1
|
Tran H, von Mackensen S, Abraham A, Castaman G, Hampton K, Knoebl P, Linari S, Odgaard-Jensen J, Neergaard JS, Stasyshyn O, Thaung Zaw JJ, Zulfikar B, Shapiro A. Concizumab prophylaxis in persons with hemophilia A or B with inhibitors: patient-reported outcome results from the phase 3 explorer7 study. Res Pract Thromb Haemost 2024; 8:102476. [PMID: 39099801 PMCID: PMC11295565 DOI: 10.1016/j.rpth.2024.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/13/2024] [Accepted: 06/11/2024] [Indexed: 08/06/2024] Open
Abstract
Background Patient-reported outcomes (PROs) reflect patient perceptions of disease and treatment and are important for evaluating new therapies. Objectives Evaluate the effects of once-daily concizumab prophylaxis on health-related quality of life (HRQoL), treatment burden, and treatment preference in males aged ≥12 years with hemophilia A/B with inhibitors. Methods Patients enrolled in the multicenter, open-label explorer7 phase 3 study (ClinicalTrials.gov identifier: NCT04083781) were randomized to receive no prophylaxis (arm 1) or concizumab prophylaxis (arm 2) or were nonrandomly allocated to concizumab prophylaxis (arms 3 and 4). The study included questionnaires to assess patients' perception of HRQoL (Haemophilia Quality of Life Questionnaire for Adults), treatment burden (Hemophilia Treatment Experience Measure), and treatment preference (Haemophilia Patient Preference Questionnaire). Results The estimated treatment difference between patients receiving concizumab prophylaxis vs no prophylaxis at week 24 for Haemophilia Quality of Life Questionnaire for Adults "total score" was -22.6 points (95% CI, -42.5; -2.7), directionally favoring patients receiving concizumab prophylaxis. For Hemophilia Treatment Experience Measure "total score," the estimated treatment difference was -19.9 points (95% CI, -34.3, -5.6) in favor of concizumab vs no prophylaxis. The majority of patients receiving concizumab expressed a preference for concizumab over their previous treatment, the main reasons being "fewer bleeds," "require less time," and "less painful to inject." Across all PROs, there were less responses collected than anticipated, limiting interpretations. Conclusion PROs collected during the explorer7 study showed improvements in some domains of HRQoL, treatment burden, and patient treatment preference in persons with hemophilia A or B with inhibitors receiving concizumab prophylaxis compared with no prophylaxis.
Collapse
Affiliation(s)
- Huyen Tran
- Ronald Sawers Haemophilia Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Aby Abraham
- Department of Hematology, Christian Medical College, Vellore, India
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Kingsley Hampton
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Knoebl
- Division of Hematology and Hemostasis, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | | | | | - Jay Jay Thaung Zaw
- Medical & Science Rare Bleeding Disorders, Novo Nordisk A/S, Søborg, Denmark
| | - Bulent Zulfikar
- Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Amy Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| |
Collapse
|
2
|
Nguyen NAT, Auquier P, Beltran Anzola A, Harroche A, Castet S, Huguenin Y, Meunier S, Repesse Y, D'Oiron R, Rauch A, Desprez D, Spiegel A, Chamouni P, Schneider P, Baumstarck K, Boucekine M, Tabele C, Viprey M, Leroy T, Roques MA, Sannie T, Giraud N, Chambost H, Resseguier N. Determinants of adherence and consequences of the transition from adolescence to adulthood among young people with severe haemophilia (TRANSHEMO): A multicentric French national observational cross-sectional study based on the FranceCoag registry. Haemophilia 2023; 29:1202-1218. [PMID: 37572328 DOI: 10.1111/hae.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION It is necessary to gain insights into adherence to healthcare in people with severe haemophilia (PwSH), especially during the transition from paediatric to adult care, which is an important phase in lives of young people with childhood chronic disease. This adherence can be considered as a marker of successful transition. OBJECTIVES The main objective of the quantitative phase of the TRANSHEMO project was to compare the adherence to healthcare between adolescents and young adults (YAs) with severe haemophilia. The secondary objective was to identify the determinants (facilitators and barriers) of this adherence and associations between these determinants. METHODS A multicentre, observational, cross-sectional study was conducted in 2017-2019 on PwSH aged between 14 and 17 years (adolescents) or between 20 and 29 years (YAs), included in the FranceCoag registry and having completed the questionnaires. The adherence to healthcare (treatment regimens and clinical follow-up) was compared between adolescents and YAs using the chi-squared test. The determinants of this adherence were analysed by structural equation modelling. RESULTS There were 277 participants, 107 adolescents, and 170 YAs. The rate of adolescents adhering to healthcare was 82.2%, while the rate of YAs was 61.2% (p < .001). The barriers to the adherence to healthcare were being YA, having repeated at least one school grade and presenting mental health concerns. CONCLUSION Adolescents had better adherence to healthcare than YAs. According to the determinants enlightened in this project, targeted supportive strategies and adapted therapeutic education programs can be developed for young PwSH to facilitate their adherence to healthcare.
