title: Haemostatic efficacy and safety of bolus and continuous infusion of recombinant factor VIIa are comparable in haemophilia patients with inhibitors undergoing major surgery. Results from an open-label, randomized, multicenter trial.
abstract: Bolus infusion (BI) recombinant factor VIIa (rFVIIa) administration is safe and effective in the surgical management of haemophilia patients with inhibitors but has not been compared directly with continuous infusion (CI). We conducted an open-label, randomized, multicenter trial comparing the efficacy and safety of rFVIIa administered by BI or CI for the surgical management of haemophilia A or B patients with inhibitors to FVIII or FIX. Safety was compared with that of a control group of non-inhibitor patients receiving FVIII or FIX concentrates for major surgery. All inhibitor subjects received an initial bolus dose of 90 microg/kg rFVIIa and were then randomly assigned to BI (n = 12) or CI (n = 12). The BI group received 90 microg/kg rFVIIa every two hours (h) during surgery through day 5, then every four hours for days 6-10. The CI group received 50 microg/kg/h rFVIIa through day 5, then 25 mg/kg/h for days 6-10. The control group (n = 12) received FVIII or FIX per institutional protocols. Twenty-two major surgeries included orthopedic procedures on the knee (n = 13), hip (n = 3), and abdominal/pelvis procedures (n = 4). One patient with an autoimmune FVIII inhibitor randomized to the BI arm was excluded from efficacy analysis. Haemostatic efficacy of rFVIIa in each group was comparable: effective in 8/11 and 9/12 subjects in the BI and CI arms, respectively, and ineffective in three subjects in each arm. Serious adverse events were related to continued or increased bleeding. In conclusion, haemostatic efficacy and safety of BI and CI of rFVIIa are comparable for the surgical management of haemophilia subjects with inhibitors.
authors.affiliation: Comprehensive Hemophilia Center, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. pruthi.rajiv@mayo.edu
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Pruthi
authors.forename: Prasad
authors.initials: P
authors.lastname: Mathew
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Valentino
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sumner
authors.forename: Stephanie
authors.initials: S
authors.lastname: Seremetis
authors.forename: W Keith
authors.initials: WK
authors.lastname: Hoots
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019774:Blood Coagulation Factor Inhibitors / Q000737:chemistry; D002648:Child; D015942:Factor VIIa / Q000737:chemistry* / Q000627:therapeutic use; D006467:Hemophilia A / Q000188:drug therapy; D002836:Hemophilia B / Q000188:drug therapy; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000737:chemistry / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019774:Blood Coagulation Factor Inhibitors; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa