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      Health‐related quality of life and caregiver burden of emicizumab in children with haemophilia A and factor VIII inhibitors—Results from the HAVEN 2 study

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          Abstract

          Introduction

          Persons with haemophilia A (PwHA) with factor (F)VIII inhibitors, including children, have impaired health‐related quality of life (HRQoL). The HAVEN 2 study (NCT027955767) of paediatric PwHA with FVIII inhibitors demonstrated that subcutaneous emicizumab prophylaxis resulted in low annualizedbleed rates.

          Aim

          We assessed the impact of emicizumab prophylaxis on the HRQoL of children and their caregivers participating in HAVEN 2.

          Methods

          Children aged 8‐11 years self‐reported HRQoL using the Haemophilia‐Specific Quality of Life Assessment Instrument for Children and Adolescents Short Form (Haemo‐QoL SF II). Caregivers of children aged 0‐11 years completed the Adapted Inhibitor‐Specific Quality of Life Assessment with Aspects of Caregiver Burden. All scores were transformed to a 0‐100 scale, where lower scores reflect a better HRQoL. The number of missed days from school/day care and hospitalizations was also recorded.

          Results

          In HAVEN 2 (n = 88), the median age was 6.5 years (range: 1‐15 years); 85 participants were aged < 12 years and included in this analysis, and 34 participants were aged 8‐11 years, thereby eligible to complete the Haemo‐QoL SF II questionnaire. The mean (standard deviation, n) baseline Haemo‐QoL SF II ‘Total’ score was 30.2 (14.9, 30), indicating moderate impairment; with emicizumab, mean score decreased by −9.62 (7.73, 17) points to 23.0 (13.93, 20) by Week 49. The most improved domains were ‘Sports & School’ and ‘Physical Health’. Caregivers reported similar improvements.

          Conclusion

          Prophylactic emicizumab is accompanied by substantial and sustained improvements in HRQoL of paediatric PwHA with FVIII inhibitors and their caregivers.

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          Most cited references33

          • Record: found
          • Abstract: found
          • Article: not found

          A Randomized Trial of Factor VIII and Neutralizing Antibodies in Hemophilia A.

          The development of neutralizing anti-factor VIII alloantibodies (inhibitors) in patients with severe hemophilia A may depend on the concentrate used for replacement therapy.
            • Record: found
            • Abstract: found
            • Article: not found

            A multicenter, open-label phase 3 study of emicizumab prophylaxis in children with hemophilia A with inhibitors

            In a Plenary Paper, Young et al describe impressive favorable outcomes of emicizumab prophylaxis in children with hemophilia A and factor VIII inhibitors, reporting a 99% reduction in annualized bleeding, with 77% of patients having no treated bleeding events.
              • Record: found
              • Abstract: found
              • Article: not found

              Factor VIII products and inhibitor development in severe hemophilia A.

              For previously untreated children with severe hemophilia A, it is unclear whether the type of factor VIII product administered and switching among products are associated with the development of clinically relevant inhibitory antibodies (inhibitor development). We evaluated 574 consecutive patients with severe hemophilia A (factor VIII activity, <0.01 IU per milliliter) who were born between 2000 and 2010 and collected data on all clotting-factor administration for up to 75 exposure days. The primary outcome was inhibitor development, which was defined as at least two positive inhibitor tests with decreased in vivo recovery of factor VIII levels. Inhibitory antibodies developed in 177 of the 574 children (cumulative incidence, 32.4%); 116 patients had a high-titer inhibitory antibody, defined as a peak titer of at least 5 Bethesda units per milliliter (cumulative incidence, 22.4%). Plasma-derived products conferred a risk of inhibitor development that was similar to the risk with recombinant products (adjusted hazard ratio as compared with recombinant products, 0.96; 95% confidence interval [CI], 0.62 to 1.49). As compared with third-generation full-length recombinant products (derived from the full-length complementary DNA sequence of human factor VIII), second-generation full-length products were associated with an increased risk of inhibitor development (adjusted hazard ratio, 1.60; 95% CI, 1.08 to 2.37). The content of von Willebrand factor in the products and switching among products were not associated with the risk of inhibitor development. Recombinant and plasma-derived factor VIII products conferred similar risks of inhibitor development, and the content of von Willebrand factor in the products and switching among products were not associated with the risk of inhibitor development. Second-generation full-length recombinant products were associated with an increased risk, as compared with third-generation products. (Funded by Bayer Healthcare and Baxter BioScience.).

                Author and article information

                Contributors
                elisamancuso@gmail.com
                Journal
                Haemophilia
                Haemophilia
                10.1111/(ISSN)1365-2516
                HAE
                Haemophilia
                John Wiley and Sons Inc. (Hoboken )
                1351-8216
                1365-2516
                21 October 2020
                November 2020
                : 26
                : 6 ( doiID: 10.1111/hae.v26.6 )
                : 1009-1018
                Affiliations
                [ 1 ] Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Milan Italy
                [ 2 ] Faculty of Health Sciences University of the Witwatersrand and NHLS Johannesburg South Africa
                [ 3 ] Emory University and Children's Healthcare of Atlanta Atlanta GA USA
                [ 4 ] Genentech, Inc. South San Francisco CA USA
                [ 5 ] F. Hoffmann‐La Roche Ltd Basel Switzerland
                [ 6 ] Nara Medical University Kashihara Japan
                [ 7 ] Children's Hospital Los Angeles University of Southern California Keck School of Medicine Los Angeles CA USA
                [ 8 ] University of Bonn Bonn Germany
                [ 9 ] Department of Medical Psychology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
                Author notes
                [*] [* ] Correspondence

                Maria Elisa Mancuso, Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical Research Center – IRCSS, Via Manzoni, Rozzano, Milan, Italy.

                Email: elisamancuso@ 123456gmail.com

                Author information
                https://orcid.org/0000-0001-5781-7669
                https://orcid.org/0000-0002-5922-7061
                https://orcid.org/0000-0001-6013-1254
                https://orcid.org/0000-0002-1585-4100
                Article
                HAE14183
                10.1111/hae.14183
                7821108
                33084175
                ddb52108-a925-44d5-a607-9b6da4c87928
                © 2020 The Authors. Haemophilia published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 20 July 2020
                : 22 September 2020
                : 28 September 2020
                Page count
                Figures: 4, Tables: 3, Pages: 10, Words: 6712
                Funding
                Funded by: F. Hoffmann‐La Roche Ltd
                Funded by: Chugai Pharmaceutical Co., Ltd
                Categories
                Original Article
                Original Articles
                Clinical Haemophilia
                Custom metadata
                2.0
                November 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:22.01.2021

                Hematology
                caregiver burden,children,emicizumab,haemophilia,health‐related quality of life,inhibitors

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