Collapse
Affiliation(s)
- Ngoc Anh Thu Nguyen
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Pascal Auquier
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Any Beltran Anzola
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Annie Harroche
- AP-HP, Haemophilia Treatment Centre, Hospital Necker, Paris, France
| | - Sabine Castet
- University Hospital of Bordeaux, Haemophilia Treatment Centre, Bordeaux, France
| | - Yoann Huguenin
- University Hospital of Bordeaux, Haemophilia Treatment Centre, Bordeaux, France
| | - Sandrine Meunier
- Hospices Civils de Lyon - Haemophilia Treatment Centre, Groupement Hospitalier Est, Bron, France
| | - Yohann Repesse
- University Hospital of Caen, Haemophilia Treatment Centre, Caen, France
| | - Roseline D'Oiron
- AP-HP, Haemophilia Treatment Centre, Hospital Bicêtre, Paris, France
| | - Antoine Rauch
- University Regional Hospital of Lille, Haemophilia Treatment Centre, Lille, France
| | - Dominique Desprez
- University Regional Hospital of Strasbourg, Haemophilia Treatment Centre, Strasbourg, France
| | - Alexandra Spiegel
- University Regional Hospital of Strasbourg, Pediatric Onco-Haematology Service, Strasbourg, France
| | - Pierre Chamouni
- University Hospital of Rouen, Haemophilia Treatment Centre, Rouen, France
| | - Pascale Schneider
- University Hospital of Rouen, Haemophilia Treatment Centre, Rouen, France
| | - Karine Baumstarck
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Mohamed Boucekine
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Clémence Tabele
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Marie Viprey
- FranceCoag Network, Marseille, France
- Hospices Civils de Lyon, Health Data Department, Lyon, France
- Inserm, U1290 Unit, Research on Healthcare Performance RESHAPE, Claude Bernard Lyon 1 University, Lyon, France
| | - Tanguy Leroy
- Inserm, U1296 Unit, Radiation: Defense, Health and Environment, Lumière Lyon 2 University, Lyon, France
| | - Marie-Anaïs Roques
- Laboratory of Clinical Psychology, Psychopathology and Psychoanalysis, UR 3278, Aix-Marseille University, Aix-en-Provence, France
- AP-HM, Haemophilia Treatment Centre, Children Hospital La Timone, Marseille, France
| | - Thomas Sannie
- French Patients' Association for People with Haemophilia (AFH), Paris, France
| | - Nicolas Giraud
- French Patients' Association for People with Haemophilia (AFH), Paris, France
| | - Hervé Chambost
- FranceCoag Network, Marseille, France
- AP-HM, Haemophilia Treatment Centre, Children Hospital La Timone, Marseille, France
| | - Noémie Resseguier
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| |
Collapse
|
3
|
Du P, Bergamasco A, Moride Y, Truong Berthoz F, Özen G, Tzivelekis S. Von Willebrand Disease Epidemiology, Burden of Illness and Management: A Systematic Review. J Blood Med 2023; 14:189-208. [PMID: 36891166 PMCID: PMC9987238 DOI: 10.2147/jbm.s389241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/06/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Although hereditary von Willebrand disease (VWD) is the most common bleeding disorder, its epidemiology is not well understood. A systematic review (PROSPERO CRD42020197674/CRD42021244374) on the epidemiology/burden of illness of VWD was conducted to better understand patients' unmet needs. Methods Observational studies (published January 1, 2010 to April 14, 2021) were identified in MEDLINE and Embase databases, using free-text keywords and thesaurus terms for VWD and outcomes of interest. Pragmatic web-based searches of the gray literature, including conference abstracts, were performed, and reference lists of retained publications were manually searched for additional sources. Case reports and clinical trials (phase 1-3) were excluded. Outcomes of interest were incidence, prevalence, mortality, patient characteristics, burden of illness, and therapeutic management/treatments currently used for VWD. Results Of the 3095 identified sources, 168 were included in this systematic review. Reported VWD prevalence (22 sources) ranged from 108.9 to 2200 per 100,000 in population-based studies and from 0.3 to 16.5 per 100,000 in referral-based studies. Reported times between first symptom onset and diagnosis (two sources; mean 669 days; median 3 years) highlighted gaps in timely VWD diagnosis. Bleeding events reported in 72-94% of the patients with VWD (all types; 27 sources) were mostly mucocutaneous including epistaxis, menorrhagia, and oral/gum bleeding. Poorer health-related quality of life (three sources) and greater health care resource utilization (three sources) were reported for patients with VWD than in general populations. Conclusion Available data suggest that patients with VWD experience high disease burden in terms of bleeding, poor quality of life, and health care resource utilization.
