1
|
Nagao A, Deguchi A, Nogami K. Real-world long-term safety and effectiveness of turoctocog alfa in the treatment of haemophilia A in Japan: results from a multicentre, non-interventional, post-marketing study. Hematology 2024; 29:2316540. [PMID: 38376107 DOI: 10.1080/16078454.2024.2316540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES To assess the safety and effectiveness of turoctocog alfa in previously treated patients (PTPs) and previously untreated patients (PUPs) with haemophilia A in a real-world setting in Japan. METHODS This multicentre, non-interventional, post-marketing study recruited patients with haemophilia A who initiated treatment with turoctocog alfa from 18 sites (08/2014-12/2018). The primary endpoint was adverse events (AEs) during the 2-year study period. RESULTS The safety and effectiveness analysis set included 39 patients. In total, 13 (33.3%) patients reported ≥1 AE; incidence rate was 60.4 events/100 patient-years of exposure (PYE). Treatment was withdrawn in two cases: pruritus in a PTP and factor VIII inhibitor development in a PUP. Inhibitor development occurred in 2.6% of all patients, with an incidence rate of 3.8 events/100 PYE. The rate of inhibitor development was 0%, 25% and 20% in PTPs, PUPs and PUPs with severe type, respectively. The haemostatic success rate was 91.4% for 383 bleeding episodes and 85.7% for 14 surgeries. The negative binomial annualised bleeding rate for the prophylaxis regimen was 6.19 episodes/year (95% CI, 3.69-10.38). The mean (SD) total consumption of turoctocog alfa (n = 34; excluding FVIII inhibitors) was 5,382.6 (7,180.1) IU/kg/year/patient; consumption was 4,133.1 (1,452.4) IU/kg/year/patient for prophylaxis. DISCUSSION The effectiveness and safety profiles were comparable to those observed in other turoctocog alfa trials; effectiveness analysis and consumption were not affected by treatment regimens. CONCLUSION Long-term use of turoctocog alfa therapy in clinical practice posed no newly identified safety issues and was effective for prophylaxis and treatment of bleeds in patients with haemophilia A in Japan.
Collapse
Affiliation(s)
- Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | - Ayumi Deguchi
- Medical Affairs, Novo Nordisk Pharma Ltd., Tokyo, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| |
Collapse
|
2
|
Aota Y, Amano K, Kurata T, Sutoh A, Moriyama M, Namioka N, Okabe M, Shinozawa K, Yokoyama T, Gotoh A. [Examination of the effect of immunosuppressive therapy on acquired hemophilia A in elderly patients with bloodstream infections]. Nihon Ronen Igakkai Zasshi 2022; 59:90-95. [PMID: 35264539 DOI: 10.3143/geriatrics.59.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM Acquired hemophilia A (AHA) is an acquired autoantibody (inhibitor) against blood coagulation factor VIII (FVIII) that significantly reduces FVIII activity and causes a bleeding tendency. Immune acquired coagulation factor deficiency. The peak age of onset is in the 70s. In Japan, which has an aging society, the number of reports has recently been increasing, and it should be noted that AHA is a bleeding disease that can occur in the elderly. Examined 5 cases of AHA that were experienced in our hospital. The FVIII inhibitor level, APTT, underlying disease, treatment history, and outcome were retrospectively examined using medical records. RESULTS The age of onset was 76-93 years. At the time of diagnosis, the Hb (mg/dL) value was 6.1-10.3, the APTT was 75.6-203.2 seconds, the FVIII inhibitor value (BU/mL) was 18-686, and the platelet count was within the normal range in all cases. Bleeding control was possible using a bypass hemostatic agent in 4 patients. All patients underwent immunosuppressive therapy. Two patients were discharged alive and 3 patients died. The cause of death was infectious disease in all cases. The total prednisolone-equivalent dose of the deceased patients was 1,240-3,206 mg; one patient was treated with cyclophosphamide and was treated with dexamethasone. CONCLUSION Long-term immunosuppressive therapy is expected to increase the risk of infection in elderly patients. The risk assessment of AHA treatment-related bloodstream infections is insufficient, and it will be necessary to accumulate data and consider appropriate assessments and countermeasures.
