Hemophilia Utilization Group Studies Part Vb collected prospective data from 10 US hemophilia treatment centers. Participants with HB completed initial surveys on sociodemographic characteristics, clinical characteristics, and treatment patterns. During the 2-year follow-up, participants reported bleeding episodes, work absenteeism, and caregiver time quarterly. These data were used to calculate ABR and indirect costs. Direct costs were calculated using 1-year clinical chart records and 2-year dispensing records. RESULTS Of the 148 participants, 112 with complete medical records and one or more follow-up survey were included. Total mean annual per-person costs were $85,852 (median $20,160) for mild/moderate HB, $198,733 (median $147,891) for severe HB, and $140,240 (median $63,617) for all participants without inhibitors (P < 0.0001). Mean ABR for participants with severe HB on prophylaxis (5.5 ± 7.9 bleeds/y) was almost half that of those treated episodically. Clotting factor and indirect costs accounted for 85% and 9% of total costs, respectively. Compared with episodic treatment, prophylaxis use was associated with 2.5-fold higher clotting factor costs (P < 0.01), low but significantly more missed parental workdays (P < 0.0001) and clinician (P < 0.001) or nursing visits (P < 0.0001), less part-time employment and unemployment, and lower hospitalizations costs (P = 0.17) and ABR (P < 0.0001). CONCLUSIONS HB is associated with high economic burden, primarily because of clotting factor costs. Nevertheless, prophylaxis treatment leads to clinical benefits and may reduce other nonfactor costs.
Collapse
Affiliation(s)
| | - Judith R Baker
- University of California Los Angeles, Los Angeles, CA, USA; Center for Inherited Blood Disorders, Orange, CA, USA
| | | |
Collapse
|
11
|
von Mackensen S, Eldar-Lissai A, Auguste P, Krishnan S, von Maltzahn R, Yu R, Wyrwich KW. Measurement properties of the Haem-A-QoL in haemophilia clinical trials. Haemophilia 2016; 23:383-391. [PMID: 28026074 DOI: 10.1111/hae.13140] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Patients with haemophilia on long-acting prophylactic treatment may experience an improvement in health-related quality of life (HRQoL) through reductions in breakthrough bleeds and associated complications, including long-term joint damage, compared with episodic treatment. AIM This analysis examined clinical trial data to understand the psychometric characteristics (reliability, validity and sensitivity to change over time) of the Haem-A-QoL Questionnaire in adult males with haemophilia. METHODS Two recent, multinational, Phase 3 clinical trials of new, long-acting factor concentrates (A-LONG: rFVIIIFc; B-LONG: rFIXFc) assessed HRQoL in adolescent and adult males with severe haemophilia A or B respectively. The adults' baseline assessments, via the 46-item Haem-A-QoL Questionnaire, and change over time at the 6-month assessment were used in the psychometric analyses. RESULTS Internal consistency reliability was adequate (Cronbach's alpha > 0.70) for nine of the 10 Haem-A-QoL domains and for 'Total Score' in both trials at baseline (A-LONG, n = 133; B-LONG, n = 73). At baseline, several Haem-A-QoL domains and 'Total Score' demonstrated known-groups and convergent validity when compared with other trial measures, including the EQ-5D (items and total scores) and joint impairment. Change score correlations (baseline to 28 weeks) between the EQ-5D and the Haem-A-QoL 'Total Score', and 'Physical Health' and 'Feelings' domains were moderate in magnitude (│r│ ≥ 0.33; P < 0.03), demonstrating sensitivity to change for these outcome measures in A-LONG. CONCLUSION These psychometric analyses provide evidence of the reliability, validity and ability to detect change of the Haem-A-QoL to assess the HRQoL of adult males with severe haemophilia A and B in longitudinal clinical trials.
Collapse
Affiliation(s)
- S von Mackensen
- Institute of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | - R Yu
- Evidera, Bethesda, MD, USA
| | | |
Collapse
|
12
|
Djambas Khayat C. Once-weekly prophylactic dosing of recombinant factor IX improves adherence in hemophilia B. J Blood Med 2016; 7:275-282. [PMID: 27942241 PMCID: PMC5138045 DOI: 10.2147/jbm.s84597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Regular prophylactic treatment in severe hemophilia should be considered an optimal treatment. There is no general agreement on the optimal prophylaxis regimen, and adherence to prophylaxis is a main challenge due to medical, psychosocial, and cost controversies. Improved approaches in prophylaxis regimen of hemophilia B are needed to make patients’ lives easier. There is some evidence to support the efficacy of once-weekly prophylaxis. Longer sampling schedules are required for the determination of pharmacokinetic (PK) properties of factor IX (FIX). The half-life of FIX seems to be longer than previously described and is expected to be 34 hours. The clinical significance of maintaining a 1% trough level is widely debated in hemophilia B. The overall relationship between factor concentrate levels and incidence of joint bleeding was found to be very weak. Data also indicate that the distribution of FIX into an extravascular FIX compartment may contribute to hemostasis independently of circulating plasma FIX levels. Clinical assessment of the frequency and severity of bleeds remain an important measure of the efficacy of treatment. Role of PK-guided therapy remains to be established. Two prospective randomized studies had evaluated the efficacy and safety of 100 IU/kg once-weekly prophylaxis with nonacog alfa, and this prophylaxis regimen was found to be associated with lower annual bleeding rate compared with on-demand treatment in adolescents and adults with moderately severe-to-severe hemophilia B. Secondary prophylaxis therapy with 100 IU/kg nonacog alfa once weekly reduced annual bleeding rate by 89.4% relative to on-demand treatment. Residual FIX may be supportive of effectiveness. Once-weekly prophylaxis was well tolerated in the two studies, with a safety profile similar to that reported during the on-demand treatment period. To individually tailor treatment to clinical response and to minimize costs of factor concentrate, it would be of interest to investigate the efficacy of lower doses of the drug administered once a week.