Collapse
Affiliation(s)
- Ping Du
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | - Yola Moride
- YOLARX Consultants, Paris, France.,Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | | | - Gülden Özen
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | |
Collapse
|
4
|
Lopez K, Norris K, Hardy M, Valentino LA. Defining the Impact of Social Drivers on Health Outcomes for People with Inherited Bleeding Disorders. J Clin Med 2022; 11:jcm11154443. [PMID: 35956060 PMCID: PMC9369198 DOI: 10.3390/jcm11154443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
The ways in which the social drivers of health, also known as the social determinants of health (SDOH), affect health outcomes for people with inherited bleeding disorders (PwIBDs) is unclear. This systematic review of the published literature examines the impact of SDOH on health outcomes in PwIBDs. Articles that included the following parameters in PubMed informed this study: published in English between 2011–2021; available in free full text; study population diagnosed with an inherited bleeding disorder; and study measured at least one of the clinical/non-clinical outcome measures: bleeding frequency, chronic pain, mortality, quality of life (QOL), and/or cost. The main findings from the 13 included articles emphasized the unmet need for reducing the economic burden with sustainable population health strategies and treatment options for PwIBDs. Rural location was also a significant contributor to both delayed diagnosis and decreased access to care. Furthermore, the need for a multidisciplinary comprehensive care team to address physical, psychosocial, and emotional needs of PwIBDs was raised as a priority target in the desire for equitable and optimal health. This systematic literature review suggests that the SDOH are associated with inferior health outcomes and may influence the clinical progression of inherited bleeding disorders.
Collapse
Affiliation(s)
- Karina Lopez
- National Hemophilia Foundation, New York, NY 10001, USA; (K.N.); (M.H.); (L.A.V.)
- Correspondence:
| | - Keri Norris
- National Hemophilia Foundation, New York, NY 10001, USA; (K.N.); (M.H.); (L.A.V.)
| | - Marci Hardy
- National Hemophilia Foundation, New York, NY 10001, USA; (K.N.); (M.H.); (L.A.V.)
| | - Leonard A. Valentino
- National Hemophilia Foundation, New York, NY 10001, USA; (K.N.); (M.H.); (L.A.V.)
- Rush University, Chicago, IL 60612, USA
| |
Collapse
|
5
|
Cruz-Montecinos C, Maas H, Cerda M, Pérez-Alenda S. Altered neural control of gait and its association with pain and joint impairment in adults with haemophilic arthropathy: Clinical and methodological implications. Haemophilia 2022; 28:497-504. [PMID: 35201643 DOI: 10.1111/hae.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION It is unknown whether altered neural control is associated with clinical outcomes in people with haemophilic arthropathy (PWHA). The dynamic motor control index during walking (Walk-DMC) is a summary metric of neural control. AIMS The primary aim of this study was to apply the Walk-DMC to assess if people diagnosed with haemophilic arthropathy have impaired neural control of gait and investigate the association of Walk-DMC with pain and joint impairment. METHOD The Walk-DMC was assessed using surface electromyography in 11 leg muscles. Twenty-two PWHA and 15 healthy subjects walked on a 30-m walkway at 1 m/s. In addition, pain (visual analogue scale), knee flexion contracture (degrees) and joint impairment (Haemophilia Joint Health Score, HJHS) were assessed. The clinical outcomes were correlated with the Walk-DMC. Multiple regression analysis was performed to predict the Walk-DMC using the clinical outcomes. RESULTS In 13 PWHA the Walk-DMC was beyond the normal range (80-120 pts). PWHA with an altered Walk-DMC showed more years with arthropathy, more pain, higher knee flexion contracture and a higher HJHS score (P < .05, effect size > .8). Significant negative moderate associations between Walk-DMC and pain, knee flexion contracture and HJHS were found (P < .05). The model that best predicted the Walk-DMC was the pain with knee flexion contracture (R2 = .44; P = .004). CONCLUSIONS PWHA with abnormal neural control of gait also has more years with arthropathy, more pain, and more impaired joints. Our results indicate an association between the Walk-DMC index and joint damage, specifically with pain in combination with knee flexion contracture.
Collapse
Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Mauricio Cerda
- SCIAN-Lab, Programme of Integrative Biology, ICBM, & Center for Medical Informatics and Telemedicine, Faculty of Medicine, University of Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| |
Collapse
|
6
|
Sanigorska A, Chaplin S, Holland M, Khair K, Pollard D. The lived experience of women with a bleeding disorder: A systematic review. Res Pract Thromb Haemost 2022; 6:e12652. [PMID: 35141459 PMCID: PMC8813663 DOI: 10.1002/rth2.12652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/14/2021] [Accepted: 12/09/2021] [Indexed: 01/30/2023] Open
Abstract
Background Research studies have described the morbidity associated with inherited bleeding disorders such as hemophilia and von Willebrand disease in women, but their effect on daily living has long been underrecognized. This systematic review sought to document the lived experience of women with a bleeding disorder by assessing research findings on quality of health care, socioeconomic factors, and mental health. Methods A systematic search was carried out in Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and PubMed on July 31, 2020. References were hand searched. Abstracts of the 2019 and 2020 congresses on bleeding disorders were hand searched. Key journals were screened for relevant studies published after the search date until the analysis was completed on December 7, 2020. Results Of 635 potentially eligible publications, 27 published since 1998 were selected for review. Most studies were of moderate to high quality but meta‐analysis of quantitative studies was not possible due to difference in outcomes and assessment. Women with a bleeding disorder experience obstacles to accessing care, difficulties living with their disorder, interference with schooling and work, and poor mental health. Diagnostic delay and lack of recognition of symptoms mean treatment and support may not be available. Where comparisons with controls were made, women’s negative experiences were greater than those of men. Conclusions Women with bleeding disorders experience major negative impacts of their disorders on daily life and mental well‐being. Many of the challenges identified in earlier research are evident in more recent studies.
