Considerations for Shared Decision Management in Previously Untreated Patients with Hemophilia A or B

Authors: Astermark, J; Blatný, J; Königs, C; Hermans, C; Jiménez-Yuste, V; Hart, DP

Affiliations: Department of Translational Medicine, Lund University, and Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Jan Waldenströms gata 14, SE-205 02 Malmö, Sweden. Department of Pediatric Hematology, University Hospital Brno and Masaryk University, Brno, Czech Republic. Clinical and Molecular Hemostasis, Department of Pediatrics, University Hospital Frankfurt, Goethe University, Frankfurt, Germany. Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium. Hematology Department, Hospital Universitario La Paz, Autónoma University, Madrid, Spain. The Royal London Hospital Haemophilia Centre, Barts and the London School of Medicine, QMUL, London, UK.

Publications: Therapeutic Advances in Hematology; 2023; 14.

Abstract: Recent advances in therapeutics are now providing a wide range of options for adults and children living with hemophilia. Although therapeutic choices are also increasing for the youngest individuals with severe disease, challenges remain about early management decisions, as supporting data are currently limited. Parents and healthcare professionals are tasked with helping children achieve an inclusive quality of life and maintain good joint health into adulthood. Primary prophylaxis is the gold standard to optimize outcomes and is recommended to start before 2 years of age. A range of topics need to be discussed with parents to aid their understanding of the decisions they can make and how these will affect the management of their child/children. For those with a family history of hemophilia, prenatal considerations include the possibility of genetic counseling, prenatal investigations, and planning for delivery, together with monitoring of the mother and neonate, as well as diagnosis of the newborn and treatment of any birth-associated bleeding. Subsequent considerations, which are also applicable to families where infant bleeding has resulted in a new diagnosis of sporadic hemophilia, involve explaining bleed recognition and treatment options, practical aspects of initiating/continuing prophylaxis, dealing with bleeds, and ongoing aspects of treatment, including possible inhibitor development. Over time, optimizing treatment efficacy, in which individualizing therapy around activities can play a role, and long-term considerations, including retaining joint health and tolerance maintenance, become increasingly important. The evolving treatment landscape is creating a need for continually updated guidance. Multidisciplinary teams and peers from patient organizations can help provide relevant information. Easily accessible, multidisciplinary comprehensive care remains a foundation to care. Equipping parents early with the knowledge to facilitate truly informed decision-making will help achieve the best possible longer-term health equity and quality of life for the child and family living with hemophilia.