Fibrinogen concentrate for treatment of bleeding and surgical prophylaxis in congenital fibrinogen deficiency patients

Authors: Lissitchkov, T., Madan, B., Djambas, Khayat C., Zozulya, N., Ross, C., Karimi, M., Kavakli, K., De Angulo, G. R., Almomen, A., Subramanian, K., D’Souza, F., Viswabandya, A., Hoorfar, H., Schwartz, B. A., Solomon, C., Knaub, S., and Peyvandi, F.

Published: J.Thromb.Haemost.; January 2020

Affiliations: Department of Hemorrhagic Diathesis and Anemia, Specialized Hospital for Active Treatment (SHAT), Joan Pavel », Sofia, Bulgaria; Centre for Haemostasis & Thrombosis, Guy’s & St Thomas’, NHS Foundation Trust, London, UK; Hotel Dieu De France, Beirut, Lebanon; Federal State-Funded Institution « National Research Center for Hematology » of the Ministry of Healthcare of the Russian Federation, Moscow, Russia; Department of Hematology, St. John’s Medical College & Hospital, Bangalore, India; Dastgheib Hospital, Shiraz, Iran ; Ege University, Children’s Hospital, Izmir, Turkey; Miami Children’s Hospital, Miami, Florida, USA; Centre of Excellence in Thrombosis & Hemostasis, College of Medicine and King, Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Sahyadri Specialty Hospital, Pune, India; Department of Hematology, St. John’s Medical College & Hospital, Bangalore, India; Christian Medical College, Vellore, India; Seyed Al Shohada Hospital, Isfahan, Iran; Clinical Research & Development, Octapharma, Hoboken, New Jersey, USA; Research & Development Department, Octapharma, Lachen, Switzerland; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Universita degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy.

Abstract: BACKGROUND: Congenital fibrinogen deficiency is an ultra-rare disorder where patients can experience severe and/or frequent bleeding episodes (BEs). Here, we present the largest prospective study to date on the treatment of this disorder. METHODS: Hemostatic efficacy of human fibrinogen concentrate (HFC; FIBRYGA((R)) , Octapharma AG) for treatment of bleeding or surgical prophylaxis was assessed by investigators and adjudicated by an independent data monitoring and endpoint adjudication committee (IDMEAC) according to a 4-point scale, using objective criteria. Thromboelastometry maximum clot firmness (MCF) was also determined. RESULTS: Twenty-five afibrinogenemia patients were treated with HFC: 24 for on-demand treatment of 89 BEs, and nine as prophylaxis for 12 surgeries. For BEs, treatment success (rating of excellent or good) evaluated by investigators was 96.6% (90% confidence interval [CI], 0.92-0.99; two missing ratings, classified as failures) and by the IDMEAC was 98.9% (90% CI, 0.95-0.999). Mean +/- standard deviation (SD) increase in MCF was 5.8+/-2.5 mm one hour after the first HFC infusion (mean +/- SD dose, 61.88+/-11.73 mg/kg). For the 12 surgeries (median [range] HFC dose/surgery, 85.80 mg/kg [34.09-225.36]), intraoperative and postoperative treatment success were both rated 100% (90% CI, 0.82-1.00) by investigators and the IDMEAC. Three adverse events were possibly treatment-related, including a moderate case of thrombosis. There were no deaths, no severe allergic or hypersensitivity reactions and no clinical evidence of neutralizing anti-fibrinogen antibodies. CONCLUSIONS: HFC was efficacious for on-demand treatment of bleeding and as surgical prophylaxis, with a favorable safety profile, in patients with congenital afibrinogenemia.