Collapse
Affiliation(s)
- Anna Sanigorska
- Oxford Haemophilia and Thrombosis Centre Churchill Hospital Oxford UK
| | | | | | | | - Debra Pollard
- Haemnet London UK
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| |
Collapse
|
7
|
Xu RH, Dong D, Luo N, Yang R, Liu J, Zhang S. Investigating the Added Value of the EQ-5D-5L With Two Bolt-On Items in Patients With Hemophilia. Front Med (Lausanne) 2021; 8:707998. [PMID: 34422863 PMCID: PMC8374886 DOI: 10.3389/fmed.2021.707998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: This study examined the impact of adding two condition-specific bolt-on items to the EQ-5D-5L and assessed their psychometric properties in patients with hemophilia. Methods: The data were obtained from a nationwide cross-sectional online survey of patients with hemophilia in China. Self-reported and proxy-reported data were analyzed separately. Ceiling effect, informativity, and discriminatory power of the EQ-5D-5L with two bolt-on items, dignity (DG), and bleeding (BL), were examined. Spearman's rank correlation (rho) was used to assess the associations of the EQ-5D-5L and two bolt-on items with the Hemophilia Quality of Life Questionnaire for Adults (Haem-A-QoL) and SF-12. Multiple regression analysis was performed to evaluate the explained variance of the EQ-5D-5L and bolt-on items in predicting EQ-VAS scores. Results: A total of 895 patients and 222 caregivers completed the questionnaire. The ceiling effect decreased from 1.9 to 0.6% and 5.9 to 0.9% when using the EQ-5D-5L and the EQ-5D-5L with two bolt-on items among participants with both self- and proxy-completed questionnaires. Both DG and BL were strongly correlated with Haem-A-QoL sum score [rho: DG = 0.64 (patient) vs. 0.66(proxy); BL = 0.49 (patient) vs. 0.31 (proxy)], SF-12 mental component [rho: DG = −0.36 (patient) vs. −0.41 (proxy); BL = −0.53 (patient) vs. −0.57(proxy)], and SF-12 physical component [rho: DG = −0.61 (patient) vs. −0.61 (proxy); BL = −0.35 (patient) vs. −0.39 (proxy)]. Known-group comparisons confirmed that the two bolt-on items had satisfactory discriminatory power. Multiple regression analysis indicated that adding two bolt-on items significantly increased the ability to predict EQ-VAS scores. The adjusted R2 increased by 8.2 and 8.8% for reports completed by the patients or patients' proxy respondents, respectively. Conclusion: Adding the DG and BL bolt-on items can increase performance on the EQ-5D-5L in patients with hemophilia. A future valuation study will be carried out.
Collapse
Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Renchi Yang
- Thrombosis and Hemostasis Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Junshuai Liu
- Beijing Society of Rare Disease Clinical Care and Accessibility, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| |
Collapse
|
8
|
Skinner MW, Négrier C, Paz-Priel I, Chebon S, Jiménez-Yuste V, Callaghan MU, Lehle M, Niggli M, Mahlangu J, Shapiro A, Shima M, Campinha-Bacote A, Levy GG, Oldenburg J, von Mackensen S, Pipe SW. The effect of emicizumab prophylaxis on long-term, self-reported physical health in persons with haemophilia A without factor VIII inhibitors in the HAVEN 3 and HAVEN 4 studies. Haemophilia 2021; 27:854-865. [PMID: 34171159 PMCID: PMC8518882 DOI: 10.1111/hae.14363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/22/2021] [Accepted: 06/05/2021] [Indexed: 12/11/2022]
Abstract
Introduction Severe haemophilia A (HA) has a major impact on health‐related quality of life (HRQoL). Aim Assess the impact of emicizumab on HRQoL in persons with severe HA (PwHA) without factor VIII (FVIII) inhibitors in the phase 3 HAVEN 3 and 4 studies. Methods This pooled analysis examines the HRQoL of PwHA aged ≥ 18 years treated with emicizumab prophylaxis via Haemophilia‐Specific Quality of Life Questionnaire for Adults (Haem‐A‐QoL) and EuroQoL 5‐Dimensions 5‐levels (EQ‐5D‐5L). In particular, changes from baseline in Haem‐A‐QoL ‘Physical Health’ (PH) domain and ‘Total Score’ (TS) are evaluated. Results Among 176 evaluable participants, 96 (55%) had received prior episodic treatment and 80 (45%) prophylaxis; 70% had ≥ 1 target joint and 51% had experienced ≥ 9 bleeds in the previous 24 weeks. Mean Haem‐A‐QoL PH and TS improved after emicizumab initiation. Mean (standard deviation) –12.0 (21.26)‐ and –8.6 (12.57)‐point improvements were observed in PH and TS from baseline to Week 73; Week 73 scores were 27.9 (24.54) and 22.0 (14.38), respectively. Fifty‐four percent of participants reported a clinically meaningful improvement in PH scores (≥ 10 points) by Week 73. Subgroups with poorer HRQoL prior to starting emicizumab (i.e. receiving episodic treatment, ≥ 9 bleeds, target joints) had the greatest improvements in PH scores, and corresponding reductions in missed workdays; change was not detected among those previously taking prophylaxis. No change over time was detected by the EQ‐5D‐5L questionnaire. Conclusions Emicizumab prophylaxis in PwHA without FVIII inhibitors resulted in persistent and meaningful improvements in Haem‐A‐QoL PH and less work disruption than previous treatment.