Collapse
|
13
|
Kesselheim AS, McGraw S, Thompson L, O'Keefe K, Gagne JJ. Development and use of new therapeutics for rare diseases: views from patients, caregivers, and advocates. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:75-84. [PMID: 25362528 DOI: 10.1007/s40271-014-0096-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with rare diseases experience the health care system differently than patients with more common conditions. They can therefore provide important perspectives on the process of developing therapeutics for their conditions. METHODS We conducted three in-person focus groups involving rare disease patients (n = 9), caregivers (n = 8), and advocates (n = 9). Focus group participants were asked to describe their experiences with a rare disease, what they would want to know about a new drug for the disease, what outcomes they believe should be assessed in drug testing, perceptions of off-label use of a drug for treating a rare disease, views on participation in clinical trials, and opinions of the US Food and Drug Administration's (FDA's) function. The coding structure was populated from the transcripts of the sessions, using Atlas.ti qualitative analysis software, and then analyzed for common themes. RESULTS Participants described the challenges of learning to live with a poorly understood condition for which treatment is limited. Rare disease patients were willing to accept certain risks in their care in the hopes of finding some benefit, but also expressed frustrations with the costs of their care and the lack of scientific data about their treatments. They were concerned that the development and testing of therapies should, as quickly as possible, yield effective treatments to advance their quality of life. CONCLUSION With limited therapeutic options, rare disease patients often considered off-label treatments or novel drugs that posed substantial risk. Nonetheless, rare disease patients generally appreciated the rigor of the research underlying the drugs and supported the FDA's gatekeeping role.
Collapse
Affiliation(s)
- Aaron S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA,
| | | | | | | | | |
Collapse
|
14
|
Chowdary P, Kearney S, Regnault A, Hoxer CS, Yee DL. Improvement in health-related quality of life in patients with haemophilia B treated with nonacog beta pegol, a new extended half-life recombinant FIX product. Haemophilia 2016; 22:e267-74. [PMID: 27352908 DOI: 10.1111/hae.12995] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) of individuals with haemophilia has greatly improved with the use of factor replacement and routine prophylaxis. AIM To explore the HRQoL of individuals with haemophilia B treated with nonacog beta pegol, an extended half-life recombinant factor IX, in a single-blind, randomized multinational phase III pivotal trial (paradigm(™) 2) and its open-label extension (paradigm(™) 4). METHODS In the pivotal trial, adolescents and adults with haemophilia B were allocated to 28-week on-demand treatment or randomized to 52 weeks of prophylaxis with 10 or 40 IU kg(-1) nonacog beta pegol administered every seven days. In the extension trial, patients could continue on the same treatment or switch to the alternate dosing regimen at any time. HRQoL was assessed with the HAEMO-QOL/HAEM-A-QOL age-specific questionnaires and the EQ-5D. RESULTS In the pivotal trial, adults receiving 40 IU kg(-1) prophylaxis reported significant improvements in the 'HAEM-A-QOL Total' score (-6.4 ± 8.5, P = 0.017) and in 'Sport' (-15.3 ± 8.5, P = 0.020), 'Feeling' (-15.2 ± 18.3, P = 0.010) and 'Partnership' (-9.6 ± 15.5, P = 0.046) domain scores; no significant improvements were seen in the other arms. At the pivotal trial end, fewer patients reported problems in the EQ-5D 'Mobility' and 'Pain/Discomfort' dimensions, in particular those receiving prophylaxis. In the extension trial, adult patients switching from 10 to 40 IU kg(-1) prophylaxis showed significant improvements in 'HAEM-A-QOL Total' score (-12.5 ± 8.7, P = 0.016) and 'Physical health' domain (-23.1 ± 14.4, P = 0.016). CONCLUSION Prophylactic treatment with nonacog beta pegol 40 IU kg(-1) once weekly leads to HRQoL benefits in individuals with haemophilia B; this might be related to fewer bleeding episodes and higher FIX activity levels.
Collapse
Affiliation(s)
- P Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - S Kearney
- CHCMN Hemophilia and Thrombosis Center Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - A Regnault
- Patient-Centered Outcomes, Mapi, Lyon, France
| | | | - D L Yee
- Department of Pediatrics, Hematology-Oncology Section, Baylor College of Medicine, Texas Children's Hemophilia & Thrombosis Center, Houston, TX, USA
| |
Collapse
|
15
|
Witkop ML, McLaughlin JM, Anderson TL, Munn JE, Lambing A, Tortella B. Predictors of non-adherence to prescribed prophylactic clotting-factor treatment regimens among adolescent and young adults with a bleeding disorder. Haemophilia 2016; 22:e245-50. [PMID: 27216992 DOI: 10.1111/hae.12951] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adherence to clotting-factor treatment regimens, especially among adolescents and young adults (AYAs), is under-researched. AIM We determined factors associated with better adherence to prophylaxis. METHODS From April through December 2012, a convenience sample of AYA (aged 13-25 years) persons with haemophilia or von Willebrand disease (VWD) completed an online survey that assessed adherence to prescribed prophylactic treatment regimens [Validated Haemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro]. Logistic regression analysis assessed demographic and clinical factors related to non-adherence (VERITAS-Pro≥57). RESULTS Seventy-three prophylactically treating AYAs participated. Of which, 88%, 8% and 4% had haemophilia A, B and VWD respectively. Almost all (90%) had severe disease and 58% had never developed an inhibitor. Most were aged 13-17 years (56%), white (78%), non-Hispanic (88%), never married (94%) and had some type of health insurance (96%). Median VERITAS-Pro score was 48 (range = 25-78) and 22 (30%) participants were non-adherent to prophylaxis (VERITAS-Pro≥57). Final logistic regression modelling suggested that, compared to those aged 13-17 years, participants aged 18-25 years were 6.2 (95% CI: 1.8-21.0; P < 0.01) times more likely to be non-adherent. Compared to respondents whose mother had at least a Bachelor's degree, respondents whose mother did not were 3.8 (95% CI: 1.0-14.3; P = 0.05) times more likely to be non-adherent. CONCLUSIONS Results suggest that adherence efforts should be especially targeted to young adults as they transition from adolescence (i.e. parental supervision) and assume primary responsibility for their bleeding disorder care. Healthcare providers should be mindful of AYAs whose mothers have less formal education and ensure that adequate time and resources are dedicated to family adherence education.