Collapse
Affiliation(s)
- Yasuo Aota
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Kagehiro Amano
- Department of Laboratory Medicine, Tokyo Medical University
| | - Teruhisa Kurata
- Department of Internal Medicine, Kohsei Chuo General Hospital
| | - Arisa Sutoh
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Mitsuru Moriyama
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Nayuta Namioka
- Department of Internal Medicine, Kohsei Chuo General Hospital
| | - Masahiro Okabe
- Department of Internal Medicine, Kohsei Chuo General Hospital
| | | | | | - Akihiko Gotoh
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| |
Collapse
|
3
|
Ichinose A, Osaki T, Souri M. A Review of Coagulation Abnormalities of Autoimmune Acquired Factor V Deficiency with a Focus on Japan. Semin Thromb Hemost 2021; 48:206-218. [PMID: 34942668 DOI: 10.1055/s-0041-1740149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coagulation factor V (or FV for the purpose of medical safety) is an essential cofactor of coagulation factor X in the common pathway of coagulation; severe FV deficiency leads to a bleeding tendency. Although both congenital and acquired FV deficiencies are widely recognized, FV deficiency also presents as an autoimmune disorder. A nationwide survey on autoimmune coagulation factor deficiencies (AiCFDs) conducted in Japan by our Japanese Collaborative Research Group identified 24 new patients with autoimmune FV deficiency (AiFVD) in the past 5 years. Furthermore, our extensive literature search confirmed that 177 AiFVD cases have been reported in previous articles published from Japan. Patients with AiFVD in Japan were predominantly men, with age similar to those with other AiCFDs. AiFVD was confirmed as a relatively mild type of bleeding diathesis, associated with lower mortality rate than that for AiFVD and other AiCFDs reported in previous studies. Patients with AiFVD had variable FV inhibitor titers and both neutralizing anti-FV autoantibodies and nonneutralizing counterparts. Although spontaneous resolution occurs in some patients, timely initiation of hemostatic and immunosuppressive therapies helps arrest the bleeding and eliminate anti-FV antibodies, resulting in a high cumulative recovery rate. Immunological anti-FV antibody detection is recommended to avoid missing AiFVD cases for the presence of nonneutralizing anti-FV autoantibodies. Further investigation is necessary to clarify the long-term prognosis and optimal management of AiFVD.
Collapse
Affiliation(s)
- Akitada Ichinose
- Department of Molecular Pathobiochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan
| | - Tsukasa Osaki
- Department of Molecular Pathobiochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
| | - Masayoshi Souri
- Department of Molecular Pathobiochemistry and Pathobiology, Yamagata University School of Medicine, Yamagata, Japan.,The Japanese Collaborative Research Group (JCRG) on Autoimmune Acquired Coagulation Factor Deficiencies supported by the Japanese Ministry of Health, Labor and Welfare (MHLW), Yamagata, Japan.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Iida-Nishi, Yamagata, Japan
| |
Collapse
|
4
|
Morita R, Doi T, Ishikawa T, Fukuma T, Sato H, Ohshiro M, Yasuda H, Konishi H, Naito Y, Itoh Y. A case of pancreatic walled-off necrosis successfully treated with endoscopic ultrasonography-guided drainage using Hot AXIOS System in a patient with severe hemophilia A. Clin J Gastroenterol 2021; 15:216-220. [PMID: 34727339 DOI: 10.1007/s12328-021-01528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemophilia A causes a bleeding tendency due to the congenital absence of coagulation factor VIII or the production of antibodies against it. It is challenging to perform invasive procedures in patients with hemophilia A. Walled-off necrosis (WON) is a serious complication of acute pancreatitis. Recently, a new metallic stent has been used to drain WON. CLINICAL COURSE We treated a 32-year-old man who developed WON due to acute pancreatitis and has severe congenital hemophilia A. Since conservative treatment was ineffective, he underwent endoscopic ultrasonography (EUS)-guided transgastric WON drainage using a new metallic stent Hot AXIOS System. The procedure was successful without any severe hemorrhagic complications. Before and after the procedure, his clotting factors were strictly monitored by a hemophilia specialist. CONCLUSION EUS-guided pancreatic cyst drainage can be an effective option for WON in patients with severe congenital hemophilia, under adequate management.
Collapse
Affiliation(s)
- Ryuichi Morita
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshifumi Doi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Takeshi Ishikawa
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
- Outpatient Oncology Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taito Fukuma
- Department of Gastroenterology and Hepatology, Kyoto City Hospital, Kyoto, Japan
| | - Hideki Sato
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Muneo Ohshiro
- Department of Hematology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Hiroaki Yasuda
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Naito
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
5
|
Nishi A, Muramatsu A, Maeda E, Kobayashi T, Waratani M, Kitawaki J. Successful management of acquired hemophilia A onset during pregnancy: A case report. J Obstet Gynaecol Res 2021; 47:4060-4066. [PMID: 34263499 DOI: 10.1111/jog.14938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies that inhibit coagulation factor VIII. Pregnancy could be associated with AHA in younger women. Because of its rarity, the optimal management for pregnancy-related AHA has not yet been established. Herein, we present the case of a 32-year-old woman with AHA diagnosed during pregnancy because of elevated activated partial prothrombin time, decreased factor VIII activity, and the presence of a factor VIII inhibitor. She was treated with immunosuppressive therapy consisting of corticosteroid and cyclosporine administration. Although complete remission could not be induced in the peripartum period, she gave birth safely by cesarean delivery in combination with prophylactic bypass hemostatic therapy. This work would provide helpful information to guide better recognition and treatment of pregnancy-related AHA cases.