Collapse
Affiliation(s)
- Mark W Skinner
- Institute for Policy Advancement Ltd, Washington, District of Columbia, USA.,McMaster University, Hamilton, Canada
| | - Claude Négrier
- Louis Pradel University Hospital, Claude Bernard University Lyon 1, Lyon, France
| | - Ido Paz-Priel
- Genentech Inc., South San Francisco, California, USA
| | | | | | | | | | | | - Johnny Mahlangu
- University of the Witwatersrand and NHLS, Johannesburg, South Africa
| | - Amy Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Midori Shima
- Nara Medical University Hospital, Kashihara, Japan
| | | | - Gallia G Levy
- Genentech Inc., South San Francisco, California, USA.,Spark Therapeutics, Inc., Philadelphia, Pennsylvania, USA
| | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steven W Pipe
- Departments of Pediatrics and Pathology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
9
|
Kinahan JY, Graham JMI, Hébert YV, Sampson M, O'Hearn K, Klaassen RJ. Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review. J Pediatr Hematol Oncol 2021; 43:121-134. [PMID: 33136776 DOI: 10.1097/mph.0000000000001984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.
Collapse
Affiliation(s)
- Julia Y Kinahan
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | - Johann M I Graham
- Children's Hospital of Eastern Ontario Research Institute
- Regional Hospital Center of Lanaudiere, Saint-Charles-Borromée
- Laval University, Quebec City, QC, Canada
| | - Yamilée V Hébert
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | | | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute
- Division of Hematology/Oncology, Department of Pediatrics
- University of Ottawa, Ottawa, ON
| |
Collapse
|
10
|
Klein DE, Winterowd CL, Ehrhardt MD, Carter JC, Khan O, Mayes S. The relationship of self-compassion and hope with quality of life for individuals with bleeding disorders. Haemophilia 2020; 26:e66-e73. [PMID: 32175665 DOI: 10.1111/hae.13959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/02/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Minimal research has been conducted examining the relationship of positive psychology variables with quality of life (QOL) for individuals with bleeding disorders. While many individuals manage their bleeding disorders well, some are at higher risk of developing psychosocial complications due to the daily stressors of managing illness-related symptoms. AIM The purpose of this study is to better understand the relationships between two positive psychology variables, self-compassion and hope and QOL (overall, psychosocial and physical) among individuals diagnosed with bleeding disorders. METHODS Participants completed a survey identifying demographic information as well as rating scales of self-compassion, hope and quality of life. We conducted Pearson correlational and standard multiple regression analyses to explore the bivariate and linear relationships between the aforementioned variables in a sample of 86 patients with bleeding disorders between the ages of 15 and 65. RESULTS Self-compassion and hope were significantly related to QOL. Together, self-compassion and hope were predictive of overall QOL, psychosocial QOL and physical QOL. However, hope was the only individual predictor of all three QOL dimensions. CONCLUSION Due to the significant relationships found between self-compassion, hope and QOL in this sample, it may be beneficial to incorporate positive psychology factors into the treatment of those diagnosed with bleeding disorders, especially those at higher risk for decreased QOL.
Collapse
Affiliation(s)
- Darci E Klein
- School of Community Health Sciences, Counseling and Counseling Psychology, Willard Hall Oklahoma State University, Stillwater, OK, USA
| | - Carrie L Winterowd
- School of Community Health Sciences, Counseling and Counseling Psychology, Willard Hall Oklahoma State University, Stillwater, OK, USA
| | | | | | - Osman Khan
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunnye Mayes
- University of Louisville School of Medicine, Louisville, KY, USA
| |
Collapse
|
11
|
Shelley AR, McCarthy Veach P, LeRoy B, Redlinger-Grosse K. A Systematized review of experiences of individuals in Arnett's emerging adulthood stage who live with or are at-risk for genetic conditions. J Genet Couns 2020; 29:1059-1080. [PMID: 32146730 DOI: 10.1002/jgc4.1238] [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: 03/20/2019] [Accepted: 02/09/2020] [Indexed: 11/10/2022]
Abstract
Emerging adulthood, a distinct developmental period between ages 18 and 29 years, comprises five features: identity exploration, experimentation/possibilities, negativity/instability regarding one's outlook, self-focus, and feeling in-between adolescence and adulthood. A growing literature examines the impact of genetic conditions on individuals who chronologically fit the emerging adulthood period. This systematized literature review uses the emerging adulthood theory to determine whether individuals living with or at-risk for a genetic condition experience the features of this period as well as similarities and differences between these two groups. A literature search yielded 1,303 peer-reviewed papers from the 17 years since emerging adulthood theory was published. Ten papers met inclusion criteria-five for those Living With a genetic condition (e.g., cystic fibrosis) and five for those At-Risk for a genetic condition (e.g., hereditary breast and ovarian cancer). Content analysis yielded themes consistent with the five emerging adulthood features for both individuals Living With and At-Risk for genetic conditions. Negativity/instability was most prevalent, and feeling in-between was least prevalent in both groups. Results further suggest unique challenges related to one's genetic conditions/risk with respect to independence (from family, healthcare providers), career/education, relationships/social life, family planning, and life perspective experiences. Salient differences were apparent between the groups in their experiences of the emerging adulthood features. For instance, Living With individuals reported challenges concerning their ongoing physical symptoms, whereas At-Risk individuals reported challenges regarding genetic testing decisions and anticipation of physical symptoms. Thus, emerging adults Living With and At-Risk for genetic conditions appear to experience the main emerging adulthood features, but they face unique challenges related to their genetic conditions/risk. Understanding emerging adults' experiences can aid genetic counselors in addressing their specific concerns.