Collapse
Affiliation(s)
- M L Witkop
- Northern Regional Bleeding Disorders Center, Traverse City, MI, USA
| | | | - T L Anderson
- Pfizer Inc, US Medical Affairs, Collegeville, PA, USA
| | - J E Munn
- University of Michigan Haemophilia Treatment Center, Ann Arbor, MI, USA
| | - A Lambing
- Henry Ford Adult Haemophilia & Thrombosis Treatment Center, Detroit, MI, USA
| | - B Tortella
- Pfizer Inc, US Medical Affairs, Collegeville, PA, USA
| |
Collapse
|
16
|
Soleimanpour S, Hassannia T, Motiee M, Amini AA, Rezaee SAR. Fcγ1 fragment of IgG1 as a powerful affinity tag in recombinant Fc-fusion proteins: immunological, biochemical and therapeutic properties. Crit Rev Biotechnol 2016; 37:371-392. [PMID: 27049690 DOI: 10.3109/07388551.2016.1163323] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Affinity tags are vital tools for the production of high-throughput recombinant proteins. Several affinity tags, such as the hexahistidine tag, maltose-binding protein, streptavidin-binding peptide tag, calmodulin-binding peptide, c-Myc tag, glutathione S-transferase and FLAG tag, have been introduced for recombinant protein production. The fragment crystallizable (Fc) domain of the IgG1 antibody is one of the useful affinity tags that can facilitate detection, purification and localization of proteins and can improve the immunogenicity, modulatory effects, physicochemical and pharmaceutical properties of proteins. Fcγ recombinant forms a group of recombinant proteins called Fc-fusion proteins (FFPs). FFPs are widely used in drug discovery, drug delivery, vaccine design and experimental research on receptor-ligand interactions. These fusion proteins have become successful alternatives to monoclonal antibodies for drug developments. In this review, the physicochemical, biochemical, immunological, pharmaceutical and therapeutic properties of recombinant FFPs were discussed as a new generation of bioengineering strategies.
Collapse
Affiliation(s)
- Saman Soleimanpour
- a Microbiology & Virology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Tahereh Hassannia
- b Internal medicine Department, Arash Hospital, the College of Medicine, Tehran University of Medical Sciences , Tehran, Iran
| | - Mahdieh Motiee
- c Inflammation and Inflammatory Diseases Research Center, Medical School, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Abbas Ali Amini
- d Department of Immunology, faculty of medicine, Kurdistan University of Medical Sciences , Sanandaj, Iran
| | - S A R Rezaee
- c Inflammation and Inflammatory Diseases Research Center, Medical School, Mashhad University of Medical Sciences , Mashhad, Iran
| |
Collapse
|
17
|
Abstract
Hemophilia B is an X-linked genetic deficiency of coagulation factor IX (FIX) activity associated with recurrent deep tissue and joint bleeding that may lead to long-term disability. FIX replacement therapy using plasma-derived protein or recombinant protein has significantly reduced bleeding and disability from hemophilia B, particularly when used in a prophylactic fashion. Although modern factor replacement has excellent efficacy and safety, barriers to the broader use of prophylaxis remain, including the need for intravenous (IV) access, frequent dosing, variability in individual pharmacokinetics, and cost. To overcome the requirement for frequent factor dosing, novel forms of recombinant FIX have been developed that possess extended terminal half-lives. Two of these products (FIXFc and rIX-FP) represent fusion proteins with the immunoglobulin G1 (IgG1) Fc domain and albumin, respectively, resulting in proteins that are recycled in vivo by the neonatal Fc receptor. The third product has undergone site-specific PEGylation on the activation peptide of FIX, similarly resulting in a long-lived FIX form. Clinical trials in previously treated hemophilia B patients have demonstrated excellent efficacy and confirmed less-frequent dosing requirements for the extended half-life forms. However, gaps in knowledge remain with regard to the risk of inhibitor formation and allergic reactions in previously untreated patient populations, safety in elderly patients with hemophilia, effects on in vivo FIX distribution, and cost-effectiveness. Additional strategies designed to rebalance hemostasis in hemophilia patients include monoclonal-antibody-mediated inhibition of tissue factor pathway inhibitor activity and siRNA-mediated reduction in antithrombin expression by the liver. Both of these approaches are long acting and potentially involve subcutaneous administration of the drug. In this review, we will discuss the biology of FIX, the evolution of FIX replacement therapy, the emerging FIX products possessing extended half-lives, and novel “rebalancing” approaches to hemophilia therapy.
Collapse
Affiliation(s)
- Moniba Nazeef
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John P Sheehan
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
18
|
Zhao J, Xu W, Ross JW, Walters EM, Butler SP, Whyte JJ, Kelso L, Fatemi M, Vanderslice NC, Giroux K, Spate LD, Samuel MS, Murphy CN, Wells KD, Masiello NC, Prather RS, Velander WH. Engineering protein processing of the mammary gland to produce abundant hemophilia B therapy in milk. Sci Rep 2015; 5:14176. [PMID: 26387706 PMCID: PMC4585688 DOI: 10.1038/srep14176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/22/2015] [Indexed: 11/20/2022] Open
Abstract
Both the low animal cell density of bioreactors and their ability to post-translationally process recombinant factor IX (rFIX) limit hemophilia B therapy to <20% of the world’s population. We used transgenic pigs to make rFIX in milk at about 3,000-fold higher output than provided by industrial bioreactors. However, this resulted in incomplete γ-carboxylation and propeptide cleavage where both processes are transmembrane mediated. We then bioengineered the co-expression of truncated, soluble human furin (rFurin) with pro-rFIX at a favorable enzyme to substrate ratio. This resulted in the complete conversion of pro-rFIX to rFIX while yielding a normal lactation. Importantly, these high levels of propeptide processing by soluble rFurin did not preempt γ-carboxylation in the ER and therefore was compartmentalized to the Trans-Golgi Network (TGN) and also to milk. The Golgi specific engineering demonstrated here segues the ER targeted enhancement of γ-carboxylation needed to biomanufacture coagulation proteins like rFIX using transgenic livestock.
