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Ramanan R, Evans N, Kaplan Z, McFadyen JD, Tran HA. Mutational landscape, inhibitor development, and health-care burden in non-severe haemophilia A: A single-centre Australian experience. Haemophilia 2024. [PMID: 38578179 DOI: 10.1111/hae.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/16/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
AIM To characterise non-severe haemophilia A (HA) patients enrolled on the Australian Bleeding Disorders Registry (ABDR) treated through a state-wide Haemophilia Treatment Centre (HTC) with respect to their mutational profile, inhibitor risk and health-care burden. METHOD We conducted a single-centre observational study of all non-severe HA patients treated at the Alfred Health HTC registered on the ABDR as of the 26th July 2023. Data were extracted from the ABDR and electronic medical record (EMR) regarding demographics, severity, genetic testing, treatment, inhibitors, bleeding events and procedures. Inhibitor risk was calculated as a function of exposure days (EDs) of FVIII replacement. RESULTS There were 289 non-severe HA patients treated at the Alfred HTC registered on the ABDR as of July 2023, all of whom were adult patients aged > 18 years old. Genotyping had been performed in 228/289 (78.9%). Of the inhibitor analysis population, 14/193 (7.3%) had an inhibitor. The cumulative incidence of inhibitor development at 75 EDs was 31% (95% CI 13%-46%). The median cost of bypassing agents per inhibitor patient was $57,087.50/year. CONCLUSION These results demonstrate a relatively high inhibitor prevalence and incidence risk in non-severe HA compared to previously published work, although this may partly reflect a smaller population size. High rates of genotyping have allowed representative mutational characterisation. The burden of care imposed by non-severe HA in terms of bleeding events, procedures and bypassing agent cost is larger than expected, particularly within the inhibitor population.
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Affiliation(s)
- Radha Ramanan
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
- Ronald Sawers Haemophilia Treatment Centre, Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
- Australian Haemophilia Centre Directors' Organisation, Melbourne, Victoria, Australia
| | - Natalie Evans
- Ronald Sawers Haemophilia Treatment Centre, Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
- Australian Haemophilia Centre Directors' Organisation, Melbourne, Victoria, Australia
| | - Zane Kaplan
- Ronald Sawers Haemophilia Treatment Centre, Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - James D McFadyen
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
- Ronald Sawers Haemophilia Treatment Centre, Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Huyen A Tran
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
- Ronald Sawers Haemophilia Treatment Centre, Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
- Australian Haemophilia Centre Directors' Organisation, Melbourne, Victoria, Australia
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