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      Real-World Experience of People with Hemophilia A Receiving Turoctocog Alfa Pegol (N8-GP): Results from a Patient Experience Survey

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          Abstract

          Purpose

          Turoctocog alfa pegol (N8-GP) is an extended half-life recombinant factor VIII molecule used for the treatment of hemophilia A (HA). The purpose of this study was to investigate real-world experiences of patients with HA treated with N8-GP.

          Patients and Methods

          A 25-minute online survey was completed by adults (≥18 years) and caregivers of adolescents (12–16 years) with HA receiving N8-GP across six countries (Germany, Italy, Portugal, Spain, UK and US). Patients were recruited using a multichannel approach through recruitment panels, referrals from healthcare professionals and patient associations. The survey comprised a questionnaire with metrics including satisfaction and preferences for N8-GP, quality of life (QoL) and long-term impact.

          Results

          A total of 62 participants (98% male [n=61], mean age 29 years) comprising 46 patients and 16 caregivers completed the survey. Patients (60% non-severe [n=37] and 40% severe [25]) were on N8-GP for a mean period of 1.4 years. Patients expressed satisfaction (95% vs 42%, p<0.001) and preference (91% vs 9%, p<0.001) for N8-GP vs their previous treatments. Most patients with severe HA (87%, p=0.038) and patients on prophylaxis (84%, p<0.001) stated lower frequency of injections as their main reason for satisfaction, while improved QoL drove satisfaction for non-severe patients (81%, p=0.053). Overall, patients perceived that QoL score improved (74.8 vs 65.9, p=0.01) with N8-GP treatment compared with previous treatments. Flexibility to store at room temperature was one of the key convenience factors driving satisfaction. Patients believed that N8-GP can offer a long-term impact in areas such as ability to perform day-to-day activities (68%), independence to live like a person without hemophilia (63%), ability to travel (60%) with a feeling of optimism and hopefulness (82%).

          Conclusion

          Lower frequency of injections, storage flexibility and improved QoL drove satisfaction and preference for N8-GP over previous treatments among patients with HA.

          Plain language summary

          Hemophilia A is a rare bleeding disorder that often runs in families. Although there is no cure, several therapeutic options are available to help control bleeding in people with hemophilia A. However, most treatments require intravenous (directly into a vein) or subcutaneous (directly under the skin) injections, which is a significant burden for all patients. In this study, adults and caregivers of adolescents, with hemophilia A answered a survey about their treatment experience with a medicine called N8-GP (turoctocog alfa pegol) compared with previous treatments.

          This is the first real-world evidence study focused on satisfaction with and preference for N8-GP compared with previous treatments. Survey results showed that adults and adolescents with hemophilia A were very satisfied with N8-GP compared with previous medicines. The main reasons for satisfaction included less frequent injections, the flexibility to store at room temperature, and improved quality-of-life.

          In addition, many patients expressed hopes for the future while taking N8-GP, such as confidence in ability to undertake physical activities and ability to plan and go on a holiday. Compared with previous treatments, patients were feeling optimistic and hopeful about N8-GP and expressed that they have started to think less about the disease.

          Despite the unique advantages of taking N8-GP, patients overall still perceive their quality-of-life to be less than an average person’s, presenting an opportunity for future advancements. Overall, this study sheds light on the unique experiences of people with hemophilia A taking N8-GP and further opens up the scope for addressing the unmet needs.

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          Most cited references19

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          WFH Guidelines for the Management of Hemophilia, 3rd edition

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            Trial designs using real‐world data: The changing landscape of the regulatory approval process

            Abstract Purpose There is a need to develop hybrid trial methodology combining the best parts of traditional randomized controlled trials (RCTs) and observational study designs to produce real‐world evidence (RWE) that provides adequate scientific evidence for regulatory decision‐making. Methods This review explores how hybrid study designs that include features of RCTs and studies with real‐world data (RWD) can combine the advantages of both to generate RWE that is fit for regulatory purposes. Results Some hybrid designs include randomization and use pragmatic outcomes; other designs use single‐arm trial data supplemented with external comparators derived from RWD or leverage novel data collection approaches to capture long‐term outcomes in a real‐world setting. Some of these approaches have already been successfully used in regulatory decisions, raising the possibility that studies using RWD could increasingly be used to augment or replace traditional RCTs for the demonstration of drug effectiveness in certain contexts. These changes come against a background of long reliance on RCTs for regulatory decision‐making, which are labor‐intensive, costly, and produce data that can have limited applicability in real‐world clinical practice. Conclusions While RWE from observational studies is well accepted for satisfying postapproval safety monitoring requirements, it has not commonly been used to demonstrate drug effectiveness for regulatory purposes. However, this position is changing as regulatory opinions, guidance frameworks, and RWD methodologies are evolving, with growing recognition of the value of using RWE that is acceptable for regulatory decision‐making.
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              Hemophilia therapy: the future has begun

              The success story of hemophilia care first began in the 1970s, when the availability of plasma-derived concentrates of coagulation factor VIII (FVIII) and factor IX (FIX) provided efficacious treatment of bleeding in patients with hemophilia A and B. This positive scenario was consolidated in terms of greater safety and availability in the 1990s, when the first recombinant coagulation factors were produced. This meant that, instead of only treating episodic bleeding events, prophylaxis regimens could be implemented as a preventive measure. Following the demonstration of its superiority in the frame of two randomized clinical trials, prophylaxis became evidence-based standard of care. In high-income countries, these achievements have led to a patients’ life expectancy being extended to close to that of the general male population. Alongside this, the last decade has witnessed further spectacular therapeutic progress, such as the availability of coagulation factors with a longer plasma half-life that allow for wider intervals between treatment. Moreover, new therapeutic products based on new mechanisms other than the replacement of the deficient factor, have become available (emicizumab) or are at an advanced stage of development. This review celebrates the success story of hemophilia care, while also discussing current limitations, issues and as yet unmet needs. The prospects of cure by means of gene therapy are also outlined.
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                Author and article information

                Journal
                Patient Prefer Adherence
                Patient Prefer Adherence
                ppa
                Patient preference and adherence
                Dove
                1177-889X
                17 November 2023
                2023
                : 17
                : 3001-3014
                Affiliations
                [1 ]Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University , Homburg, Germany
                [2 ]Department of Blood Coagulation, Ogikubo Hospital , Tokyo, Japan
                [3 ]Novo Nordisk , Zurich, Switzerland
                [4 ]Patient Author , Braunwald, Switzerland
                Author notes
                Correspondence: Hermann Eichler, Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University , Ringstrasse 52, Geb. 1, Homburg, 66421, Germany, Tel +49 6841 1622530, Email Hermann.Eichler@uks.eu
                Author information
                http://orcid.org/0000-0002-1372-0619
                Article
                394216
                10.2147/PPA.S394216
                10661914
                ea092edb-8c37-43df-870b-f0823baa5455
                © 2023 Eichler et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 26 July 2023
                : 08 November 2023
                Page count
                Figures: 6, Tables: 4, References: 19, Pages: 14
                Categories
                Original Research

                Medicine
                hemophilia a,turoctocog alfa pegol,patient preference,real-world evidence,patient satisfaction,quality of life

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