Berntorp E, Dolan G, Hay C, Linari S, Santagostino E, Tosetto A, Castaman G, Álvarez-Román M T, Parra Lopez R, Oldenburg J, Albert T, Scholz U, Holmström M, Schved J-F, Trossaërt M, Hermans C, Boban A, Ludlam C, Lethagen S
Clinical Coagulation Research Unit, Lund University, Malmö, Sweden.
St Thomas' Hospital Haemophilia Centre, St Thomas' Hospital, London, UK.
Haemophilia. 2017 Jan;23(1):105-114. doi: 10.1111/hae.13111. Epub 2016 Oct 20.
Haemophilia treatment varies significantly between individuals, countries and regions and details of bleed rates, factor consumption and injection frequency are often not available.
To provide an overview of the FVIII/FIX treatment practice and outcome for patients with haemophilia A (HA) or haemophilia B (HB) across Europe.
Non-interventional, 12-month retrospective study where anonymized data were retrieved from haemophilia centres/registers in Belgium, France, Germany, Italy, Spain, Sweden and the United Kingdom. Male patients (all ages) receiving coagulation factor treatment 24 months prior to the study, with basal FVIII/FIX levels ≤5 IU dL , without inhibitors, were included. Data were summarized descriptively.
In total, 1346 patients with HA and 312 with HB were included in the analysis; 75% and 57% had severe disease (FVIII/FIX < 1 IU dL ) respectively. Prophylaxis was most common for severe haemophilia, especially for children, whereas on-demand treatment was more common for moderate haemophilia in most countries. The mean (SD) prescribed prophylactic treatment ranged from 67.9 (30.4) to 108.4 (78.1) (HA) and 32.3 (10.2) to 97.7 (32.1) (HB) IU kg per week, across countries. Most patients on prophylaxis were treated ≥3 times/week (HA) or two times/week (HB). The median annual bleeding rate (ABR) for patients on prophylaxis ranged from 1.0 to 4.0 for severe HA, and from 1.0 to 6.0 for severe HB, while those with moderate haemophilia generally had slightly higher ABRs. Median ABRs for on-demand-treated severe HA ranged from 4.5 to 18.0, and for HB, 1.5 to 14.0.
Treatment practice varied greatly between centres and countries and patients treated on-demand and prophylactically both experienced bleeds, emphasizing the need for further optimization of care.
血友病的治疗在个体、国家和地区之间存在显著差异,出血率、凝血因子消耗量和注射频率的详细信息往往难以获取。
概述欧洲A 型血友病(HA)或B 型血友病(HB)患者的FVIII/FIX 治疗实践及结果。
进行一项为期12 个月的非干预性回顾性研究,从比利时、法国、德国、意大利、西班牙、瑞典和英国的血友病中心/登记处获取匿名数据。纳入研究前24 个月接受凝血因子治疗、基础FVIII/FIX 水平≤5 IU/dL 且无抑制剂的男性患者(各年龄段)。数据进行描述性汇总。
分析共纳入1346 例HA 患者和312 例HB 患者;分别有75%和57%患有严重疾病(FVIII/FIX < 1 IU/dL)。预防治疗在重度血友病患者中最为常见,尤其是儿童,而在大多数国家,按需治疗在中度血友病患者中更为常见。各国规定的预防性治疗平均(标准差)剂量范围为67.9(30.4)至108.4(78.1)(HA)以及32.3(10.2)至97.7(32.1)(HB)IU/kg 每周。大多数接受预防治疗的患者每周接受治疗≥3 次(HA)或每周两次(HB)。接受预防治疗的重度HA 患者的年出血率(ABR)中位数为1.0 至4.0,重度HB 患者为1.0 至6.0,而中度血友病患者的ABR 通常略高。按需治疗的重度HA 患者的ABR 中位数为4.5 至18.0,HB 患者为1.5 至14.0。
各中心和国家之间的治疗实践差异很大,按需治疗和预防治疗的患者均有出血情况,这凸显了进一步优化治疗的必要性。