Abstract
Objective: Factor VIII (FVIII) prophylaxis is now considered a gold standard for the treatment of hemophilia A patients to prevent bleeding and maintain musculoskeletal function. FVIII prophylaxis, tailored with pharmacokinetic data, is the most successful approach in preventing bleeding and reducing the cost of treatment.
Material and Methods: In this study, 17 patients with severe hemophilia A (median age 11.5 years, median factor 25 U / kg) whose FVIII pharmacokinetic data were obtained through the myPKFiT web access program, were presented.
Results: The mean FVIII half-life of the patients was 9.1 hours (min-max: 6.8-11.4); the mean FVIII clearance was 4.7 ml/hour/kg (min-max: 2.6-6.8); and the mean duration of FVIII levels under 1% was 47 hours (min-max: 33-61). The half-life of FVIII was increased with the age of the patient. When a weekly dose schedule simulated with the target FVIII trough level above 1%, it was observed that the dose of FVIII was sufficient in three, it was high in five, and it was insufficient in nine patients.
Conclusion: In our study, prophylaxis doses and frequencies were adjusted according to the FVIII pharmacokinetic data.
Keywords: Hemophilia A, Pharmacokinetic data, Prophylaxis, The Bayesian method
References
- Petrini P, Valentino LA, Gringeri A, Re WM, Ewenstein B. Individualizing prophylaxis in hemophilia: a review. Expert Rev Hematol. 2015;8:237-46
- Pasca S, Milan M, Sarolo L, Zanon E. PK-driven prophylaxis versus standard prophylaxis: When a tailored treatment may be a real and achievable cost-saving approach in children with severe hemophilia A. Thromb Res. 2017;157:58-63.
- Megías-Vericat JE, Bonanad S, Haya S, Cid AR, Marqués MR, Monte E, Pérez-Alenda S, Bosch P, Querol F, Poveda JL. Bayesian pharmacokinetic-guided prophylaxis with recombinant factor VIII in severe or moderate haemophilia A. Thromb Res. 2019;174:151-162.
- McEneny-King A, Iorio A, Foster G, Edginton AN. The use of pharmacokinetics in dose individualization of factor VIII in the treatment of hemophilia A. Expert Opin Drug Metab Toxicol. 2016;12:1313-1321.
- Björkman S, Oh M, Spotts G, Schroth P, Fritsch S, Ewenstein BM, Casey K, Fischer K, Blanchette VS, Collins PW. Population pharmacokinetics of recombinant factor VIII: the relationships of pharmacokinetics to age and body weight. Blood. 2012;119:612-8.
- Björkman S. Limited blood sampling for pharmacokinetic dose tailoring of FVIII in the prophylactic treatment of haemophilia A. Haemophilia. 2010;16:597-605.
- Valentino LA, Mamonov V, Hellmann A, Quon DV, Chybicka A, Schroth P, Patrone L, Wong WY; Prophylaxis Study Group. A randomized comparison of two prophylaxis regimens and a paired comparison of on-demand and prophylaxis treatments in hemophilia A management. J Thromb Haemost. 2012;10:359-67.
- Preijers T, van Moort I, Fijnvandraat K, Leebeek FWG, Cnossen MH, Mathôt RAA; ‘OPTI-CLOT’ Study Group. Cross-evaluation of Pharmacokinetic-Guided Dosing Tools for Factor VIII. Thromb Haemost. 2018;118:514-525.
- Pasca S, Zanon E. Savings without changing: How to use the MyPKfit® device to improve treatment strategies in a cohort of patients with haemophilia A. Thromb Res. 2019;183:1-3.
- Álvarez-Román MT, Fernandez-Bello I, de la Corte-Rodríguez H, Hernández-Moreno AL, Martín-Salces M, Butta-Coll N, Rivas-Pollmar MI, Rivas-Muñoz S, Jiménez-uste V. Experience of tailoring prophylaxis using factor VIII pharmacokinetic parameters estimated with myPKFiT(®) in patients with severe haemophilia A without inhibitors. Haemophilia. 2017;23:e50-e54.
- Collins PW, Blanchette VS, Fischer K, et al. Break-through bleeding in relation to predicted factor VIII levels in patients receiving prophylactic treatment for severe hemophilia A. J Thromb Haemost. 2009;7:413‐420.
- Nagao A, Yeung CHT, Germini F, Suzuki T. Clinical outcomes in hemophilia A patients undergoing tailoring of prophylaxis based on population-based pharmacokinetic dosing. Thromb Res. 2019;173:79-84.
- Mingot-Castellano ME, Parra R, Núñez R, Martorell M. Improvement in clinical outcomes and replacement factor VIII use in patients with haemophilia A after factor VIII pharmacokinetic-guided prophylaxis based on Bayesian models with myPKFiT(®). Haemophilia. 2018;24:e338-e343.
Copyright and license
Copyright © 2020 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.