Quality of life in a large multinational haemophilia B cohort (The B-Natural study) – Unmet needs remain

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  • Erik Berntorp
  • Petra LeBeau
  • Margaret V. Ragni
  • Munira Borhany
  • Yasmina L. Abajas
  • Michael D. Tarantino
  • Katharina Holstein
  • Stacy E. Croteau
  • Raina Liesner
  • Cristina Tarango
  • Manuela Carvalho
  • Catherine McGuinn
  • Christine L. Kempton
  • Christoph Bidlingmaier
  • Alice Cohen
  • Johannes Oldenburg
  • Susan Kearney
  • Christine Knoll
  • Philip Kuriakose
  • Suchitra Acharya
  • Ulrike M. Reiss
  • Roshni Kulkarni
  • Michelle Witkop
  • Stefan Lethagen
  • Rebecca Krouse
  • Amy D. Shapiro
  • Jan Astermark

Introduction: The B-Natural study is a multicentre, multinational, observational study of haemophilia B (HB) designed to increase understanding of clinical manifestations, treatment and quality of life (QoL). Aim: To characterise and compare QoL in HB across disease severity groups and individuals with inhibitors to identify gaps in treatment. Methods: A total of 224 individuals from 107 families were enrolled from a total of 24 centres in North America (n = 16), Europe (n = 7) and Asia (n = 1). Of these, 68 (30.4%) subjects had severe (<1 IU/dL), median age 15.6 years, 114 (50.9%) moderate (1–5 IU/dL), age 13.3 years, and 42 (18.8%) mild (>5–< 40 IU/dL), age 12.1 years, disease. Twenty-nine participants had inhibitors or a history of inhibitors. Three versions of the EQ-5D instrument were used as a measure of QoL: proxy (ages 4–7), youth (ages 8–15) and self (age 16+). Each instrument included a visual analogue scale ranging from 100 (best health) to 0 (worst health) to assess current day's health (EQ VAS). Range-of-motion (ROM) for elbows, knees and ankles was assessed using a four-point scale, from which a composite score was calculated. Results: In all severity groups, a proportion of subjects showed less than optimal QoL. The majority of the mild and moderate severe participants reported a normal EQ-5D health profile (79% and 72%, respectively), whereas about half (47%) of the severe participants and only 13% of the inhibitor participants reported this profile. Conclusion: The B-Natural study reveals impacted QoL in all disease severities of HB including those with inhibitors. Unmet needs remain and include nonsevere HB.

OriginalsprogEngelsk
TidsskriftHaemophilia
Vol/bind28
Udgave nummer3
Sider (fra-til)453-461
Antal sider9
ISSN1351-8216
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
The authors thank the participants who volunteered to enroll in B‐Natural. The investigators and haemophilia treatment centres in order of contribution: Margaret V. Ragni, MD, MPH and Amy Steele, BSN, RN, University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA; Amy D. Shapiro, MD and Kathleen F. Molitor, BSN, RN‐BC, CCRC, Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA; Munira Borhany, MD, MBBS, MCPS, FCPS and Madiha Abid, PharmD, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan; Yasmina Abajas, MD and Marcus Allen Layer, MPH, Hemophilia and Thrombosis Center, University of North Carolina, Chapel Hill, NC, USA; Jan Astermark, MD, PhD, Malin Axelsson, and Marcus Ljungkvist, BSc, PhD, Department of Translational Medicine, Lund University and Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden; Michael D. Tarantino, MD and Sarah Gonzales, BS, MT (ASCP), CCRP, Bleeding and Clotting Disorders Institute, Peoria, IL, USA; Katharina Holstein, MD, University Medical Center Hamburg‐Eppendorf, Medical Department, Haemophilia Center, Hamburg, Germany; Stacy E. Croteau, MD and Emily Coe, Boston Children's Hospital, Boston Hemophilia Center, Boston, MA, USA; Raina Liesner, MA, MBBChir, MD, FRCPath, FRCPCH, Anja Griffioen and Alpha Barrie, MSc, Great Ormond Street Hospital for Children, NHS Trust supported by NIHR, GOSH, BRC, London, UK; Cristina Tarango, MD and Amanda Pfeiffer, MA, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Manuela Carvalho, MD, Congenital Coagulopathies Reference Centre, Centro Hospitalar Universitário São João, Porto, Portugal; Catherine McGuinn, MD and Ilene Goldburg, RN, Weill Cornell Medical College, New York, NY, USA; Eva Funding, MD, Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Christine L. Kempton, MD, MSc and Stephanie Whitten, CCRP, Emory University School of Medicine, Emory University, Atlanta, GA, USA; Christoph Bidlingmaier, MD, Dr. v. Hauner's Childrens University Hospital, Hemophilia Center, LMU Hospital, Munich, Germany; Alice Cohen, MD and Ellen White, RN, MSN, Newark Beth Israel Medical Center, Newark, NJ, USA; Johannes Oldenburg, MD, PhD, Kerstin Liphardt, PhD, and Thilo Albert, PhD, University Clinic Bonn, Bonn, Germany; Susan Kearney, MD and Ashley Kinsella, BS, Children's Minnesota Center for Bleeding and Clotting Disorders, Minneapolis, MN, USA; Christine Knoll, MD, Erica Olson, RN, BA and Courtney Moyer, CCRP, Phoenix Children's Hospital, Phoenix, AZ, USA; Philip Kuriakose, MD and Laura Gusba, NP, Henry Ford Hospital, Detroit, MI, USA; Suchitra Acharya, MD and Joseph Stanco, RN, Northwell Hemostasis and Thrombosis Center, New Hyde Park, New York, NY, USA; Ulrike M. Reiss, MD and Megan Wilson, MSW, CCRP, St. Jude Children's Research Hospital, Memphis, TN, USA; Roshni Kulkarni, MD and Kathleen Anderson, RN, Michigan State University, East Lansing, MI, USA; Michelle Witkop, DNP, FNP‐BC and Stephanie Roessler, Northern Regional Bleeding Disorders Center, Munson Medical Center, Traverse City, MI, USA. B‐Natural is funded through an investigator‐initiated academic collaboration with, Biogen/Bioverativ/Sanofi, Paris, France and Swedish Orphan Biovitrum (Sobi), Stockholm, Sweden.

