Switching toward the use of recombinant factor VIII Fc fusion protein Study among 30 patients with severe hemophilia A

Authors: Sattler, L., Raissi, A., Fornoff, D., Gerout, A. C., Feugeas, O., Grunebaum, L., Desprez, D.

Publication : Ann.Biol.Clin.(Paris); 2020; 78,1:35-46.

Affiliations: Laboratoire d’hematologie, CHU Hautepierre, Strasbourg, France ; Laboratoire d’hematologie, CHR Mulhouse, Mulhouse, France ; Centre de ressource et de competence, maladie hemorragique constitutionnelle, CHU Hautepierre, Strasbourg, France.

Abstract: Only a few studies on real-world clinical use of recombinant factor VIII -fusionned with Fc (rFVIIIFc, efmoroctocog alpha) have been performed to date, with data on the annual bleeding rate (ABR), the prophylaxis regimen, and FVIII consumption. The aim of our study was to report the real-world clinical application of rFVIIIFc with additional elements, both biological and clinical. A prospective monocentric study has been conducted in the Haemophilia treatment center (HTC) of the Strasbourg university hospital among the severe haemophilia A patients. Thirty male patients were enrolled in the study. After injection of rFVIIIFc, the average time spent above 5%, 2% and 1% of FVIII was respectively almost 3, 4 and 5 days. The average half-life was 15.8 hours. A strong linear correlation between incremental recovery of rFVIIIFc and weight and between rFVIIIFc half-life and basal VWF:Ag level was observed. FVIII activity measurement for rFVIIIFc showed similar results than those previously published. In the follow-up, residual FVIII activity was on average the one of a mild haemophilia patient, corroborated by the results of endogenous thrombin potential of the thrombin generation assay. In clinical practice, rFVIIIFc was well tolerated and patients were mostly satisfied or indifferent of the switch. A single failure was however noticed. No FVIII inhibitor has been detected. Decrease in FVIII consumption was observed, with reduced or unchanged ABR. The switch was an actual success for almost all of the 30 patients, corroborated by satisfactory clinical and biological results.