Collapse
Affiliation(s)
- Jianguo Zhao
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA.,State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China, 100101
| | - Weijie Xu
- Protein Purification and Characterization Laboratories, Department of Chemical and Biomolecular Engineering, 207 Othmer Hall, University of Nebraska, Lincoln 68588, USA
| | - Jason W Ross
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA.,Department of Animal Science, Iowa State University, Ames, IA 50011, USA
| | - Eric M Walters
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | | | - Jeff J Whyte
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - Lindsey Kelso
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - Mostafa Fatemi
- Protein Purification and Characterization Laboratories, Department of Chemical and Biomolecular Engineering, 207 Othmer Hall, University of Nebraska, Lincoln 68588, USA
| | - Nicholas C Vanderslice
- Protein Purification and Characterization Laboratories, Department of Chemical and Biomolecular Engineering, 207 Othmer Hall, University of Nebraska, Lincoln 68588, USA
| | - Keith Giroux
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - Lee D Spate
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - Melissa S Samuel
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - Cliff N Murphy
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - Kevin D Wells
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | | | - Randall S Prather
- National Swine Resource and Research Center &Division of Animal Science, University of Missouri, Columbia, MO 65211, USA
| | - William H Velander
- Protein Purification and Characterization Laboratories, Department of Chemical and Biomolecular Engineering, 207 Othmer Hall, University of Nebraska, Lincoln 68588, USA
| |
Collapse
|
19
|
Henrard S, Speybroeck N, Hermans C. Classification and regression tree analysis vs. multivariable linear and logistic regression methods as statistical tools for studying haemophilia. Haemophilia 2015; 21:715-22. [PMID: 26248714 DOI: 10.1111/hae.12778] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Haemophilia is a rare genetic haemorrhagic disease characterized by partial or complete deficiency of coagulation factor VIII, for haemophilia A, or IX, for haemophilia B. As in any other medical research domain, the field of haemophilia research is increasingly concerned with finding factors associated with binary or continuous outcomes through multivariable models. Traditional models include multiple logistic regressions, for binary outcomes, and multiple linear regressions for continuous outcomes. Yet these regression models are at times difficult to implement, especially for non-statisticians, and can be difficult to interpret. AIMS The present paper sought to didactically explain how, why, and when to use classification and regression tree (CART) analysis for haemophilia research. MATERIALS & METHODS The CART method is non-parametric and non-linear, based on the repeated partitioning of a sample into subgroups based on a certain criterion. Breiman developed this method in 1984. Classification trees (CTs) are used to analyse categorical outcomes and regression trees (RTs) to analyse continuous ones. RESULTS The CART methodology has become increasingly popular in the medical field, yet only a few examples of studies using this methodology specifically in haemophilia have to date been published. Two examples using CART analysis and previously published in this field are didactically explained in details. CONCLUSION There is increasing interest in using CART analysis in the health domain, primarily due to its ease of implementation, use, and interpretation, thus facilitating medical decision-making. This method should be promoted for analysing continuous or categorical outcomes in haemophilia, when applicable.
Collapse
Affiliation(s)
- S Henrard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.,Haemostasis-Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - N Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - C Hermans
- Haemostasis-Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
20
|
|
21
|
Abstract
Hemophilia, when severe, leads to spontaneous life-threatening bleeding episodes. Current therapy requires frequent intravenous infusions. Most patients must limit their physical activities to avoid bleeding when the factor activity levels are below normal. In 2014, new therapeutic factor VIII and IX products were approved in Canada and the U.S. Over the next couple of years, other new factor products will likely be approved. These new factors have been engineered to have improved pharmacokinetic properties, including extended half-life in circulation, thus providing major therapeutic advances for patients with hemophilia. In the completed clinical trials, over 700 patients have successfully used these longer acting products regularly for more than one year. These promising new therapies should allow patients with hemophilia to use fewer infusions to prevent spontaneous bleeding or to treat bleeding episodes, and to provide appropriate clotting factor levels for different physical activities.
Collapse
Affiliation(s)
- J S Powell
- Division of Hematology and Oncology, University of California Davis Medical Center, Sacramento, CA, USA
| |
Collapse
|
22
|
Metzger JM, Tadin-Strapps M, Thankappan A, Strapps WR, DiPietro M, Leander K, Zhang Z, Shin MK, Levorse J, Desai K, Xu Y, Lai K, Wu W, Chen Z, Cai TQ, Jochnowitz N, Bentley R, Hoos L, Zhou Y, Sepp-Lorenzino L, Seiffert D, Andre P. Titrating haemophilia B phenotypes using siRNA strategy: evidence that antithrombotic activity is separated from bleeding liability. Thromb Haemost 2015; 113:1300-11. [PMID: 25790442 DOI: 10.1160/th14-06-0505] [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] [Received: 06/11/2014] [Accepted: 01/20/2015] [Indexed: 11/05/2022]
Abstract
Haemophilia A and B are characterised by a life-long bleeding predisposition, and several lines of evidence suggest that risks of atherothrombotic events may also be reduced. Establishing a direct correlation between coagulation factor levels, thrombotic risks and bleeding propensity has long been hampered by an inability to selectively and specifically inhibit coagulation factor levels. Here, the exquisite selectivity of gene silencing combined with a gene knockout (KO) approach was used to define the relative contribution of factor IX (fIX) to thrombosis and primary haemostasis in the rat. Using a lipid nanoparticle (LNP) formulation, we successfully delivered fIX siRNAs to the liver by intravenous administration. The knockdown (KD) of target gene mRNA was achieved rapidly (within 24 hour post-siRNA dosing), sustained (maintained for at least 7 days post dosing) and not associated with changes in mRNA expression levels of other coagulation factors. We found that intermediate levels of liver fIX mRNA silencing (60-95 %) translating into a 50-99 % reduction of plasma fIX activity provided protection from thrombosis without prolonging the cuticle bleeding time. Over 99 % inhibition of fIX activity was required to observe increase in bleeding, a phenotype confirmed in fIX KO rats. These data provide substantial evidence of a participation of fIX in the mechanisms regulating thrombosis prior to those regulating primary haemostasis, therefore highlighting the potential of fIX as a therapeutic target. In addition, hepatic mRNA silencing using LNP-encapsulated siRNAs may represent a promising novel approach for the chronic treatment and prevention of coagulation-dependent thrombotic disorders in humans.
