Bleeding events and safety outcomes in persons with haemophilia A with inhibitors: A prospective, multi-centre, non-interventional study

Johnny Mahlangu, Johannes Oldenburg, Michael U. Callaghan, Midori Shima, Elena Santagostino, Maggie Moore, Michael Recht, Claudia Garcia, Renchi Yang, Michaela Lehle, Harrison Macharia, Elina Asikanius, Gallia G. Levy, Rebecca Kruse-Jarres

Research output: Contribution to journalArticle

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Abstract

Introduction: Prospectively collected, real-world data on bleeds, haemophilic treatment and safety outcomes in persons with haemophilia A (PwHA) with factor VIII (FVIII) inhibitors are limited. A prospective, global, multi-centre, non-interventional study (NIS; NCT02476942) collected detailed real-world data in PwHA treated per local routine clinical practice. Aim: To characterize bleeding rates, haemophilic treatment practices, prophylaxis adherence and adverse events (AEs) in adult/adolescent PwHA with inhibitors in the NIS. Methods: Participants aged ≥12 years with congenital haemophilia A/documented high-titre FVIII inhibitor history were enrolled. Participants remained on their usual treatment; no interventions were applied. Results: Overall, 103 PwHA with inhibitors enrolled, (median [range] age 31 [12-75] years) and were monitored for median (range) 26.0 (4.1-69.6) weeks. In the episodic (n = 75) and prophylactic (n = 28) treatment groups, respectively, 1244 and 325 bleeds were reported, and 528 (42.4%) and 104 (32.0%) were not treated; annualized bleeding rates (ABRs; 95% confidence interval) were 18.6 (15.2-22.8) and 14.9 (10.5-21.2) for treated bleeds, and 32.7 (27.3-39.1) and 25.0 (18.4-34.0) for all bleeds. Coagulation products used included activated prothrombin complex concentrate (aPCC) and/or recombinant activated FVII. Among participants prescribed aPCC prophylaxis, 35.0% adhered to both prescribed frequency of aPCC administration and prescribed dose. Serious AEs of haemarthrosis and muscle haemorrhage were reported; most common AEs were arthralgia, viral upper respiratory tract infection and pyrexia. Conclusions: ABRs (treated bleeds and all bleeds) remain high on standard treatment; this prospective NIS demonstrates the need for more effective treatments for PwHA with inhibitors to reduce/prevent bleeds, with potential to improve prophylaxis adherence and further improve outcomes.

Original languageEnglish
Pages (from-to)921-929
JournalHaemophilia
Volume24
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

Hemophilia A
Hemorrhage
Safety
Factor VIII
Hemarthrosis
Therapeutics
Arthralgia
Respiratory Tract Infections
Fever
History
Confidence Intervals
Muscles
prothrombin complex concentrates

Keywords

  • blood coagulation factor inhibitors
  • factor VIII
  • haemophilia A
  • non-interventional study
  • observational study
  • prospective study

ASJC Scopus subject areas

  • Hematology
  • Genetics(clinical)

Cite this

Bleeding events and safety outcomes in persons with haemophilia A with inhibitors : A prospective, multi-centre, non-interventional study. / Mahlangu, Johnny; Oldenburg, Johannes; Callaghan, Michael U.; Shima, Midori; Santagostino, Elena; Moore, Maggie; Recht, Michael; Garcia, Claudia; Yang, Renchi; Lehle, Michaela; Macharia, Harrison; Asikanius, Elina; Levy, Gallia G.; Kruse-Jarres, Rebecca.

In: Haemophilia, Vol. 24, No. 6, 2018, p. 921-929.

Research output: Contribution to journalArticle

Mahlangu, J, Oldenburg, J, Callaghan, MU, Shima, M, Santagostino, E, Moore, M, Recht, M, Garcia, C, Yang, R, Lehle, M, Macharia, H, Asikanius, E, Levy, GG & Kruse-Jarres, R 2018, 'Bleeding events and safety outcomes in persons with haemophilia A with inhibitors: A prospective, multi-centre, non-interventional study', Haemophilia, vol. 24, no. 6, pp. 921-929. https://doi.org/10.1111/hae.13612
Mahlangu, Johnny ; Oldenburg, Johannes ; Callaghan, Michael U. ; Shima, Midori ; Santagostino, Elena ; Moore, Maggie ; Recht, Michael ; Garcia, Claudia ; Yang, Renchi ; Lehle, Michaela ; Macharia, Harrison ; Asikanius, Elina ; Levy, Gallia G. ; Kruse-Jarres, Rebecca. / Bleeding events and safety outcomes in persons with haemophilia A with inhibitors : A prospective, multi-centre, non-interventional study. In: Haemophilia. 2018 ; Vol. 24, No. 6. pp. 921-929.
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AU - Shima, Midori

AU - Santagostino, Elena

AU - Moore, Maggie

AU - Recht, Michael

AU - Garcia, Claudia

AU - Yang, Renchi

AU - Lehle, Michaela

AU - Macharia, Harrison

AU - Asikanius, Elina

AU - Levy, Gallia G.

AU - Kruse-Jarres, Rebecca

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N2 - Introduction: Prospectively collected, real-world data on bleeds, haemophilic treatment and safety outcomes in persons with haemophilia A (PwHA) with factor VIII (FVIII) inhibitors are limited. A prospective, global, multi-centre, non-interventional study (NIS; NCT02476942) collected detailed real-world data in PwHA treated per local routine clinical practice. Aim: To characterize bleeding rates, haemophilic treatment practices, prophylaxis adherence and adverse events (AEs) in adult/adolescent PwHA with inhibitors in the NIS. Methods: Participants aged ≥12 years with congenital haemophilia A/documented high-titre FVIII inhibitor history were enrolled. Participants remained on their usual treatment; no interventions were applied. Results: Overall, 103 PwHA with inhibitors enrolled, (median [range] age 31 [12-75] years) and were monitored for median (range) 26.0 (4.1-69.6) weeks. In the episodic (n = 75) and prophylactic (n = 28) treatment groups, respectively, 1244 and 325 bleeds were reported, and 528 (42.4%) and 104 (32.0%) were not treated; annualized bleeding rates (ABRs; 95% confidence interval) were 18.6 (15.2-22.8) and 14.9 (10.5-21.2) for treated bleeds, and 32.7 (27.3-39.1) and 25.0 (18.4-34.0) for all bleeds. Coagulation products used included activated prothrombin complex concentrate (aPCC) and/or recombinant activated FVII. Among participants prescribed aPCC prophylaxis, 35.0% adhered to both prescribed frequency of aPCC administration and prescribed dose. Serious AEs of haemarthrosis and muscle haemorrhage were reported; most common AEs were arthralgia, viral upper respiratory tract infection and pyrexia. Conclusions: ABRs (treated bleeds and all bleeds) remain high on standard treatment; this prospective NIS demonstrates the need for more effective treatments for PwHA with inhibitors to reduce/prevent bleeds, with potential to improve prophylaxis adherence and further improve outcomes.

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