Key Issues In Inhibitor Management In Patients With Haemophilia

[No abstract available]12SUPPL.1s319s329Bray, G.L., Gomperts, E.D., Courter, S., A multicenter study of recombinant factor VIII (recombinate): Safety, efficacy, and inhibitor risk in previously untreated patients with hemophilia A. The recombinate study group (1994) Blood, 83, pp. 2428-2435Lusher, J.M., Arkin, S., Abildgaard, C.F., Schwartz, R.S., Recombinant factor VIII for the treatment of previously untreated patients with hemophilia A. Safety, efficacy, and development of inhibitors. 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(2011) Haemophilia, 17, pp. e849-e857Dimichele, D., Negrier, C., A retrospective postlicensure survey of FEIBA efficacy and safety (2006) Haemophilia, 12, pp. 352-362Valentino, L.A., Assessing the benefits of FEIBA prophylaxis in haemophilia patients with inhibitors (2010) Haemophilia, 16, pp. 263-271Brackmann, H.H., Schwaab, R., Effenberger, W., Hemophilia treatment. Side effects during immune tolerance induction (2000) Haematologica, 85, pp. 75-77Young, G., McDaniel, M., Nugent, D.J., Prophylactic recombinant factor VIIa in haemophilia patients with inhibitors (2005) Haemophilia, 11, pp. 203-207Morfini, M., Auerswald, G., Kobelt, R.A., Prophylactic treatment of haemophilia patients with inhibitors: Clinical experience with recombinant factor VIIa in European Haemophilia Centres (2007) Haemophilia, 13, pp. 502-507Jimenez-Yuste, V., Alvarez, M.T., Martin-Salces, M., Prophylaxis in 10 patients with severe haemophilia A and inhibitor: Different approaches for different clinical situations (2009) Haemophilia, 15, pp. 203-209Young, G., Auerswald, G., Jimenez-Yuste, V., PRO-PACT: Retrospective observational study on the prophylactic use of recombinant factor VIIa in hemophilia patients with inhibitors (2012) Thromb ResGupta, S., Siddiqi, A.E., Soucie, J.M., The effect of secondary prophylaxis versus episodic treatment on the range of motion of target joints in patients with haemophilia (2013) Br J Haematol, 161, pp. 424-433Carcao, M., Lambert, T., Prophylaxis in haemophilia with inhibitors: Update from international experience (2010) Haemophilia, 16 (SUPPL. 2), pp. 16-23Dimichele, D.M., Hoots, W.K., Pipe, S.W., International workshop on immune tolerance induction: Consensus recommendations (2007) Haemophilia, 13 (SUPPL. 1), pp. 1-22Lenk, H., The German Registry of immune tolerance treatment in hemophilia-1999 update (2000) Haematologica, 85, pp. 45-47Brackmann, H.H., Oldenburg, J., Schwaab, R., Immune tolerance for the treatment of factor VIII inhibitors-twenty years' 'bonn protocol' (1996) Vox Sang, 70 (SUPPL. 1), pp. 30-35Oldenburg, J., Schwaab, R., Brackmann, H.H., Induction of immune tolerance in haemophilia A inhibitor patients by the 'Bonn Protocol': Predictive parameter for therapy duration and outcome (1999) Vox Sang, 77 (SUPPL. 1), pp. 49-54Mauser-Bunschoten, E.P., Nieuwenhuis, H.K., Roosendaal, G., Van Den Berg, H.M., Low-dose immune tolerance induction in hemophilia A patients with inhibitors (1995) Blood, 86, pp. 983-988Indications and recommended doses for treating patients with factor VIII inhibitors in hemophilia A (2008) Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivatives. Executive Committee of the German Medical Association on the Recommendation of the Scientific Advisory Board, p. 91. , German Medical AssociationCoppola, A., Margaglione, M., Santagostino, E., Factor VIII gene (F8) mutations as predictors of outcome in immune tolerance induction of hemophilia A patients with highresponding inhibitors (2009) J Thromb Haemost, 7, pp. 1809-1815Freiburghaus, C., Berntorp, E., Ekman, M., Immunoadsorption for removal of inhibitors: Update on treatments in Malmo-Lund between 1980 and 1995 (1998) Haemophilia, 4, pp. 16-20Auerswald, G., Spranger, T., Brackmann, H.H., The role of plasmaderived factor VIII/von Willebrand factor concentrates in the treatment of hemophilia A patients (2003) Haematologica, 88, pp. EREP05Dimichele, D., The North American Immune Tolerance Registry: Contributions to the thirty-year experience with immune tolerance therapy (2009) Haemophilia, 15, pp. 320-328Mariani, G., Ghirardini, A., Bellocco, R., Immune tolerance in hemophilia-principal results from the International Registry. Report of the factor VIII and IX Subcommittee (1994) Thromb Haemost, 72, pp. 155-158Mariani, G., Kroner, B., Immune tolerance in hemophilia with factor VIII inhibitors: Predictors of success (2001) Haematologica, 86, pp. 1186-1193Franchini, M., Mannucci, P.M., Inhibitors of propagation of coagulation (factors VIII, IX and XI): A review of