Collapse
Affiliation(s)
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Bonnie LeRoy
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
12
|
Blaauwgeers MW, Kruip MJHA, Beckers EAM, Coppens M, Eikenboom J, van Galen KPM, Tamminga RYJ, Urbanus RT, Schutgens REG. Congenital platelet disorders and health status-related quality of life. Res Pract Thromb Haemost 2020; 4:100-105. [PMID: 31989090 PMCID: PMC6971322 DOI: 10.1002/rth2.12281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with congenital blood platelet disorders (CPDs) demonstrate a predominantly mucocutaneous bleeding tendency. Repeated bleeds throughout life can have a significant impact on health status-related quality of life (HR-QoL), but few studies have investigated HR-QoL in patients with CPDs. OBJECTIVES To determine HR-QoL in patients with suspected or confirmed CPDs as compared with the general Dutch population and to assess the association between bleeding phenotype and HR-QoL. METHODS Data were derived from the Thrombocytopathy in the Netherlands (TiN) study, a cross-sectional study of individuals suspected for a congenital platelet defect. TiN patients with an increased ISTH Bleeding Assessment Tool (ISTH-BAT) score (>3 in men and > 5 in women) were included for analysis. HR-QoL was assessed with the Short Form (SF)-36 survey. Bleeding symptoms were evaluated with the ISTH-BAT, resulting in a bleeding score. RESULTS One hundred fifty-six patients were analyzed, of whom 126 (81%) were women. Sixty-two patients (40%) had a confirmed CPD. Compared to the general Dutch population, patients with a suspected or confirmed CPD reported decreased physical functioning, limitations in daily activities due to physical health problems, limitations in social activities, decreased energy levels and fatigue, pain, and lower general health status. HR-QoL was not correlated with the ISTH-BAT score and was similar in patients with a confirmed CPD and those in whom a CPD could not be diagnosed. CONCLUSION A bleeding tendency in patients with a suspected or confirmed CPD significantly impacts HR-QoL, independent of a confirmed explanatory diagnosis.
Collapse
Affiliation(s)
- Maaike W. Blaauwgeers
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | | | - Erik A. M. Beckers
- Department of HematologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Jeroen Eikenboom
- Department of Internal MedicineDivision of Thrombosis and HaemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Karin P. M. van Galen
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Rienk Y. J. Tamminga
- Department of Pediatric HematologyBeatrix Children's HospitalUniversity Medical Center GroningenGroningenThe Netherlands
| | - Rolf T. Urbanus
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
- Van Creveld LaboratoryUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Roger E. G. Schutgens
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | | |
Collapse
|
13
|
Patel AM, Corman SL, Chaplin S, Raimundo K, Sidonio RF. Economic impact model of delayed inhibitor development in patients with hemophilia a receiving emicizumab for the prevention of bleeding events. J Med Econ 2019; 22:1328-1337. [PMID: 31530050 DOI: 10.1080/13696998.2019.1669614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims: Cumulative exogenous factor VIII (FVIII) exposure is an important predictor of developing neutralizing antibodies (inhibitors) to FVIII in patients with persons with hemophilia A (PwHA). The aim of this study was to model the costs of emicizumab versus FVIII prophylaxis and total treatment costs for patients with severe HA.Materials and Methods: An Excel-based decision model was developed to calculate cumulative costs in PwHA over a 20-year time horizon from the US payer perspective. The model considered persons with severe HA beginning at age 12 months with no prior FVIII exposure and initiating prophylaxis with emicizumab or FVIII. PwHA could develop inhibitors on accumulation of 20 FVIII exposure days. PwHA with inhibitors replaced FVIII with bypassing agents until inhibitors resolved spontaneously, following immune tolerance induction (ITI), or at the end of the time horizon. The primary model outcome was the difference in emicizumab versus FVIII treatment costs in 2019 USD. Sensitivity analyses were performed to test the robustness of results.Results: Total incremental cost over 20 years was -$1,945,480 (emicizumab arm, $4,919,058; FVIII arm, $6,864,538). Prophylaxis costs (emicizumab arm, $4,096,105; FVIII arm, $6,290,919) comprised the majority of costs in both groups, followed by breakthrough bleed treatment for the FVIII arm ($342,652) and ITI costs for the emicizumab arm ($733,671). Higher costs in the FVIII group reflected earlier inhibitor development (FVIII, 4 months; emicizumab, 162 months) and switch to bypassing agents.Limitations: The model design reflects a simplified treatment pathway for patients with severe HA who initiate FVIII or emicizumab prophylaxis. In the absence of clinical data, a key conservative assumption of the model is that patients receiving emicizumab and FVIII prophylaxis have the same risk of developing inhibitors.Conclusions: This study suggests that prophylaxis with emicizumab results in cost savings compared to FVIII prophylaxis in HA.