Collapse
Affiliation(s)
| | - Marija Tadin-Strapps
- Marija Tadin-Strapps, Department of Genetics and Pharmacogenomics, Merck Research Laboratories, Merck & Co., Inc., 33 Avenue E Louis Pasteur, Boston, MA 02115, USA, Tel.:+1 617 992 2339, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Patrick Andre
- Patrick Andre, Cardiometabolic Disease, Merck & Co., Inc., Galloping Hill Road, Kenilworth, NJ 07033, USA, Tel.:+1 908 740 7329, E-mail:
| |
Collapse
|
23
|
Perot E, Enjolras N, Le Quellec S, Indalecio A, Girard J, Negrier C, Dargaud Y. Expression and characterization of a novel human recombinant factor IX molecule with enhanced in vitro and in vivo clotting activity. Thromb Res 2015; 135:1017-24. [PMID: 25795563 DOI: 10.1016/j.thromres.2015.02.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/04/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hemophilia B is an inherited X-linked recessive bleeding disorder, due to a defect in human factor IX (FIX). The main treatment for hemophilia B is replacement therapy using FIX concentrates. Prophylactic treatment in severe hemophilia B is very effective but is limited by cost issues. Production of a recombinant FIX (rFIX) with enhanced clotting activity, offering the possibility of fewer infusions and fewer costs with similar efficacy, is one of the current challenges for hemophilia B treatment. The present study focused on an important amino acid sequence known to be involved in the interaction of activated FIX (FIXa) with its cofactor, activated factor VIII (FVIIIa). MATERIALS AND METHODS Using site-directed mutagenesis of glutamate E410 (c240, chymotrypsin numbering), four recombinant FIX-E410 (E410H, A, L and N) mutants were developed and produced by the human hepatoma cell line Huh-7. RESULTS The in-vitro clotting activity of mutant FIX molecules was 3 to 5-fold higher than wild-type recombinant FIX (FIX-WT). FIX-E410H compound showed the highest in-vitro procoagulant activity. Enhanced specific activity was confirmed using thrombin generation assay. FIX-E410H induced 5.2-fold higher thrombin generation than FIX-WT. In hemophilia B mice, we observed significantly higher in-vivo clotting activity and thrombin generating capacity with FIX-E410H compared to FIX-WT. We demonstrated that increased procoagulant activity of FIX-E410H was mainly explained by 2.5- fold enhanced affinity of the mutant for human FVIIIa. CONCLUSION We have engineered and characterized four improved FIX proteins with enhanced in-vitro and in-vivo activity. Future studies are required to evaluate the immunogenicity of FIX-E410.
Collapse
Affiliation(s)
- Eloïse Perot
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France
| | - Nathalie Enjolras
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France
| | - Sandra Le Quellec
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France; Unite d'Hemostase Clinique, Centre Regional de Traitement des Hemophiles, Hopital Cardiologique Louis Pradel, 28Bd du Doyen Jean Lepine, 69500 Bron, France
| | - Alice Indalecio
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France
| | - Jonathan Girard
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France
| | - Claude Negrier
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France; Unite d'Hemostase Clinique, Centre Regional de Traitement des Hemophiles, Hopital Cardiologique Louis Pradel, 28Bd du Doyen Jean Lepine, 69500 Bron, France
| | - Yesim Dargaud
- EA 4174, Hemostase, Inflammation & Sepsis, Universite Lyon1, Faculte de Medecine Laennec, 69372 Lyon cedex 08, France; Unite d'Hemostase Clinique, Centre Regional de Traitement des Hemophiles, Hopital Cardiologique Louis Pradel, 28Bd du Doyen Jean Lepine, 69500 Bron, France.
| |
Collapse
|
24
|
Polack B, Calvez T, Chambost H, Rothschild C, Goudemand J, Claeyssens S, Borel‐Derlon A, Bardoulat I, Maurel F, Woronoff‐Lemsi M. EQOFIX: a combined economic and quality‐of‐life study of hemophilia B treatments in France. Transfusion 2015; 55:1787-97. [DOI: 10.1111/trf.13016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Benoît Polack
- Department of HematologyUniversity Hospital, and CNRS UMR5525, Grenoble‐Alpes UniversityGrenoble France
| | - Thierry Calvez
- Sorbonne University, UPMC University of Paris 06, INSERM, UMR‐S 1136, Pierre Louis Institute of Epidemiology and Public HealthParis France
| | - Hervé Chambost
- APHMDepartment of Pediatric HematologyChildren Hospital La Timone, and INSERM, UMR 1062, Aix‐Marseille UniversityMarseille France
| | - Chantal Rothschild
- Regional Hemophilia CenterDepartment of HematologyUniversity Hospital Necker Enfants MaladesParis France
| | - Jenny Goudemand
- Department of Hematology‐TransfusionUniversity HospitalLille France
| | | | - Annie Borel‐Derlon
- Regional Hemophilia and VWD CenterUniversity Hospital, and INSERM U919Caen France
| | - Isabelle Bardoulat
- Department of Health Economics and Outcome ResearchIMS HealthLa Défense France
| | - Frédérique Maurel
- Department of Health Economics and Outcome ResearchIMS HealthLa Défense France
| | | | | |
Collapse
|
25
|
Powell J, Shapiro A, Ragni M, Negrier C, Windyga J, Ozelo M, Pasi J, Baker R, Potts J, Li S, Mei B, Pierce GF, Robinson B. Switching to recombinant factor IX Fc fusion protein prophylaxis results in fewer infusions, decreased factor IX consumption and lower bleeding rates. Br J Haematol 2015; 168:113-23. [PMID: 25209873 DOI: 10.1111/bjh.13109] [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] [Received: 05/15/2014] [Accepted: 07/29/2014] [Indexed: 01/25/2023]
Abstract
In the phase 3 B-LONG [Recombinant Factor IX Fc Fusion Protein (rFIXFc) in Subjects with Haemophilia B] study, rFIXFc dosed every 1-2 weeks was safe and efficacious in previously treated subjects with haemophilia B. To date, there are no evaluations of transitioning from conventional to long-acting factor IX (FIX) prophylaxis. This post-hoc analysis of B-LONG subjects compared prophylaxis with other FIX products and rFIXFc. Pre- and on-study data were analysed to assess dosing regimen, weekly FIX consumption and annualized bleeding rates (ABRs). Population pharmacokinetics models were used to generate FIX activity profiles with rFIXFc and recombinant FIX prophylaxis. Thirty-nine subjects, previously treated prophylactically, were evaluated. Prior to study, most subjects (69·2%) received twice-weekly FIX infusions; on study, subjects infused rFIXFc once every 1-2 weeks with c. 30-50% reductions in weekly consumption. On-study estimated mean ABRs were lower than pre-study estimated mean ABRs. Models predicted that rFIXFc administered 50 iu/kg weekly and 100 iu/kg every 10 d would maintain steady-state FIX trough levels ≥1 iu/dl in 95·4% and 89·2% of subjects, respectively. These results indicate that patients receiving rFIXFc prophylaxis can markedly reduce infusion frequency and FIX consumption, have a greater likelihood of maintaining FIX activity >1 iu/dl and experience fewer bleeding episodes compared with prior FIX prophylaxis.