current therapeutic practice (2011) Br J Clin Pharmacol, 72, pp. 553-562Greninger, D.A., Saint-Remy, J.M., Jacquemin, M., The use of factor VIII/von Willebrand factor concentrate for immune tolerance induction in haemophilia A patients with high-titre inhibitors: Association of clinical outcome with inhibitor epitope profile (2008) Haemophilia, 14, pp. 295-302Gringeri, A., Musso, R., Mazzucconi, M.G., Immune tolerance induction with a high purity von Willebrand factor/VIII complex concentrate in haemophilia A patients with inhibitors at high risk of a poor response (2007) Haemophilia, 13, pp. 373-379Kurth, M.A., Dimichele, D., Sexauer, C., Immune tolerance therapy utilizing factor VIII/von Willebrand factor concentrate in haemophilia A patients with high titre factor VIII inhibitors (2008) Haemophilia, 14, pp. 50-55Astermark, J., Morado, M., Rocino, A., Current European practice in immune tolerance induction therapy in patients with haemophilia and inhibitors (2006) Haemophilia, 12, pp. 363-371Garvey, B., Rituximab in the treatment of autoimmune haematological disorders (2008) Br J Haematol, 141, pp. 149-169Franchini, M., Mengoli, C., Lippi, G., Immune tolerance with rituximab in congenital haemophilia with inhibitors: A systematic literature review based on individual patients' analysis (2008) Haemophilia, 14, pp. 903-912Sorensen, B., Johansen, P., Christiansen, K., Whole blood coagulation thrombelastographic profiles employing minimal tissue factor activation (2003) J Thromb Haemost, 1, pp. 551-558De Paula, E.V., Kavakli, K., Mahlangu, J., Recombinant factor VIIa analog (vatreptacog alfa [activated]) for treatment of joint bleeds in hemophilia patients with inhibitors: A randomized controlled trial (2012) J Thromb Haemost, 10, pp. 81-89Holmberg, H.L., Lauritzen, B., Tranholm, M., Ezban, M., Faster onset of effect and greater efficacy of NN1731 compared with rFVIIa, aPCC and FVIII in tail bleeding in hemophilic mice (2009) J Thromb Haemost, 7, pp. 1517-1522Moss, J., Scharling, B., Ezban, M., Moller Sorensen, T., Evaluation of the safety and pharmacokinetics of a fast-acting recombinant FVIIa analogue, NN1731, in healthy male subjects (2009) J Thromb Haemost, 7, pp. 299-305Sorensen, B., Persson, E., Ingerslev, J., Factor VIIa analogue (V158D/E296V/M298Q-FVIIa) normalises clot formation in whole blood from patients with severe haemophilia A (2007) Br J Haematol, 137, pp. 158-165Allen, G.A., Persson, E., Campbell, R.A., A variant of recombinant factor VIIa with enhanced procoagulant and antifibrinolytic activities in an in vitro model of hemophilia (2007) Arterioscler Thromb Vasc Biol, 27, pp. 683-689Mahlangu, J.N., Coetzee, M.J., Laffan, M., Phase I, randomized, double-blind, placebo-controlled, single-dose escalation study of the rFVIIa variant BAY 86-6150 in hemophilia (2012) J Thromb Haemost, 10, pp. 773-780Karpf, D.M., Sorensen, B.B., Hermit, M.B., Prolonged halflife of glycoPEGylated rFVIIa variants compared to native rFVIIa (2011) Thromb Res, 128, pp. 191-195Sen, P., Ghosh, S., Ezban, M., Effect of glycoPEGylation on factor VIIa binding and internalization (2010) Haemophilia, 16, pp. 339-348Toschi, V., OBI-1, porcine recombinant factor VIII for the potential treatment of patients with congenital hemophilia A and alloantibodies against human Factor VIII (2010) Curr Opin Mol Ther, 12, pp. 617-625Parker, E.T., Craddock, H.N., Barrow, R.T., Lollar, P., Comparative immunogenicity of recombinant B domain-deleted porcine factor VIII and Hyate: C in hemophilia A mice presensitized to human factor VIII (2004) J Thromb Haemost, 2, pp. 605-611Kempton, C.L., Abshire, T.C., Deveras, R.A., Pharmacokinetics and safety of OBI-1, a recombinant B domain-deleted porcine factor VIII, in subjects with haemophilia A (2012) Haemophilia, 18, pp. 798-804Abshire, T.C., Brackmann, H.H., Scharrer, I., Sucrose formulated recombinant human antihemophilic factor VIII is safe and efficacious for treatment of hemophilia A in home therapy-International Kogenate-FS Study Group (2000) Thromb Haemost, 83, pp. 811-816Tarantino, M.D., Collins, P.W., Hay, C.R., Clinical evaluation of an advanced category antihaemophilic factor prepared using a plasma/albumin-free method: Pharmacokinetics, efficacy, and safety in previously treated patients with haemophilia A (2004) Haemophilia, 10, pp. 428-437Young, G., Cooper, D.L., Gut, R.Z., Dosing and effectiveness of recombinant activated factor VII (rFVIIA) in congenital haemophilia with inhibitors by bleed type and location: The experience of the Haemophilia and Thrombosis Research Society (HTRS) Registry (2004-2008) (2012) Haemophilia, 18, pp. 990-99

