This is a single arm, phase 4, prospective, open-label, United States single-center study to assess the hemostatic efficacy and safety of Hemlibra (emicizumab) for hemostatic control of hemophilia A patients (baseline FVIII level \<40%) with and without inhibitors with hemophilic pseudotumors; secondary outcomes will assess changes in quality of life and activity level in treated patients.
This is a single arm, phase 4, prospective, open-label, United States single-center study to assess the hemostatic efficacy and safety of Hemlibra (emicizumab) for hemostatic control of hemophilia A patients, (baseline FVIII level \<40%), children and adults, with and without inhibitors with hemophilic pseudotumors; secondary outcomes will assess changes in quality of life and activity level in treated patients. Hemlibra (emicizumab) will be administered as primary weekly prophylaxis after the enrollment/screening visit is complete (approximately 7-10 days after screening, if laboratory results are available and eligibility is confirmed). If an activity monitoring device is typically utilized by the patient (eg, a Fitbit) then permission will be requested from the patient at screening to access the data for 1 month prior to screening as a baseline comparator for post-treatment activity. The use of an activity-monitoring device is not required by the study. The enrollment period is 2 years and the study will last a maximum of 4 years; subjects will receive study medication (Hemlibra, emicizumab) for a minimum of 2 years and a maximum of 4 years based upon time of enrollment. Hemlibra (emicizumab) will be administered using the FDA-approved once-weekly dosing regimen for loading dose and prophylactic dose. Breakthrough bleeding events will be recorded and treated with locally available FVIII (eg, pdFVIII or rFVIII) in non-inhibitor subjects and inhibitor subjects with low titer inhibitors (titer\<5 BU). The lowest dose of FVIII expected to achieve hemostasis will be utilized for treatment of breakthrough bleeding events in non-inhibitor and low-titer inhibitor patients. Subjects with high-titer inhibitors (titer ≥5 BU) and those with low titer inhibitors who do not respond to FVIII will be required to utilize rFVIIa as first line therapy; aPCC (\<100 U/kg/day for preferably no more than 1 day) may only be used upon approval of the Study Investigator and under the supervision of a physician. The proposed study is seeking to address the following knowledge gaps: Does weekly prophylactic Hemlibra (emicizumab) reduce the rate of bleeding events in subjects with hemophilia A and pseudotumor, including the rate of hospitalization, anemia and transfusion? Does weekly prophylactic Hemlibra (emicizumab) control the progression of hemophilic pseudotumor? Does weekly prophylactic Hemlibra (emicizumab) result in an increase in QoL and activity level?
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
1
bispecific monoclonal antibody binding to activated Factor IX and Factor X
Indiana Hemophila @Thrombosis Center
Indianapolis, Indiana, United States
Hemostatic Efficacy of Prophylactic Weekly Injections of Hemlibra (Emicizumab) Based on Hemoglobin
Maintenance or increase of hemoglobin (g/dl) from participants' baseline level based on serial blood tests.
Time frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
Hemostatic Efficacy of Prophylactic Weekly Injections of Hemlibra (Emicizumab) Based on Participants' Need for Blood Transfusions or Lack of
Whether or not the patient requires blood transfusions (units of RBCs) due to blood loss secondary to lack of hemostatic efficacy during the duration of study treatment duration.
Time frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
Breakthrough Bleeds
Number of breakthrough bleeding events that require hemostatic therapy in addition to Hemlibra prophylaxis
Time frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
Pseudotumor Status
Radiologic evaluation (CT and/or MRI) to evaluate control of progression, stabilization or regression per change in size (measured in cm) of the pseudotumor
Time frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
Patient Quality of Life Based on Haem-A-QOL
The subjective change in quality of life and activity with Hemlibra (emicizumab) prophylaxis will be evaluated during the study. QoL and activity will be assessed using Haem-A-QoL and EQ-5D-5L. Changes in these measures will be determined by changes from the baseline scores compared to follow-up scores.
Time frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
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Patient Quality of Life Based on EQ-5D-5L
The subjective change in quality of life and activity with Hemlibra (emicizumab) prophylaxis will be evaluated during the study. QoL and activity will be assessed using Haem-A-QoL and EQ-5D-5L. Changes in these measures will be determined by changes from the baseline scores compared to follow-up scores.
Time frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
Adverse Events
Number of adverse events while on HemLibra (emicizumab) prophylaxis.
Time frame: Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
Serious Adverse Events
Number of SAEs while on HemLibra (emicizumab) prophylaxis
Time frame: Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
Number of Participants With Adverse Events
Number of participants with adverse events while on HemLibra (emicizumab) prophylaxis
Time frame: Every 3 months, for the 2 years and 10 months of the patient's study participation duration.
Anti-Drug Antibodies (ADA)
Development of emicizumab anti-drug antibodies using the ADA assay
Time frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
ADA and Activated Partial Thromboplastin Time (APTT)
If the patient develops an ADA: the ADA's effect on the patient's APTT
Time frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
ADA and Factor VIII (FVIII)
If the patient develops an ADA: the ADA's effecton the patient's FVIII assay
Time frame: Every 12 months, for the 2 years and 10 months of the patient's study participation duration.
Planned or Unplanned Surgery
If the patient requires surgery: Whether the procedure(s) was/were planned versus unplanned
Time frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
Hemostatic Agents in Surgery
If the patient requires surgery: Whether hemostatic agents in addition to Hemlibra were required to achieve or maintain hemostasis
Time frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.
Blood Loss in Surgery
If the patient requires surgery: Whether blood loss exceeded the estimated/predicted blood loss relative to a patient without hemophilia
Time frame: Every 6 months, for the 2 years and 10 months of the patient's study participation duration.