Collapse
Affiliation(s)
- Akane Nishi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ayako Muramatsu
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Eiko Maeda
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Miyoko Waratani
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| |
Collapse
|
6
|
Mihara M, Ogawa Y, Nagasaka M, Kobayashi N, Shimizu H, Shinozawa K, Fukutake K, Inoue M, Murakami M, Handa H. Successful Management of Acquired Factor V Inhibitor by Monitoring Factor V Activity, Antigen, and Inhibitor Values during Immunosuppressive Therapy. Acta Haematol 2019; 143:486-490. [PMID: 31563916 DOI: 10.1159/000502730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022]
Abstract
Acquired factor V inhibitor (AFVI) results from the formation of autoantibodies to coagulation factor V (FV), and the clinical phenotype can range from asymptomatic laboratory abnormalities to life-threatening bleeds. We describe a 74-year-old man who developed AFVI along with a massive subcutaneous hematoma. He was initially treated with prednisolone (PSL), but AFVI recurred when the dose was reduced after a short period. We subsequently increased the PSL dose and added cyclophosphamide (CY), which resulted in a complete response. We then gradually tapered PSL and stopped CY, and the patient has since remained free of recurrent AFVI symptoms. We monitored FV activity, antigen concentrations, and inhibitor titers of this patient throughout the clinical course. The ratio of FV activity to antigen concentration was low at diagnosis and gradually increased along with the patient's improvement. This ratio might be a useful parameter for evaluating the effects of immunosuppressive therapy in patients with AFVI.
Collapse
Affiliation(s)
- Masahiro Mihara
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Internal Medicine, Kiboukan Hospital, Takasaki, Japan
| | - Yoshiyuki Ogawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan,
| | - Motoo Nagasaka
- Department of Internal Medicine, Kiboukan Hospital, Takasaki, Japan
| | - Nobuhiko Kobayashi
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroaki Shimizu
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Internal Medicine, Kiboukan Hospital, Takasaki, Japan
| | - Keiko Shinozawa
- Department of Molecular Genetics of Coagulation Disorders, Tokyo Medical University, Tokyo, Japan
| | - Katsuyuki Fukutake
- Department of Molecular Genetics of Coagulation Disorders, Tokyo Medical University, Tokyo, Japan
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Madoka Inoue
- Department of Clinical Laboratory, Gunma University Hospital, Maebashi, Japan
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
7
|
Yamada S, Arahata M, Morishita E, Ichinose A, Asakura H. The first reported case of acquired haemophilia A in which bleeding episodes were successfully treated via administration of a single-dose mixture of activated factor VIIa/X. Haemophilia 2019; 25:e350-e352. [PMID: 31487088 DOI: 10.1111/hae.13843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shinya Yamada
- Department of Hematology, Kanazawa University Hospital, Ishikawa, Japan
| | - Masahisa Arahata
- Department of Hematology, Kanazawa University Hospital, Ishikawa, Japan
| | - Eriko Morishita
- Department of Hematology, Kanazawa University Hospital, Ishikawa, Japan
| | - Akitada Ichinose
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School, Yamagata, Japan
| | - Hidesaku Asakura
- Department of Hematology, Kanazawa University Hospital, Ishikawa, Japan
| |
Collapse
|
8
|
Management of Acquired Hemophilia A in Elderly Patients. Case Rep Hematol 2018; 2018:6757345. [PMID: 30538871 PMCID: PMC6260550 DOI: 10.1155/2018/6757345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
This report describes six elderly patients with acquired hemophilia A (AHA), including four individuals aged ≥90 years. Bleeding symptoms were subcutaneous or intramuscular hemorrhage (n=4), hematuria (n=1), and hemorrhagic shock after tooth extraction (n=1). Factor VIII (FVIII) activity ranged from <1.0% to 3.0%, and anti-FVIII inhibitor titers ranged from 8.8 to 240 BU/mL. Treatment was administered at the discretion of the responsible physician. Hemostatic agents applied in the six patients comprised rFVIIa (NovoSeven®) (n=4), APCC (Feiba®) (n=2), and fresh frozen plasma/plasma exchange (n=1). Agents employed for inhibitor eradication comprised prednisolone only (n=3), prednisolone with cyclophosphamide (n=1), prednisolone with cyclosporine (n=1), and prednisolone with rituximab (n=1). In five patients, management was successful, with complete response. Treatment failed in the patient with the highest inhibitor level (240 BU/mL) in whom treatment with APCC (Feiba®; 100 U/kg/dose, three doses) and prednisolone (0.5 mg/kg/day) was followed by several episodes of relapse. The present data demonstrate that AHA severity shows wide variation in elderly subjects, indicating the necessity of individualized management.
Collapse
|
9
|
Saito M, Ogasawara R, Izumiyama K, Mori A, Kondo T, Tanaka M, Morioka M, Ieko M. Acquired hemophilia A in solid cancer: Two case reports and review of the literature. World J Clin Cases 2018; 6:781-785. [PMID: 30510943 PMCID: PMC6264993 DOI: 10.12998/wjcc.v6.i14.781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Acquired hemophilia A (AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor VIII (FVIII) activity related to the appearance of inhibitors against FVIII. Common etiological factors include autoimmune diseases, malignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because treatment of the underlying malignancy is also required.
Collapse
Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masahiro Ieko
- Department of Internal Medicine, Health Sciences University of Hokkaido, Toubetsu 0610293, Japan
| |
Collapse
|