Impact of Adopting Population Pharmacokinetics for Tailoring Prophylaxis in Haemophilia A Patients

TY - JOUR

T1 - Impact of Adopting Population Pharmacokinetics for Tailoring Prophylaxis in Haemophilia A Patients

T2 - A Historically Controlled Observational Study

AU - Stemberger, Michaela

AU - Kallenbach, Felix

AU - Schmit, Elisabeth

AU - McEneny-King, Alanna

AU - Germini, Federico

AU - Yeung, Cindy H T

AU - Edginton, Andrea N

AU - von Mackensen, Sylvia

AU - Kurnik, Karin

AU - Iorio, Alfonso

N1 - Georg Thieme Verlag KG Stuttgart · New York.

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND:  Performing individual pharmacokinetics (PK) studies in clinical practice can be simplified by adopting population PK-based profiling on limited post-infusion samples. The objective of this study was to assess the impact of population PK in tailoring prophylaxis in patients with haemophilia A.PATIENTS AND METHODS:  Individual weekly treatment plans were developed considering predicted plasma factor activity levels and patients' lifestyle. Patients were trained using a visual traffic-light scheme to help modulate their level of physical activity with respect to factor infusions timing. Annualized joint bleeding rate (ABJR), haemophilia-specific quality of life questionnaire for adults (Haemo-QoL-A) and factor utilization were measured for 12 months before and after tailoring, compared within patients and analysed separately for those previously on prophylaxis (P), situational prophylaxis (SP) or on-demand (OD).RESULTS:  Sixteen patients previously on P, 10 on SP and 10 on OD were enrolled in the study. The median (lower, upper quartile) ABJR changed from 2.0 (0, 4.0) to 0 (0, 1.6) for P (p = 0.003), from 2.0 (2.0, 13.6) to 3.0 (1.4, 7.2) for SP (p = 0.183) and from 16.0 (13.0, 25.0) to 2.3 (0, 5.0) for OD (p = 0.003). The Haemo-QoL-A total score improved for 58% of P, 50% of SP and 29% of OD patients. Factor utilization (IU/kg/patient/year) increased by 2,400 (121; 2,586) for P, 1,052 (308; 1,578) for SP and 2,086 (1,498; 2,576) for OD. One of 138 measurements demonstrated a factor activity level below the critical threshold of 0.03 IU/mL while the predicted level was above the threshold.CONCLUSION:  Implementing tailored prophylaxis using a Bayesian forecasting approach in a routine clinical practice setting may improve haemophilia clinical outcomes.

AB - BACKGROUND:  Performing individual pharmacokinetics (PK) studies in clinical practice can be simplified by adopting population PK-based profiling on limited post-infusion samples. The objective of this study was to assess the impact of population PK in tailoring prophylaxis in patients with haemophilia A.PATIENTS AND METHODS:  Individual weekly treatment plans were developed considering predicted plasma factor activity levels and patients' lifestyle. Patients were trained using a visual traffic-light scheme to help modulate their level of physical activity with respect to factor infusions timing. Annualized joint bleeding rate (ABJR), haemophilia-specific quality of life questionnaire for adults (Haemo-QoL-A) and factor utilization were measured for 12 months before and after tailoring, compared within patients and analysed separately for those previously on prophylaxis (P), situational prophylaxis (SP) or on-demand (OD).RESULTS:  Sixteen patients previously on P, 10 on SP and 10 on OD were enrolled in the study. The median (lower, upper quartile) ABJR changed from 2.0 (0, 4.0) to 0 (0, 1.6) for P (p = 0.003), from 2.0 (2.0, 13.6) to 3.0 (1.4, 7.2) for SP (p = 0.183) and from 16.0 (13.0, 25.0) to 2.3 (0, 5.0) for OD (p = 0.003). The Haemo-QoL-A total score improved for 58% of P, 50% of SP and 29% of OD patients. Factor utilization (IU/kg/patient/year) increased by 2,400 (121; 2,586) for P, 1,052 (308; 1,578) for SP and 2,086 (1,498; 2,576) for OD. One of 138 measurements demonstrated a factor activity level below the critical threshold of 0.03 IU/mL while the predicted level was above the threshold.CONCLUSION:  Implementing tailored prophylaxis using a Bayesian forecasting approach in a routine clinical practice setting may improve haemophilia clinical outcomes.

KW - Adolescent

KW - Adult

KW - Bayes Theorem

KW - Coagulants/administration & dosage

KW - Drug Administration Schedule

KW - Hemarthrosis/blood

KW - Hemophilia A/blood

KW - Humans

KW - Male

KW - Middle Aged

KW - Models, Biological

KW - Prospective Studies

KW - Quality of Life

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1055/s-0039-1677700

DO - 10.1055/s-0039-1677700

M3 - SCORING: Journal article

C2 - 30685872

VL - 119

SP - 368

EP - 376

JO - THROMB HAEMOSTASIS

JF - THROMB HAEMOSTASIS

SN - 0340-6245

IS - 3

ER -