Collapse
Affiliation(s)
- Jerry Powell
- University of California Davis, Sacramento, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Berger K, Schopohl D, Hilger A, Behr Gross ME, Giangrande P, Peyvandi F, Seitz R, Schramm W. Research in haemophilia B - approaching the request for high evidence levels in a rare disease. Haemophilia 2014; 21:4-20. [DOI: 10.1111/hae.12603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 01/01/2023]
Affiliation(s)
- K. Berger
- Department of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - D. Schopohl
- Department of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - A. Hilger
- Paul-Ehrlich-Institute; Langen Germany
| | - M. -E. Behr Gross
- European Directorate for the Quality of Medicines & HealthCare (EDQM); Council of Europe; Strasbourg France
| | - P. Giangrande
- Oxford Haemophilia & Thrombosis Centre; Oxford University Hospitals NHS Trust; Oxford Oxfordshire UK
| | - F. Peyvandi
- Department of Pathophysiology and Transplantation; Angelo Bianchi Bonomi Haemophilia and Thrombosis Center; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano; Luigi Villa Foundation; Milan Italy
| | - R. Seitz
- Paul-Ehrlich-Institute; Langen Germany
| | - W. Schramm
- Rudolf-Marx-Foundation; University of Munich; Munich Germany
| |
Collapse
|
27
|
Alamelu J, Bevan D, Sorensen B, Rangarajan S. Pharmacokinetic and pharmacodynamic properties of plasma-derived vs. recombinant factor IX in patients with hemophilia B: a prospective crossover study. J Thromb Haemost 2014; 12:2044-8. [PMID: 25315324 DOI: 10.1111/jth.12756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 10/12/2014] [Indexed: 08/31/2023]
Abstract
BACKGROUND Effective treatment of acute bleeding episodes in patients with hemophilia B relies on factor IX recovery, with higher levels being more desirable, whereas prevention of bleeds with a prophylactic regimen depends on the half-life of the product. Lower recovery values have been reported following administration of recombinant FIX (rFIX) than following administration of plasma-derived FIX (pdFIX). OBJECTIVES To compare the pharmacokinetic and pharmacodynamic properties of rFIX and pdFIX in patients with hemophilia B. METHODS A prospective crossover study of nine patients with moderate to severe hemophilia B was performed. Following a washout period, 50 U kg(-1) FIX was administered, and blood samples were taken as per protocol up to 48 h postinfusion. Paired data were analyzed with the Wilcoxon signed rank test. RESULTS Mean peak recovery at 10 min postinfusion was 62.14 IU dL(-1) with pdFIX and 52.7 IU dL(-1) with rFIX (P = 0.08). Mean half-life was 16.6 h with pdFIX and 17.5 h with rFIX (P = 0.55). Maximum peak thrombin generation (PTG) was 35.9 nm with pdFIX and 28.9 nm with rFIX (P = 0.21). Administration of rFIX resulted in early PTG, whereas administration of pdFIX resulted in slightly later and sustained PTG. At 48 h, PTG was similar with pdFIX (19.0 nm) and rFIX (19.4 nm) (P = 0.91). CONCLUSIONS Patients experienced better recovery with pdFIX than with rFIX. pdFIX and rFIX had similar half-lives. Maximum PTG was higher for pdFIX; however, this difference did not reach statistical significance. The clinical impact of the slightly increased, delayed and sustained PTG with pdFIX requires further investigation.
