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      Plasma‐derived factor X concentrate compassionate use for hereditary factor X deficiency: Long‐term safety and efficacy in a retrospective data‐collection study

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          Abstract

          Background

          Coagadex is a high‐purity plasma‐derived factor X concentrate (pdFX) developed to treat hereditary factor X deficiency (FXD).

          Objective

          Evaluate the efficacy and safety of pdFX administered to patients with hereditary FXD.

          Methods

          This was an open‐label, multicenter, retrospective analysis of patients receiving pdFX for compassionate use. Efficacy end points included treatments administered, the number and treatment of bleeds, and investigator assessments. Adverse drug reactions (ADRs) were monitored.

          Results

          Fifteen patients were included: seven received routine prophylaxis, seven received on‐demand treatment, and one alternated. Most were aged ≥12 years (n = 13) and had severe hereditary FXD (n = 12). The median follow‐up time was 19.2 months (range, 3.5‐48.8). The number of infusions per patient per month was higher for the routine prophylaxis group (median [range], 5.4 [1.4‐10.1]) than for the on‐demand group (0.8 [0.1‐2.3]), as was the dose per infusion (27.9 [21.9‐53.6] IU/kg vs 20.0 [13.6‐27.7] IU/kg). Patients experienced 88 bleeds (34 minor, 7 major, 47 unclassified). The monthly bleed rate per patient was 0.04 in the routine prophylaxis group (based on 17 bleeds in four patients) and 0.8 in the on‐demand group (based on 71 bleeds in eight patients). pdFX was used to treat 79 bleeds and was rated effective in all instances. In an overall assessment, investigators rated pdFX as excellent for 14 patients (93.3%) and good for 1 patient (6.3%). No ADRs or safety concerns were reported.

          Conclusions

          This analysis supports the use of pdFX as a safe, effective treatment for hereditary FXD. Routine prophylaxis with pdFX may reduce bleed frequency.

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          Most cited references15

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          Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European Network of Rare Bleeding Disorders.

          The European Network of Rare Bleeding Disorders (EN-RBD) was established to bridge the gap between knowledge and practise in the care of patients with RBDs. To explore the relationship between coagulation factor activity level and bleeding severity in patients with RBDs. Cross-sectional study using data from 489 patients registered in the EN-RBD. Coagulation factor activity levels were retrieved. Clinical bleeding episodes were classified into four categories according to severity. The mean age of patients at data collection was 31 years (range, 7 months to 95 years), with an equal sex distribution. On linear regression analysis, there was a strong association between coagulation factor activity level and clinical bleeding severity for fibrinogen, factor (F) X, FXIII, and combined FV and FVIII deficiencies. A weaker association was present for FV and FVII deficiencies. There was no association between coagulation factor activity level and clinical bleeding severity for FXI. The coagulation factor activity levels that were necessary for patients to remain asymptomatic were: fibrinogen, > 100 mg dL(-1); FV, 12 U dL(-1); combined FV + VIII, 43 U dL(-1); FVII, 25 U dL(-1); FX, 56 U dL(-1) ; FXI, 26 U dL(-1); FXIII, 31 U dL(-1). Moreover, coagulation factor activity levels that corresponded with Grade III bleeding were: undetectable levels for fibrinogen, FV and FXIII, < 15 U dL(-1) for combined FV + VIII; < 8 U dL(-1) for FVI; < 10 U dL(-1) for FX; and < 25 U dL(-1) for FXI. There is a heterogeneous association between coagulation factor activity level and clinical bleeding severity in different RBDs. A strong association is only observed in fibrinogen, FX and FXIII deficiencies. © 2012 International Society on Thrombosis and Haemostasis.
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            Guideline for the diagnosis and management of the rare coagulation disorders: a United Kingdom Haemophilia Centre Doctors' Organization guideline on behalf of the British Committee for Standards in Haematology.

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              • Article: not found

              The rare coagulation disorders--review with guidelines for management from the United Kingdom Haemophilia Centre Doctors' Organisation.

              The rare coagulation disorders are heritable abnormalities of haemostasis that may present significant difficulties in diagnosis and management. This review summarizes the current literature for disorders of fibrinogen, and deficiencies of prothrombin, factor V, FV + VIII, FVII, FX, the combined vitamin K-dependent factors, FXI and FXIII. Based on both collective clinical experience and the literature, guidelines for management of bleeding complications are suggested with specific advice for surgery, spontaneous bleeding, management of pregnancy and the neonate. We have chosen to include a section on Ehlers-Danlos Syndrome because haematologists may be consulted about bleeding manifestations in such patients.
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                Author and article information

                Contributors
                chioma.akanezi@bpl.co.uk
                Journal
                Res Pract Thromb Haemost
                Res Pract Thromb Haemost
                10.1002/(ISSN)2475-0379
                RTH2
                Research and Practice in Thrombosis and Haemostasis
                John Wiley and Sons Inc. (Hoboken )
                2475-0379
                02 July 2021
                July 2021
                : 5
                : 5 ( doiID: 10.1002/rth2.v5.5 )
                : e12550
                Affiliations
                [ 1 ] UCSF Benioff Children's Hospital and University of California San Francisco San Francisco CA USA
                [ 2 ] Haemophilia Comprehensive Care Centre Great Ormond Street Hospital NHS Foundation Trust London UK
                [ 3 ] St George's Haemophilia Centre St George's University Hospitals NHS Foundation Trust London UK
                [ 4 ] Department of Pediatric Hematology Ege University Children's Hospital Izmir Turkey
                [ 5 ] Bio Products Laboratory Ltd Elstree UK
                Author notes
                [*] [* ] Correspondence

                Chioma Akanezi, Bio Products Laboratory, Dagger Lane, Elstree, Hertfordshire WD6 3BX, UK.

                Email: chioma.akanezi@ 123456bpl.co.uk

                Article
                RTH212550
                10.1002/rth2.12550
                8268662
                34263102
                68cc6fd7-1cc7-4a21-8bbf-c4a2a43fcbab
                © 2021 Bio Products Laboratory. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH)

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 02 April 2021
                : 21 August 2020
                : 07 April 2021
                Page count
                Figures: 1, Tables: 4, Pages: 9, Words: 6211
                Funding
                Funded by: Bio Products Laboratory Ltd
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:02.07.2021

                blood coagulation disorders and inherited,compassionate use trials,factor x deficiency,retrospective studies,treatment outcome

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