The B-Natural study—The outcome of immune tolerance induction therapy in patients with severe haemophilia B

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Jan Astermark
  • Katharina Holstein
  • Yasmina L. Abajas
  • Susan Kearney
  • Stacy E. Croteau
  • Riana Liesner
  • Funding, Eva
  • Christine L. Kempton
  • Suchitra Acharya
  • Stefan Lethagen
  • Petra LeBeau
  • Joel Bowen
  • Erik Berntorp
  • Amy D. Shapiro

Introduction: Inhibitors develop less frequently in haemophilia B (HB) than haemophilia A (HA). However, when present, the success of tolerization by immune tolerance induction (ITI) therapy is lower and the risk of complications higher. Aim: To evaluate the use and outcome of ITI in patients with HB and inhibitors. Methods: Subjects include singletons or siblings with a current/history of inhibitors enrolled in B-Natural—an observational study designed to increase understanding of clinical management of patients with HB. Patients were followed for 6 months and information on demographics, medical and social history, and treatment were recorded. Results: Twenty-nine patients with severe HB and inhibitors were enrolled in 24 centres. Twenty-two underwent one or more courses of ITI with or without immune suppression. Eight patients (36.4%) were successfully tolerized after the first course of ITI. One of these successes (12.5%) experienced allergic manifestations, whereas the corresponding number for the 10 treatment failures was five (50%). One of seven (14.2%) patients with large deletions and three of eight (37.5%) with nonsense mutations were tolerized at the first attempt, and all patients experiencing nephrosis either failed or were on-going. At study end, 11 (50%) were considered successfully tolerized after one or more ITI courses, three were unsuccessful, and eight were still undergoing treatment. Conclusion: Our data underscore the possibilities and difficulties of achieving tolerization in patients with HB with inhibitors. The type of mutation and complications appear to correlate with ITI outcome, but more accurate definitions of successful ITI are warranted.

OriginalsprogEngelsk
TidsskriftHaemophilia
Vol/bind27
Udgave nummer5
Sider (fra-til)802-813
ISSN1351-8216
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
Jan Astermark: has received research grants from Sobi, CSL Behring, Takeda/Shire, and Bayer. Speakers fee and consultant for Octapharma, Novo Nordisk, Pfizer, Bayer, Sobi, CSL Behring, Takeda/Shire, BioMarin, Uniqure, and Spark Therapeutics. Katharina Holstein: received honoraria for Advisory Boards and/or speaker fees from Bayer, Biotest, CSL Behring, Novo Nordisk, Pfizer, Roche, Shire/Takeda, Sobi, and unrestricted grants from Bayer, CSL Behring and Pfizer. Yasmina L. Abajas: has no competing interests to declare. Susan Kearney: has no competing interests to declare. Stacy E. Croteau: has received honoraria or consulting fees from Bayer, Biomarin, CSL‐Behring, Hemabiologics, and Pfizer and she has received institutional research funding from Spark Therapeutics and Novo Nordisk. Riana Liesner: has received consultancy fees, speakers fees, and/or travel support from Octapharma, SOBI, and CSL Behring. Eva Funding: has received honoraria from Roche and Shire, and chaired a symposium for Roche. Eva Funding 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. Christine L. KemptonSuchitra Acharya: has received honoraria from Spark Therapeutics and Takeda. Received research support from Novo Nordisk. Suchitra Acharya: received research funding for investigator‐initiated study from Bayer. Advisory Board: Novo Nordisk and BPL. Stefan Lethagen: a full‐time employee of Sobi. Petra LeBeau: has received research funding from Takeda, Biogen/Bioverativ and Sobi. Joel Berntorp: has received educational grant from BioMarin. Erik Berntorp: 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. Amy D. Shapiro: Dr. Shapiro reports the following; however, she does not retain any personal honoraria. All is paid to the Indiana Haemophilia and Thrombosis Centre, 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.

Funding Information:
The authors thank the participants who volunteered to enrol 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.

Publisher Copyright:
© 2021 The Authors. Haemophilia published by John Wiley & Sons Ltd.

ID: 273652480