Collapse
Affiliation(s)
- J Alamelu
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|
28
|
Ducore JM, Miguelino MG, Powell JS. Alprolix (recombinant Factor IX Fc fusion protein): extended half-life product for the prophylaxis and treatment of hemophilia B. Expert Rev Hematol 2014; 7:559-71. [DOI: 10.1586/17474086.2014.951322] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
29
|
McLaughlin JM, Witkop ML, Lambing A, Anderson TL, Munn J, Tortella B. Better adherence to prescribed treatment regimen is related to less chronic pain among adolescents and young adults with moderate or severe haemophilia. Haemophilia 2014; 20:506-12. [DOI: 10.1111/hae.12360] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J. M. McLaughlin
- Medicines Development Group; Pfizer Specialty Care; Collegeville PA USA
| | - M. L. Witkop
- Northern Regional Bleeding Disorders Center; Munson Medical Center; Traverse City MI USA
| | - A. Lambing
- Adult Hemophilia & Thrombosis Treatment Center; Henry Ford Health System; Detroit MI USA
| | - T. L. Anderson
- Medicines Development Group; Pfizer Specialty Care; Collegeville PA USA
| | - J. Munn
- Hemophilia Treatment Center; University of Michigan; Ann Arbor MI USA
| | - B. Tortella
- Medicines Development Group; Pfizer Specialty Care; Collegeville PA USA
| |
Collapse
|
30
|
Windyga J, Lin VW, Epstein JD, Ito D, Xiong Y, Abbuehl BE, Ramirez JH. Improvement in health-related quality of life with recombinant factor IX prophylaxis in severe or moderately severe haemophilia B patients: results from the BAX326 Pivotal Study. Haemophilia 2013; 20:362-8. [DOI: 10.1111/hae.12315] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 01/31/2023]
Affiliation(s)
- J. Windyga
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - V. W. Lin
- Baxter BioScience; Westlake Village CA USA
| | | | - D. Ito
- Baxter BioScience; Westlake Village CA USA
| | - Y. Xiong
- Baxter BioScience; Westlake Village CA USA
| | | | | |
Collapse
|
31
|
Lanzetta P, Mitchell P, Wolf S, Veritti D. Different antivascular endothelial growth factor treatments and regimens and their outcomes in neovascular age-related macular degeneration: a literature review. Br J Ophthalmol 2013; 97:1497-507. [DOI: 10.1136/bjophthalmol-2013-303394] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Kwon KC, Verma D, Singh ND, Herzog R, Daniell H. Oral delivery of human biopharmaceuticals, autoantigens and vaccine antigens bioencapsulated in plant cells. Adv Drug Deliv Rev 2013; 65:782-99. [PMID: 23099275 PMCID: PMC3582797 DOI: 10.1016/j.addr.2012.10.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/26/2012] [Accepted: 10/17/2012] [Indexed: 12/19/2022]
Abstract
Among 12billion injections administered annually, unsafe delivery leads to >20million infections and >100million reactions. In an emerging new concept, freeze-dried plant cells (lettuce) expressing vaccine antigens/biopharmaceuticals are protected in the stomach from acids/enzymes but are released to the immune or blood circulatory system when plant cell walls are digested by microbes that colonize the gut. Vaccine antigens bioencapsulated in plant cells upon oral delivery after priming, conferred both mucosal and systemic immunity and protection against bacterial, viral or protozoan pathogens or toxin challenge. Oral delivery of autoantigens was effective against complications of type 1 diabetes and hemophilia, by developing tolerance. Oral delivery of proinsulin or exendin-4 expressed in plant cells regulated blood glucose levels similar to injections. Therefore, this new platform offers a low cost alternative to deliver different therapeutic proteins to combat infectious or inherited diseases by eliminating inactivated pathogens, expensive purification, cold storage/transportation and sterile injections.
Collapse
Affiliation(s)
- Kwang-Chul Kwon
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| | - Dheeraj Verma
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| | - Nameirakpam D. Singh
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| | - Roland Herzog
- Department of Pediatrics, College of Medicine, University of Florida, Cancer and Genetics Research Complex, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Henry Daniell
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| |
Collapse
|
33
|
Sayyar B, Dodd M, Marquez-Curtis L, Janowska-Wieczorek A, Hortelano G. Cell-matrix Interactions of Factor IX (FIX)-engineered human mesenchymal stromal cells encapsulated in RGD-alginate vs. Fibrinogen-alginate microcapsules. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2013; 42:102-9. [DOI: 10.3109/21691401.2013.794354] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
34
|
Franchini M, Frattini F, Crestani S, Sissa C, Bonfanti C. Treatment of hemophilia B: focus on recombinant factor IX. Biologics 2013; 7:33-8. [PMID: 23430394 PMCID: PMC3575125 DOI: 10.2147/btt.s31582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hemophilia B is a recessive X-linked bleeding disorder characterized by deficiency of the coagulation factor IX (FIX). In hemophilia B patients the severity of the bleeding phenotype is related to the degree of the FIX defect. Hemophilia B treatment has improved greatly in the last 20 years with the introduction first of plasma-derived and then of recombinant FIX concentrates. Replacement therapy may be administered through on-demand or prophylaxis regimens, but the latter treatment modality has been shown to be superior in prevention of hemophilic arthropathy and in improvement of patients' quality of life. The purpose of this narrative review is to summarize the current knowledge on treatment strategies for hemophilia B, focusing on recombinant FIX products either clinically used or in development. There is only one rFIX product that is licensed to treat hemophilia B patients; from the analysis of the literature data presented in this review, the authors conclude that this rFIX product has demonstrated an excellent safety profile and excellent clinical efficacy for halting and preventing bleeds in hemophilia B patients. While prophylaxis has emerged as the best therapeutic strategy for such patients because of its ability to prevent hemophilic arthropathy and to improve patients' quality of life, the pharmacokinetically tailored dosing of rFIX is another key point when planning hemophilia B treatment, as it allows optimization of the factor concentrate usage. Further clinical studies are needed to better assess the safety and efficacy (ie, the incidence of adverse reactions and inhibitor development) of newer rFIX products.
Collapse
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantua, Italy
| | | | | | | | | |
Collapse
|
35
|
von Mackensen S, Campos IG, Acquadro C, Strandberg-Larsen M. Cross-cultural adaptation and linguistic validation of age-group-specific haemophilia patient-reported outcome (PRO) instruments for patients and parents. Haemophilia 2012; 19:e73-83. [DOI: 10.1111/hae.12054] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 11/26/2022]
Affiliation(s)
- S. von Mackensen
- Institute of Medical Psychology; University Medical Centre Hamburg-Eppendorf; Hamburg; Germany
| | | | | | | |
Collapse
|
36
|
Sayyar B, Dodd M, Wen J, Ma S, Marquez-Curtis L, Janowska-Wieczorek A, Hortelano G. Encapsulation of factor IX-engineered mesenchymal stem cells in fibrinogen-alginate microcapsules enhances their viability and transgene secretion. J Tissue Eng 2012; 3:2041731412462018. [PMID: 23316273 PMCID: PMC3540750 DOI: 10.1177/2041731412462018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cell microencapsulation holds significant promise as a strategy for cellular therapies; however, inadequate survival and functionality of the enclosed cells limit its application in hemophilia treatment. Here, we evaluated the use of alginate-based microcapsules to enhance the viability and transgene secretion of human cord blood–derived mesenchymal stem cells in three-dimensional cultures. Given the positive effects of extracellular matrix molecules on mesenchymal stem cell growth, we tested whether fibrinogen-supplemented alginate microcapsules can improve the efficiency of encapsulated factor IX–engineered mesenchymal stem cells as a treatment of hemophilia B. We found that fibrinogen-supplemented alginate microcapsules (a) significantly enhanced the viability and proliferation of factor IX–engineered mesenchymal stem cells and (b) increased factor IX secretion by mesenchymal stem cells compared to mesenchymal stem cells in nonsupplemented microcapsules. Moreover, we observed the osteogenic, but not chondrogenic or adipogenic, differentiation capability of factor IX–engineered cord blood mesenchymal stem cells and their efficient factor IX secretion while encapsulated in fibrinogen-supplemented alginate microcapsules. Thus, the use of engineered mesenchymal stem cells encapsulated in fibrinogen-modified microcapsules may have potential application in the treatment of hemophilia or other protein deficiency diseases.