Collapse
MESH Headings
- Antibodies, Bispecific/economics
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/therapeutic use
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Coagulants/administration & dosage
- Coagulants/immunology
- Coagulants/therapeutic use
- Factor VIII/administration & dosage
- Factor VIII/immunology
- Factor VIII/therapeutic use
- Hemophilia A/drug therapy
- Hemorrhage/prevention & control
- Humans
- Models, Economic
- Severity of Illness Index
Collapse
Affiliation(s)
| | | | | | | | - Robert F Sidonio
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| |
Collapse
|
14
|
Leebeek FWG, Atiq F. How I manage severe von Willebrand disease. Br J Haematol 2019; 187:418-430. [PMID: 31498884 PMCID: PMC6899759 DOI: 10.1111/bjh.16186] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/29/2022]
Abstract
Von Willebrand disease (VWD) is the most common inherited bleeding disorder. Most patients with mild and moderate VWD can be treated effectively with desmopressin. The management of severe VWD patients, mostly affected by type 2 and type 3 disease, can be challenging. In this article we review the current diagnosis and treatment of severe VWD patients. We will also discuss the management of severe VWD patients in specific situations, such as pregnancy, delivery, patients developing alloantibodies against von Willebrand factor and VWD patients with recurrent gastrointestinal bleeding. Moreover, we review emerging treatments that may be applied in future management of patients with severe VWD.
Collapse
Affiliation(s)
- Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Ferdows Atiq
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
15
|
Limperg PF, Maurice-Stam H, Haverman L, Coppens M, Kruip MJHA, Eikenboom J, Grootenhuis MA, Peters M. Professional functioning of young adults with congenital coagulation disorders in the Netherlands. Haemophilia 2019; 25:e138-e145. [PMID: 30859671 PMCID: PMC6850762 DOI: 10.1111/hae.13698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 01/17/2023]
Abstract
Introduction and Aim Suboptimal health‐related quality of life and lowered employment rates found in a previous study in young adults (YA) with congenital coagulation disorders (CCD) in the Netherlands underline the need for more insight into professional functioning of YA with CCD and into determinants of professional functioning. Methods Young adults (18‐30 years) with CCD participated in a cross‐sectional study. Professional functioning was assessed with the Work Productivity and Activity Impairment questionnaire (WPAI). Potential determinants were assessed with the Course of Life Questionnaire (CoLQ), Pediatric Quality of Life Inventory Young Adult version (PedsQL_YA), Illness Cognition Questionnaire (ICQ) and Haemophilia Activities List (HAL). Logistic regression analyses were performed in the complete sample of YA with CCD, and in YA men with haemophilia separately, to examine determinants of WPAI outcomes. Results Ninety‐four YA (77 men; mean age 24.1 years, SD 3.5 and 17 women; mean age 24.5 years, SD 3.8) with CCD (74% haemophilia A/B) participated. 74.5% of YA were paid employed for on average 30 hours per week. Of these, more than a quarter reported work impairment. Older age and a non‐severe type of haemophilia (in the sample of YA men with haemophilia) were associated with successful (paid) employment. No variables were associated with professional functioning (expressed as Presenteeism and Overall work impairment) in patients with CCD or haemophilia. Conclusion Three‐quarters of YA with CCD were successful in finding paid employment. Though absenteeism was low, YA with paid employment needs attention as a considerable part experienced work impairment.
Collapse
Affiliation(s)
- Perrine F Limperg
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Hemophilia Comprehensive Care Treatment Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Peters
- Department of Pediatric-Hematology and Hemophilia Comprehensive Care Treatment Center, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Pinto PR, Paredes AC, Almeida A. Pain Prevalence, Characteristics, and Impact Among People with Hemophilia: Findings from the First Portuguese Survey and Implications for Pain Management. PAIN MEDICINE 2019; 21:458-471. [DOI: 10.1093/pm/pny309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Background
Hemophilia is a rare disorder characterized by spontaneous bleeding, with pain being a critical aspect. However, a systematic assessment of hemophilia-related pain in Portugal has never been conducted.
Objective
To understand the pain experience among Portuguese people with hemophilia (PWH) by describing its prevalence, characteristics, and impact and uncovering intervention needs in the realm of hemophilia-related pain care.
Methods
A cross-sectional observational survey, with age-adapted versions of questions concerning pain, emotional distress, and quality of life, was answered by 104 adults, 21 children/teenagers (10–17 years), and 19 children (1–9 years).
Results
Pain was reported by 82 (78.8%) adults, 16 (76.2%) children/teenagers, and 13 (68.4%) children, with 65 (62.5%), 13 (61.9%), and eight (42.1%) of them reporting pain lasting more than three months, respectively. The mean number of pain locations (SD) was 5.23 (3.95) for adults, 4.13 (3.48) for children/teenagers, and 3.15 (1.99) for children age 1–9 years, with lower limbs pain causing the greatest negative impact. More frequent pain-triggering factors were physical effort/movements (61, 74.4%) for adults and hemarthrosis for younger groups (children/teenagers: 14, 87.5%; children: 9, 69.2%). Bleeds yielded the highest mean pain intensity (adults: M [SD] = 5.67 [2.09]; children/teenagers: M [SD] = 5.69 [2.15]). Adults with pain revealed more anxiety (odds ratio [OR] = 1.698, P = 0.003) and depression (OR = 1.961, P = 0.025) and lower quality of life (OR = 0.928, P = 0.001).