Funding Information:
The authors thank the participants who volunteered to enroll in B-Natural. The investigators and haemophilia treatment centres in order of contribution: Margaret V. Ragni, MD, MPH and Amy Steele, BSN, RN, University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA; Amy D. Shapiro, MD and Kathleen F. Molitor, BSN, RN-BC, CCRC, Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA; Munira Borhany, MD, MBBS, MCPS, FCPS and Madiha Abid, PharmD, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan; Yasmina Abajas, MD and Marcus Allen Layer, MPH, Hemophilia and Thrombosis Center, University of North Carolina, Chapel Hill, NC, USA; Jan Astermark, MD, PhD, Malin Axelsson, and Marcus Ljungkvist, BSc, PhD, Department of Translational Medicine, Lund University and Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden; Michael D. Tarantino, MD and Sarah Gonzales, BS, MT (ASCP), CCRP, Bleeding and Clotting Disorders Institute, Peoria, IL, USA; Katharina Holstein, MD, University Medical Center Hamburg-Eppendorf, Medical Department, Haemophilia Center, Hamburg, Germany; Stacy E. Croteau, MD and Emily Coe, Boston Children's Hospital, Boston Hemophilia Center, Boston, MA, USA; Raina Liesner, MA, MBBChir, MD, FRCPath, FRCPCH, Anja Griffioen and Alpha Barrie, MSc, Great Ormond Street Hospital for Children, NHS Trust supported by NIHR, GOSH, BRC, London, UK; Cristina Tarango, MD and Amanda Pfeiffer, MA, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Manuela Carvalho, MD, Congenital Coagulopathies Reference Centre, Centro Hospitalar Universitário São João, Porto, Portugal; Catherine McGuinn, MD and Ilene Goldburg, RN, Weill Cornell Medical College, New York, NY, USA; Eva Funding, MD, Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Christine L. Kempton, MD, MSc and Stephanie Whitten, CCRP, Emory University School of Medicine, Emory University, Atlanta, GA, USA; Christoph Bidlingmaier, MD, Dr. v. Hauner's Childrens University Hospital, Hemophilia Center, LMU Hospital, Munich, Germany; Alice Cohen, MD and Ellen White, RN, MSN, Newark Beth Israel Medical Center, Newark, NJ, USA; Johannes Oldenburg, MD, PhD, Kerstin Liphardt, PhD, and Thilo Albert, PhD, University Clinic Bonn, Bonn, Germany; Susan Kearney, MD and Ashley Kinsella, BS, Children's Minnesota Center for Bleeding and Clotting Disorders, Minneapolis, MN, USA; Christine Knoll, MD, Erica Olson, RN, BA and Courtney Moyer, CCRP, Phoenix Children's Hospital, Phoenix, AZ, USA; Philip Kuriakose, MD and Laura Gusba, NP, Henry Ford Hospital, Detroit, MI, USA; Suchitra Acharya, MD and Joseph Stanco, RN, Northwell Hemostasis and Thrombosis Center, New Hyde Park, New York, NY, USA; Ulrike M. Reiss, MD and Megan Wilson, MSW, CCRP, St. Jude Children's Research Hospital, Memphis, TN, USA; Roshni Kulkarni, MD and Kathleen Anderson, RN, Michigan State University, East Lansing, MI, USA; Michelle Witkop, DNP, FNP-BC and Stephanie Roessler, Northern Regional Bleeding Disorders Center, Munson Medical Center, Traverse City, MI, USA. B-Natural is funded through an investigator-initiated academic collaboration with, Biogen/Bioverativ/Sanofi, Paris, France and Swedish Orphan Biovitrum (Sobi), Stockholm, Sweden.