Collapse
Affiliation(s)
- Bahareh Sayyar
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
37
|
Franchini M, Frattini F, Crestani S, Bonfanti C. Haemophilia B: current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:2053-63. [PMID: 22946758 DOI: 10.1517/14656566.2012.721780] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Hemophilia B is a rare hereditary hemorrhagic disorder characterized by deficiency of the clotting factor IX (FIX). Hemophilia B patients experience mild to severe bleeding complications according to the degree of FIX defect. Nowadays, the most challenging complication of individuals with hemophilia B is the development of alloantibodies, which render the standard replacement therapy with FIX concentrates ineffective, exposing them to a significantly increased morbidity and mortality. AREAS COVERED This review summarizes the most important events leading to the development of the current FIX products available for the treatment of hemophilia B patients. In addition, it focuses on the more recent advances in the production of new FIX molecules aimed at improving the clinical management of such patients. EXPERT OPINION Although the availability of plasma-derived FIX concentrates has greatly improved the clinical management of hemophilia B patients, the introduction of FIX products using recombinant DNA technology has represented the most significant therapeutic progress in hemophilia B therapy, ensuring an advanced level of safety. The development of rFIX products with extended half lives will further improve the therapeutic armamentarium for hemophilia B patients.
Collapse
Affiliation(s)
- Massimo Franchini
- Carlo Poma Hospital, Department of Transfusion Medicine and Hematology, Mantova, Italy.
| | | | | | | |
Collapse
|
38
|
Martinowitz U, Shapiro A, Quon DV, Escobar M, Kempton C, Collins PW, Chowdary P, Makris M, Mannucci PM, Morfini M, Valentino LA, Gomperts E, Lee M. Pharmacokinetic properties of IB1001, an investigational recombinant factor IX, in patients with haemophilia B: repeat pharmacokinetic evaluation and sialylation analysis. Haemophilia 2012; 18:881-7. [DOI: 10.1111/j.1365-2516.2012.02897.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
- U. Martinowitz
- Institute of Thrombosis and Hemostasis and the National Hemophilia Center; Sheba Medical Center; Tel Hashomer; Israel
| | - A. Shapiro
- Indiana Hemophilia and Thrombosis Center; Indianapolis; IN; USA
| | - D. V. Quon
- The Hemophilia Treatment Center at Los Angeles Orthopaedic Hospital; Los Angeles; CA; USA
| | - M. Escobar
- University of Texas Houston Health Sciences Center; Houston; TX; USA
| | - C. Kempton
- Aflac Cancer Center and Blood Disorders Service; Emory University School of Medicine; Atlanta; GA; USA
| | - P. W. Collins
- Arthur Bloom Haemophilia Centre; University Hospital of Wales School of Medicine; Cardiff University; Cardiff; UK
| | - P. Chowdary
- KD Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London; UK
| | - M. Makris
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - P. M. Mannucci
- Scientific Direction and A. Bianchi Bonomi Hemophilia and Thrombosis Center; IRCCS Cà Granda Foundation Maggiore Policlinico Hospital; Milan; Italy
| | - M. Morfini
- Agency for Haemophilia; Azienda Ospedaliero-Universitaria Careggi; Florence; Italy
| | - L. A. Valentino
- Rush Hemophilia and Thrombophilia Center; Rush University Medical Center; Chicago; IL; USA
| | - E. Gomperts
- Inspiration Biopharmaceuticals; Cambridge; MA; USA
| | - M. Lee
- Inspiration Biopharmaceuticals; Cambridge; MA; USA
| |
Collapse
|
39
|
Recombinant factor IX-Fc fusion protein (rFIXFc) demonstrates safety and prolonged activity in a phase 1/2a study in hemophilia B patients. Blood 2011; 119:666-72. [PMID: 22110246 DOI: 10.1182/blood-2011-07-367003] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Current factor IX (FIX) products display a half-life (t(1/2)) of ∼ 18 hours, requiring frequent intravenous infusions for prophylaxis and treatment in patients with hemophilia B. This open-label, dose-escalation trial in previously treated adult subjects with hemophilia B examined the safety and pharmacokinetics of rFIXFc. rFIXFc is a recombinant fusion protein composed of FIX and the Fc domain of human IgG(1), to extend circulating time. Fourteen subjects received a single dose of rFIXFc; 1 subject each received 1, 5, 12.5, or 25 IU/kg, and 5 subjects each received 50 or 100 IU/kg. rFIXFc was well tolerated, and most adverse events were mild or moderate in intensity. No inhibitors were detected in any subject. Dose-proportional increases in rFIXFc activity and Ag exposure were observed. With baseline subtraction, mean activity terminal t(1/2) and mean residence time for rFIXFc were 56.7 and 71.8 hours, respectively. This is ∼ 3-fold longer than that reported for current rFIX products. The incremental recovery of rFIXFc was 0.93 IU/dL per IU/kg, similar to plasma-derived FIX. These results show that rFIXFc may offer a viable therapeutic approach to achieve prolonged hemostatic protection and less frequent dosing in patients with hemophilia B. The trial was registered at www.clinicaltrials.gov as NCT00716716.
Collapse
|