Nugent D J, Ashley C, García-Talavera J, Lo L C, Mehdi A S, Mangione A
Children's Hospital of Orange County (CHOC), Orange, CA, USA.
Haemophilia. 2015 Jan;21(1):95-101. doi: 10.1111/hae.12505. Epub 2014 Dec 2.
Congenital factor XIII (FXIII) deficiency is a rare condition with substantial risk for life-threatening bleeding. Replacement of deficient FXIII with plasma-derived FXIII concentrate is a treatment option. The current 12-week study evaluated the steady-state pharmacokinetic (PK) and safety profile of prophylactic infusions of FXIII concentrate (human) in patients with congenital FXIII deficiency. Patients received FXIII concentrate (human) 40 IU kg(-1) on Days 0, 28, and 56. FXIII levels were assessed before and after each infusion; steady-state PK parameters were assessed up to 28 days after the infusion on Day 56. Treatment effectiveness in maintaining trough FXIII activity levels ≥ 5% over 28 days and safety parameters were also assessed. Fourteen patients received FXIII concentrate (human) and 13 completed the study. Post-infusion, FXIII activity levels increased to within the range found in patients without congenital FXIII deficiency without reaching supra-therapeutic levels. Non-baseline-adjusted trough FXIII activity levels were maintained at or above 10% at all post-baseline visits in all patients. Steady-state PK parameters were baseline-adjusted; maximum FXIII activity was 87.7% at 1.72 h post-infusion, subsequently declining to a minimum of 5.0%. The half-life was 6.6 days. FXIII concentrate (human) was generally well tolerated. Two patients had possibly treatment-related adverse events. There were no reports of thromboembolism, viral transmission, bleeding events or treatment-related hypersensitivity. These findings support use of FXIII concentrate (human) 40 IU kg(-1) every 28 days as an appropriate regimen for routine, long-term prophylaxis in children and adults with congenital FXIII deficiency.
先天性因子 XIII(FXIII)缺乏症是一种罕见疾病,存在危及生命的出血风险。用血浆源性 FXIII 浓缩物替代缺乏的 FXIII 是一种治疗选择。当前这项为期 12 周的研究评估了先天性 FXIII 缺乏症患者预防性输注 FXIII 浓缩物(人源)的稳态药代动力学(PK)和安全性。患者在第 0、28 和 56 天接受 40 IU/kg(人源)的 FXIII 浓缩物。在每次输注前后评估 FXIII 水平;在第 56 天输注后长达 28 天评估稳态 PK 参数。还评估了在 28 天内维持谷值 FXIII 活性水平≥5%的治疗效果和安全性参数。14 名患者接受了 FXIII 浓缩物(人源),13 名完成了研究。输注后,FXIII 活性水平升至无先天性 FXIII 缺乏症患者的水平范围内,未达到超治疗水平。所有患者在所有基线后访视时,未进行基线调整的谷值 FXIII 活性水平维持在 10%或以上。稳态 PK 参数进行了基线调整;输注后 1.72 小时时最大 FXIII 活性为 87.7%,随后降至最低 5.0%。半衰期为 6.6 天。FXIII 浓缩物(人源)总体耐受性良好。两名患者发生了可能与治疗相关的不良事件。没有血栓栓塞、病毒传播、出血事件或治疗相关超敏反应的报告。这些发现支持每 28 天使用 40 IU/kg(人源)的 FXIII 浓缩物作为先天性 FXIII 缺乏症儿童和成人常规长期预防的合适方案。