Conclusions
The current findings highlight the high prevalence, duration, and frequency of pain at all ages, its potentially simultaneous acute and chronic nature, its likelihood to affect multiple locations concurrently, and its detrimental impact. Important insights concerning intervention needs are presented, ultimately contributing to the improvement of hemophilia-related pain management and patient care.
Collapse
Affiliation(s)
- Patrícia Ribeiro Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
17
|
Chai-Adisaksopha C, Skinner MW, Curtis R, Frick N, Nichol MB, Noone D, O'Mahony B, Page D, Stonebraker J, Thabane L, Crowther M, Iorio A. Psychometric properties of the Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire. BMJ Open 2018; 8:e021900. [PMID: 30093520 PMCID: PMC6089314 DOI: 10.1136/bmjopen-2018-021900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the psychometric properties of the Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire. METHODS This study was a cross-sectional, multinational study. Participants were enrolled if they were more than 10 years old and people with haemophilia A or B or people without a bleeding disorder. Participants were invited through non-governmental patient organisations in 21 countries between 01/27/2016 and 02/23/2017. The following psychometric properties: missing data, floor and ceiling effects, exploratory factor analysis and internal consistency reliability were examined. A PROBE Score was derived and assessed for its convergent and known groups validity. RESULTS The study analysed the data on 916 participants with median age of 37.0 (IQR 27.0 to 48.0) years, 74.8% male. In the domain assessing patient-reported outcomes (PROs), more than 15% of participants presented a ceiling effect for all items but two, and a floor effect for one item. Factor analysis identified three factors explaining the majority of the variance. Cronbach's alpha coefficient indicated good internal consistency reliability (0.84). PROBE items showed moderate to strong correlations with corresponding EuroQol five dimension 5-level instrument (EQ-5D-5L) domains. The PROBE Score has a strong correlation (r=0.67) with EQ-5D-5L utility index score. The PROBE Score has a known groups validity among various groups. CONCLUSIONS The results of this study suggest that PROBE is a valid questionnaire for evaluating PROs in people with haemophilia as well as control population. The known-group property of PROBE will allow its use in future clinical trials, longitudinal studies, health technology assessment studies, routine clinical care or registries. Additional studies are needed to test responsiveness and sensitivity to change. TRIAL REGISTRATION NUMBER NCT02439710; Results.
Collapse
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, USA
| | | | - Neil Frick
- Research and Medical Information, National Hemophilia Foundation, New York City, New York, USA
| | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | | | - 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, USA
| | - 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 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
| |
Collapse
|
18
|
D'Angiolella LS, Cortesi PA, Rocino A, Coppola A, Hassan HJ, Giampaolo A, Solimeno LP, Lafranconi A, Micale M, Mangano S, Crotti G, Pagliarin F, Cesana G, Mantovani LG. The socioeconomic burden of patients affected by hemophilia with inhibitors. Eur J Haematol 2018; 101:435-456. [DOI: 10.1111/ejh.13108] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 01/19/2023]
Affiliation(s)
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Angiola Rocino
- Hemophilia & Thrombosis Centre; San Giovanni Bosco Hospital; Naples Italy
| | - Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders; University Hospital of Parma; Parma Italy
| | - Hamisa J. Hassan
- Department of Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - Adele Giampaolo
- Department of Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - Luigi P. Solimeno
- Division of Orthopaedic Surgery and Traumatology; Fondazione IRCCS Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | | | - Mariangela Micale
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Sveva Mangano
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Giacomo Crotti
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Federica Pagliarin
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Lorenzo G. Mantovani
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| |
Collapse
|
19
|
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
|
20
|
Limperg PF, Joosten MMH, Fijnvandraat K, Peters M, Grootenhuis MA, Haverman L. Male gender, school attendance and sports participation are positively associated with health-related quality of life in children and adolescents with congenital bleeding disorders. Haemophilia 2018; 24:395-404. [DOI: 10.1111/hae.13420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 12/19/2022]
Affiliation(s)
- P. F. Limperg
- Psychosocial Department; Emma Children's Hospital/Academic Medical Center; Amsterdam The Netherlands
| | - M. M. H. Joosten
- Psychosocial Department; Emma Children's Hospital/Academic Medical Center; Amsterdam The Netherlands
| | - K. Fijnvandraat
- Department of Pediatric-Hematology; Hemophilia Comprehensive Care Treatment Center; Academic Medical Center; Emma Children's Hospital; Amsterdam The Netherlands
| | - M. Peters
- Department of Pediatric-Hematology; Hemophilia Comprehensive Care Treatment Center; Academic Medical Center; Emma Children's Hospital; Amsterdam The Netherlands
| | - M. A. Grootenhuis
- Psychosocial Department; Emma Children's Hospital/Academic Medical Center; Amsterdam The Netherlands
| | - L. Haverman
- Psychosocial Department; Emma Children's Hospital/Academic Medical Center; Amsterdam The Netherlands
| |
Collapse
|