Cognitive and psychological profiles in treatment compliance: a study in an elderly population with hemophilia

Elderly patients with hemophilia have to face new challenges linked to concomitant pathologies and concurrent use of different treatments. In order to promote optimal care in the elderly hemophilia population, this study is aimed to analyze treatment compliance in relation to the presence of comorbidities and the role of potential determinants that can affect compliance (positively or negatively), including health-related quality of life, cognitive decline, and sociodemographic parameters (eg, living situation, partnership, presence of caregivers). This will be an observational study of elderly patients with hemophilia (aged >60 years). Patients will be interviewed during their routine medical visits. The data interview will pertaining to several dimension of treatment management. This study will detect more vulnerable patients with special care needs and will highlight psychological factors that should be considered for future psychosocial interventions

A recurrent F8 mutation (c.6046C>T) causing hemophilia A in 8% of northern Italian patients : evidence for a founder effect

Hemophilia A is a heterogeneous hemorrhagic disorder caused by a large number of mutations. Recurrent mutations are rare, except intron 22 and intron 1 inversions. The substitution of a cytosine to a thymine at nucleotide 6046 in F8 gene was identified in a group of Italian patients affected by hemophilia A from a specific region of Northern Italy with a prevalence of 7.6%. This F8 variant was the second most frequent mutation in our cohort, after the intron 22 inversion. The identification of the same mutation in a restricted population gets to suppose the existence of a founder effect. Intragenic and extragenic polymorphic markers were tested to assess this assumption. A peculiar haplotype in linkage disequilibrium with this recurrent mutation (c.6046C>T) was identified in 71% of patients, supporting a founder effect. This distinctive haplotype was not identified in a control group (Fisher's exact test, P\ua0<\ua00.0001), coming from the same geographic region. These data strongly suggested the presence of a founder effect, supporting the existence of a single mutation event. Using DMLE+2.3 software and the mathematical approach described by Bengtsson and Thomson, the inferred age of this mutation is supposed to be about 2325\ua0years (95% CI: 904-5081) ago

The Science of Sungrazers, Sunskirters, and Other Near-Sun Comets

This review addresses our current understanding of comets that venture close to the Sun, and are hence exposed to much more extreme conditions than comets that are typically studied from Earth. The extreme solar heating and plasma environments that these objects encounter change many aspects of their behaviour, thus yielding valuable information on both the comets themselves that complements other data we have on primitive solar system bodies, as well as on the near-solar environment which they traverse. We propose clear definitions for these comets: We use the term near-Sun comets to encompass all objects that pass sunward of the perihelion distance of planet Mercury (0.307 AU). Sunskirters are defined as objects that pass within 33 solar radii of the Sun’s centre, equal to half of Mercury’s perihelion distance, and the commonly-used phrase sungrazers to be objects that reach perihelion within 3.45 solar radii, i.e. the fluid Roche limit. Finally, comets with orbits that intersect the solar photosphere are termed sundivers. We summarize past studies of these objects, as well as the instruments and facilities used to study them, including space-based platforms that have led to a recent revolution in the quantity and quality of relevant observations. Relevant comet populations are described, including the Kreutz, Marsden, Kracht, and Meyer groups, near-Sun asteroids, and a brief discussion of their origins. The importance of light curves and the clues they provide on cometary composition are emphasized, together with what information has been gleaned about nucleus parameters, including the sizes and masses of objects and their families, and their tensile strengths. The physical processes occurring at these objects are considered in some detail, including the disruption of nuclei, sublimation, and ionisation, and we consider the mass, momentum, and energy loss of comets in the corona and those that venture to lower altitudes. The different components of comae and tails are described, including dust, neutral and ionised gases, their chemical reactions, and their contributions to the near-Sun environment. Comet-solar wind interactions are discussed, including the use of comets as probes of solar wind and coronal conditions in their vicinities. We address the relevance of work on comets near the Sun to similar objects orbiting other stars, and conclude with a discussion of future directions for the field and the planned ground- and space-based facilities that will allow us to address those science topics

