TY - JOUR
T1 - Current Choices and Management of Treatment in Persons with Severe Hemophilia A without Inhibitors: A Mini‐Delphi Consensus
AU - Coppola, Antonio
AU - Franchini, Massimo
AU - Pappagallo, Giovanni
AU - Borchiellini, Alessandra
AU - De Cristofaro, Raimondo
AU - Molinari, Angelo Claudio
AU - Santoro, Rita Carlotta
AU - Santoro, Cristina
AU - Tagliaferri, Annarita
PY - 2022
Y1 - 2022
N2 - Background. Regular treatment to prevent bleeding and consequent joint deterioration (prophylaxis) is the standard of care for persons with severe hemophilia A, traditionally based on intravenous infusions of the deficient clotting FVIII concentrates (CFCs). In recent years, extended half‐life (EHL) CFCs and the non‐replacement agent emicizumab, subcutaneously administered, have reduced the treatment burden. Methods. To compare and integrate the opinions on the different therapies available, eight hemophilia specialists were involved in drafting items of interest and relative statements through the Estimate‐Talk‐Estimate (ETE) method (“mini‐Delphi”), in this way reaching consensus. Results. Eighteen items were identified, then harmonized to 10, and a statement was generated for each. These statements highlight the importance of personalized prophylaxis regimens. CFCs, particularly EHL products, seem more suitable for this, despite the challenging intravenous (i.v.) administration. Limited real‐world experience, particularly in some clinical settings, and the lack of evidence on long‐term safety and efficacy of non‐replacement agents, require careful individual risk/benefit assessment and multidisciplinary data collection. Conclusions. The increased treatment options extend the opportunities of personalized prophylaxis, the mainstay of modern management of hemophilia. Close, long‐term clinical and laboratory follow‐up of patients using newer therapeutic approaches by specialized hemophilia treatment centers is needed.
AB - Background. Regular treatment to prevent bleeding and consequent joint deterioration (prophylaxis) is the standard of care for persons with severe hemophilia A, traditionally based on intravenous infusions of the deficient clotting FVIII concentrates (CFCs). In recent years, extended half‐life (EHL) CFCs and the non‐replacement agent emicizumab, subcutaneously administered, have reduced the treatment burden. Methods. To compare and integrate the opinions on the different therapies available, eight hemophilia specialists were involved in drafting items of interest and relative statements through the Estimate‐Talk‐Estimate (ETE) method (“mini‐Delphi”), in this way reaching consensus. Results. Eighteen items were identified, then harmonized to 10, and a statement was generated for each. These statements highlight the importance of personalized prophylaxis regimens. CFCs, particularly EHL products, seem more suitable for this, despite the challenging intravenous (i.v.) administration. Limited real‐world experience, particularly in some clinical settings, and the lack of evidence on long‐term safety and efficacy of non‐replacement agents, require careful individual risk/benefit assessment and multidisciplinary data collection. Conclusions. The increased treatment options extend the opportunities of personalized prophylaxis, the mainstay of modern management of hemophilia. Close, long‐term clinical and laboratory follow‐up of patients using newer therapeutic approaches by specialized hemophilia treatment centers is needed.
KW - Consensus
KW - Emicizumab
KW - Extended‐half‐life factor VIII concentrates
KW - Factor VIII concentrates
KW - Hemophilia A
KW - Mini‐Delphi
KW - Non‐replacement therapy
KW - Prophylaxis
KW - Consensus
KW - Emicizumab
KW - Extended‐half‐life factor VIII concentrates
KW - Factor VIII concentrates
KW - Hemophilia A
KW - Mini‐Delphi
KW - Non‐replacement therapy
KW - Prophylaxis
UR - http://hdl.handle.net/10807/205662
U2 - 10.3390/jcm11030801
DO - 10.3390/jcm11030801
M3 - Article
SN - 2077-0383
VL - 11
SP - 801
EP - 810
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
ER -