Funding Information:
EB: has acted as paid consultant to Bayer, CSL Behring, Octapharma, Sobi, Takeda, and has received funding for research carried out in this work from Sobi and Bioverativ. PL: has received research funding from Takeda, Biogen/Bioverativ and Sobi. MVR: has been a consultant to Alnylam, BioMarin, Bioverativ MOGAM and Spark Therapeutics, and has research funding from Alnylam, Bayer, BioMarin, Bioverativ, Sangamo and Spark Therapeutics. MB: has no competing interests to declare. YLA: has no competing interests to declare. MDT: is a past advisor for Grifols, Novo Nordisk, speaker for Biomarin, Grifols, Pfizer, Takeda, clinical investigator for Spark, Takeda and a grant reviewer for Pfizer. KH: received honoraria for Advisory Boards and/or speaker fees from Biotest, CSL Behring, Novo Nordisk, Pfizer, Shire/Takeda, Sobi and unrestricted grants from CSL Behring and Pfizer. SEC: has received honoraria or consulting fees from Bayer, CSL‐Behring, Genentech and Pfizer and has received institutional research support from Novo Nordisk and Spark Therapeutics. RL: has no competing interests to declare. CT: has received honoraria for Advisory Boards for Takeda/Shire and Sanofi, and sits on a study Steering Committee for Bayer. MC: has received support for attending scientific meetings and honoraria (speaker fees/consultant for Advisory Boards) from Bayer, Baxalta (Shire), CSL Behring, Novo Nordisk, Octapharma, Pfizer, Sobi, Siemens and Stago. CM: has acted as a paid consultant for BioMarin, Bayer, Octapharma and Genentech/Roche. She is a site PI study investigator for Pfizer, Spark Therapeutics, Sanofi and Genentech/Roche. EF: has received honoraria from Roche and Shire, and chaired a symposium for Roche. EF was invited to ISTH 2015 by Novo Nordisk, EAHAD 2016 by Octapharma, ASH 2016 by Shire, EAHAD 2017 by Pfizer and to an AOP orphan pharmaceuticals meeting in 2019. CLK: has received honoraria for participation on Advisory Boards for Spark Therapeutics, Pfizer and Genentech and has received research funding from Novo Nordisk. CB: has acted as a paid speaker and consultant and has received funding for research from Bayer, Biotest, CSL Behring, Novo Nordisk, Octapharma, Pfizer, Roche, Shire/Takeda and Sobi. AC: has no competing interests to declare. JO: reports grants and personal fees from Bayer, personal fees from Biogen, grants and personal fees from Biotest, personal fees from Chugai, grants and personal fees from CSL Behring, personal fees from Grifols, grants and personal fees from Novo Nordisk, grants and personal fees from Octapharma, personal fees from Pfizer, personal fees from Roche, personal fees from Sobi, grants and personal fees from Takeda, outside the submitted work. Personal fees were received for travel support, participation in Advisory Boards and participation in symposia as Chair or Speaker. SK: has no competing interests to declare. CK: is a paid member of the Novo Nordisk Advisory Board. PK: has no competing interests to declare. SA: received research funding for investigator‐initiated study from Bayer. UMR: has no competing interests to declare. RK: has served on Advisory Boards for Sanofi/Bioverativ, BPL, Genentech, Bayer, Pfizer, Takeda, Catalyst Bioscience, Novo Nordisk; has received clinical trials support from Sanofi/Bioverativ, Bayer, BioMarin, Takeda, Novo Nordisk, Freeline. Speakers Bureau, stocks, shares: none. MW: has no competing interests to declare. SL: a full‐time employee of Sobi. RK: has received research funding from Takeda, Biogen/Bioverativ and Sobi. ADS: Dr. Shapiro reports the following; however, she does not retain any personal honoraria. All is paid to the Indiana Hemophilia and Thrombosis Center, Inc. Dr. Shapiro does not have personal financial interest in any healthcare related companies. Clinical research support: Agios, BioMarin, Bioverativ, Daiichi Sankyo, Genentech (Roche), Glover Blood Therapeutics, Kedrion Biopharma, Novartis, Novo Nordisk, OPKO, Octapharma, Pfizer, ProMetic Bio Therapeutics, Sangamo, Takeda. Speaker's Bureau: Genentech (Roche), Novo Nordisk. Advisory Board: Bioverativ, Genentech, Novo Nordisk, Sangamo, Sigilon Therapeutics. JA: has received research grants from Sobi, CSL Behring, Takeda/Shire and Bayer. Speaker's fee and consultant for Octapharma, Novo Nordisk, Pfizer, Bayer, Sobi, CSL Behring, Takeda/Shire, BioMarin, Uniqure and Spark Therapeutics.

Publisher Copyright:
© 2022 The Authors. Haemophilia published by John Wiley & Sons Ltd.

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