The factor VIII treatment history of non-severe hemophilia A

Background: In patients with non-severe hemophilia A, we lack detailed knowledge on the timing of treatment with factor VIII (FVIII) concentrates. This knowledge could provide information about the expected treatment timing in patients with severe hemophilia A treated with non-replacement therapies. Objective: To assess the FVIII treatment history in patients with non-severe hemophilia A. Methods: Patients with non-severe hemophilia (baseline FVIII activity [FVIII:C] 2-40 IU/dL) were included from the INSIGHT study. The primary outcome was median age at first FVIII exposure (ED1). In a subgroup of patients for whom more detailed information was available, we analyzed the secondary outcomes: median age at first 20 EDs, annualized bleeding rate for all bleeds (ABR), joint bleeds (AJBR), and major spontaneous bleeds (ASmBR). Results: In the total cohort (n = 1013), median baseline FVIII activity was 8 IU/dL (interquartile range [IQR] 4-15) and the median age at ED1 was 3.7 years (IQR 1.4-7.7). Median age at ED1 rose from 2.5 years (IQR 1.2-5.7) in patients with FVIII:C 2-5 IU/dL to 9.7 years (IQR 4.8-16.0) in patients with FVIII:C 25-40 IU/dL. In the subgroup (n = 104), median age at ED1, ED5, ED10, and ED20 was 4.0 years (IQR 1.4-7.6), 5.6 years (IQR 2.9-9.3), 7.5 years (IQR 4.4-11.3), and 10.2 years (IQR 6.5-14.2), respectively. Median ABR, AJBR, and ASmBR were 1.1 (IQR 0.5-2.6), 0.3 (IQR 0.1-0.7), and 0 (IQR 0-0), respectively. Conclusion: This study demonstrates that in non-severe hemophilia A, the age at first FVIII exposure increases with baseline FVIII:C and that major spontaneous bleeds rarely occur

Treatment-related risk factors for inhibitor development in non-severe hemophilia A after 50 cumulative exposure days: a case-control study

Background Non-severe hemophilia A patients have a life-long inhibitor risk. Yet, no studies have analyzed risk factors for inhibitor development after 50 factor VIII (FVIII) exposure days (EDs). Objectives This case-control study investigated treatment-related risk factors for inhibitor development in non-severe hemophilia A and assessed whether these risk factors were different for early versus late inhibitor development. Patients/Methods Non-severe hemophilia A patients (FVIII:C 2%-40%) were selected from the INSIGHT study. Inhibitor-positive patients were defined as early (50EDs) cases and matched to 1-4 inhibitor-negative controls by year of birth, cumulative number of EDs, and center/country. We investigated treatment intensity during the last 10 EDs prior to inhibitor development. Intensive treatment was defined as: surgery, peak treatment (10 consecutive EDs), and high mean FVIII dose (>45 IU/kg/ED). Odds ratios (OR) were calculated by logistic regression. Results Of 2709 patients, we analyzed 63 early and 26 late cases and 195 and 71 respectively matched controls. Peak treatment was associated with early and late inhibitor risk (crude OR 1.8, 95% confidence interval [CI] 1.0-3.4; 4.0, 95%CI 1.1-14.3). This association was slightly less pronounced after adjustment for mean FVIII dose. High mean FVIII dose was also associated with early and late inhibitor risk (crude OR 2.8, 95%CI 1.5-5.1; 4.5, 95%CI 1.2-16.6). Surgery increased inhibitor risk for early cases. This was less pronounced for late cases. Conclusions Our findings suggest that intensive FVIII treatment remains a risk factor for inhibitor development in non-severe hemophilia A after more than 50 EDs. Therefore, persistent caution is required throughout the life-time treatment course.Clinical epidemiolog

Transethnic meta-analysis of rare coding variants in PLCG2, ABI3, and TREM2 supports their general contribution to Alzheimer's disease

Rare coding variants in TREM2, PLCG2, and ABI3 were recently associated with the susceptibility to Alzheimer's disease (AD) in Caucasians. Frequencies and AD-associated effects of variants differ across ethnicities. To start filling the gap on AD genetics in South America and assess the impact of these variants across ethnicity, we studied these variants in Argentinian population in association with ancestry. TREM2 (rs143332484 and rs75932628), PLCG2 (rs72824905), and ABI3 (rs616338) were genotyped in 419 AD cases and 486 controls. Meta-analysis with European population was performed. Ancestry was estimated from genome-wide genotyping results. All variants show similar frequencies and odds ratios to those previously reported. Their association with AD reach statistical significance by meta-analysis. Although the Argentinian population is an admixture, variant carriers presented mainly Caucasian ancestry. Rare coding variants in TREM2, PLCG2, and ABI3 also modulate susceptibility to AD in populations from Argentina, and they may have a European heritage.Acknowledgements: This work was supported by grants from the International Society for Neurochemistry (ISN) and Alexander von Humboldt Foundation (to M.C.D.); Agencia Nacional de Promoción Científica y Tecnológica (PBIT/09 2013, PICT-2015-0285 and PICT-2016-4647 to L.M.; PICT-2014-1537 to M.C.D.); GENMED Labex and JPND PERADES grant; and JPND EADB grant (German Federal Ministry of Education and Research, BMBF: 01ED1619A)

Scholarly publishing depends on peer reviewers

The peer-review crisis is posing a risk to the scholarly peer-reviewed journal system. Journals have to ask many potential peer reviewers to obtain a minimum acceptable number of peers accepting reviewing a manuscript. Several solutions have been suggested to overcome this shortage. From reimbursing for the job, to eliminating pre-publication reviews, one cannot predict which is more dangerous for the future of scholarly publishing. And, why not acknowledging their contribution to the final version of the article published? PubMed created two categories of contributors: authors [AU] and collaborators [IR]. Why not a third category for the peer-reviewer?Scopu

Measurement of CP asymmetries and branching fraction ratios of B− decays to two charm mesons

The $CP$ asymmetries of seven $B^-$ decays to two charm mesons are measured using data corresponding to an integrated luminosity of $9\text{fb}^{-1}$ of proton-proton collisions collected by the LHCb experiment. Decays involving a $D^{*0}$ or $D^{*-}_s$ meson are analysed by reconstructing only the $D^0$ or $D^-_s$ decay products. This paper presents the first measurement of $\mathcal{A}^{CP}(B^- \rightarrow D^{*-}_s D^0)$ and $\mathcal{A}^{CP}(B^- \rightarrow D^{-}_s D^{*0})$, and the most precise measurement of the other five $CP$ asymmetries. There is no evidence of $CP$ violation in any of the analysed decays. Additionally, two ratios between branching fractions of selected decays are measured.The CP asymmetries of seven B$^{−}$ decays to two charm mesons are measured using data corresponding to an integrated luminosity of 9 fb$^{−1}$ of proton-proton collisions collected by the LHCb experiment. Decays involving a D$^{*0}$ or ${D}_s^{\ast -}$ meson are analysed by reconstructing only the D$^{0}$ or ${D}_s^{-}$ decay products. This paper presents the first measurement of $\mathcal{A} ^{CP}$(B$^{−}$→${D}_s^{\ast -}$D$^{0}$) and $\mathcal{A} ^{CP}$(B$^{−}$→${D}_s^{-}$D$^{∗0}$), and the most precise measurement of the other five CP asymmetries. There is no evidence of CP violation in any of the analysed decays. Additionally, two ratios between branching fractions of selected decays are measured.[graphic not available: see fulltext]The $CP$ asymmetries of seven $B^-$ decays to two charm mesons are measured using data corresponding to an integrated luminosity of $9\text{ fb}^{-1}$ of proton-proton collisions collected by the LHCb experiment. Decays involving a $D^{*0}$ or $D^{*-}_s$ meson are analysed by reconstructing only the $D^0$ or $D^-_s$ decay products. This paper presents the first measurement of $\mathcal{A}^{CP}(B^- \rightarrow D^{*-}_s D^0)$ and $\mathcal{A}^{CP}(B^- \rightarrow D^{-}_s D^{*0})$, and the most precise measurement of the other five $CP$ asymmetries. There is no evidence of $CP$ violation in any of the analysed decays. Additionally, two ratios between branching fractions of selected decays are measured