Objective:
Highlight the importance of collaboration in addition to dose, frequency, and PK data to personalize regimens in order to minimize bleed rates in Hemophilia A patients on prophylaxis.
Methods:
Dose and bleed data was collected and reviewed from January 1, 2015 through March 31, 2015 for all moderate to severe hemophilia A patients on prophylaxis regimens with traditional acting products in 2 regional bleeding disorder hubs. Units per kilogram per dose, units per kilogram per week, and spontaneous bleed rate were calculated from data. If reporter was unsure of bleed origin, it was counted as a spontaneous bleed.
Results:
Region X had 34 and Region Y had 40 patients that met the inclusion criteria for review. The average dispensed dose for Region X was 43.89 units per kg per dose. For Region Y, it was 35.47 units per kg per dose; a difference of 8.42 units per kg per dose. Due to varying frequency orders, regimens were further calculated in units per kg per week. Region X’s average was 121.38 units per kg per week and Region Y’s was 96.98; a difference of 24.4 units per kg per week. Patients in Region X reported zero spontaneous bleeds during the study period. Patients in Region Y reported 16 spontaneous bleeds from 12 unique patients. Of these patients, target joints were cited as contributing factors with 8 of the 16 bleeds. When appropriate, prescribers were notified and collaboration on regimen adjustments was made. Pharmacokinetic data was inconsistently available.
Conclusion:
Zero spontaneous bleeds should be the goal for hemophilia A patients on prophylaxis. Small changes in dose or frequency can make significant changes in outcomes. Many variables impact bleed rates and doses vary widely. There is the potential for refining dosing algorithms based on a more personalized approach that includes close and careful monitoring of trough levels, patients activity level, bleed pattern and response to changes in treatment plans. This individualized approach would require collaboration between patients, prescribers, and pharmacies. Such an approach can have huge and long-term beneficial effects on pharmacoeconomic, clinical, and quality of life outcomes. Data collected from this study may further assist pharmacists with influencing prescribers to consider pharmacist obtained bleed data and/or obtain and provide PK data so they can assist with regimen adjustment recommendations based on their assessments. With increasing payer pressure and the introduction of longer acting products, this collaboration will become even more imperative.