Real-world data shows that breakthrough bleeds continue to happen1,2
The risk of breakthrough bleeds persists, despite therapy with emicizumab1
Study design: An observational study was conducted that analyzed breakthrough bleeding patterns in patients with severe hemophilia A who were prophylactically treated with emicizumab. The study included 70 patients (42 with hemophilia A and 28 with hemophilia A with inhibitors) who completed at least 18 months of follow-up.1
In a real-world study of 70 hemophilia A patients:
51% of patients treated with emicizumab had at least 1 breakthrough spontaneous bleeding episode1
(n=36)
80% of spontaneous bleeds were joint bleeds1
The odds of bleeding while on emicizumab increased by a factor of 1.029 (P=0.034) for every 1 year of age1,a
aWithin the 18-month period of emicizumab treatment.
Untreated bleeds persist in patients with hemophilia A with inhibitors2
Study design: A global observational study collected data on people with hemophilia A treated with the standard therapy at the time. The study included adults/adolescents (age ≥12 years) with FVIII inhibitors, children (aged <12 years) with FVIII inhibitors, and adults/adolescents without FVIII inhibitors.2
In a study of 221 hemophilia A patients:
40% of bleeds in people with FVIII inhibitors were untreated2
(n=815)
~55% of untreated bleeds in adults/adolescents with FVIII inhibitors treated with emicizumab were in joints2,b
(n=362)
63% of untreated bleeds in adults/adolescents with FVIII inhibitors were spontaneous bleeds2
bIn adults/adolescents with FVIII inhibitors, untreated bleeds in joints were distributed among the knee (28.7%), elbow (21.0%), ankle (15.7%), and other locations (34.6%). In children with FVIII inhibitors, 7.1% of untreated bleeds were in joints, with these most commonly located in the knee (63.6%).2
When and how would you decide to treat a potential breakthrough bleed?
An illustrative patient scenario may help you make the decision.
References:
- Levy-Mendelovich S, Brutman-Barazani T, Budnik I, et al. Real-world data on bleeding patterns of hemophilia A patients treated with emicizumab. J Clin Med. 2021;10(19):4303.
- Callaghan MU, Asikanius E, Lehle M, et al. Untreated bleeds in people with hemophilia A in a noninterventional study and intrapatient comparison after initiating emicizumab in HAVEN 1-3. Res Pract Thromb Haemost. 2022;6(6):e12782.