Last updated on October 2017

ATHN 2: Factor Switching Study


Brief description of study

This is a longitudinal, observational study of patients with Hemophilia A or B who are planning to switch to a newly approved coagulation factor replacement product, or who have recently switched factor products. The study will follow each patient for up to 1 year. Patients will be recruited at Hemophilia Treatment Centers (HTC) which are ATHN-affiliates. The primary outcome being studied is the development of inhibitor (i.e., antibodies to factor) at 1 year or 50 exposure days, whichever comes first. The study will be conducted at approximately 30 HTCs, with a planned enrollment of 600 patients.The entire study duration is projected to be approximately 6 years. In addition, optional substudies will be included for some products, as "Product-Specific Modules". These will be questionnaires to collect data for subjects receiving selected Factor products. For example, subjects receiving Eloctate will be approached to participate in the 'Eloctate Product-Specific Module'; subjects receiving Adynovate will be approached to participate in the 'Adynovate Product-Specific Module'. Questions will be related to product use, perceptions of product use, and other post-marketing consumer data.

Detailed Study Description

This non-interventional, minimal risk cohort study will enroll patients with Hemophilia A or B who are planning or have recently switched to a new Factor product. The study will have 2 Arms, prospective and retrospective. The Prospective Arm will enroll patients who plan to switch to a new factor. The Retrospective Arm will enroll patients who have recently switched to a new factor (within the previous 50 weeks). Patient will be seen at baseline and for up to 4 additional visits, and quarterly follow-up by phone. Required study visits will be planned to coincide with routine follow-up visits whenever possible. Please note that Factor Replacement Products are not being provided by the study. The primary objective is to assess and characterize the rate of inhibitor development within one (1) year or fifty (50) exposure days, whichever is first, after switching clotting factor replacement products in previously treated patients (PTPs) with hemophilia A or B. Data collected will include eligibility, demographics, medical history, hemophilia history (clotting history, product history, genotype and family history), inhibitor history, co-morbidities at baseline (i.e., HIV, Hepatitis C.), detailed clotting factor replacement product(s) usage and switching plan, and reasons for switching factor products. Also targeted physical exams will be performed at baseline and during follow-up, and targeted concomitant medication data will be collected. Data collection will also include patient-reported outcome(s) after 1 year, bleeding events, surgeries, laboratory Inhibitor testing and details regarding testing methodology, pharmacokinetic (PK) data (if known), new diagnoses, and co-morbidities (targeted), Safety/Adverse Events using European Union Hemophilia Safety Surveillance (EUHASS) definitions. This study will evolve to include any newly approved (since January 2013) factors as they come to market. Cohorts will be defined by the brand/type of new clotting factor replacement product approved after January 1, 2013. The current list of specific new Factor VIII replacement products include Eloctate® (Bioverativ) and NovoEight® (NovoNordisk); Factor IX replacement products include Alprolix® (Bioverativ), Rixubis® (Baxalta) and IXinity® (Emergent Biosolutions). Others are imminent. The over-arching rationale for this protocol is that a pragmatic study which is consistent with real world practices across a wide range of patients that is not principally tied to a particular manufacturer or product may be of great advantage to the entire hemophilia community. Study Duration - Subjects on prophylaxis will be followed on study for up to 1 year. Each subject will be seen during a study visit or contacted by telephone at least once every 3 months (i.e., quarterly). Patients may participate for multiple 'cycles', if they switch factor products more than once while the study is actively recruiting. Treatment regimen will be at the discretion of the subject's hemophilia caregivers. No treatment is being provided by the study. - Substudies A number of substudies are planned with pharmaceutical sponsors to collect information from patients about their products' use. Participation in these optional substudies (product-specific modules) will be planned to coincide with study visits. These modules will collect information from subjects about their perception and use of factor use/treatment, physical activity levels and other general health questions. These data will be collected via questionnaire, primarily via phone. Concomitant and Excluded Therapies - Immune tolerance therapy is excluded on study. This includes immunosuppressive treatments used to eradicate inhibitors. Steroid treatments for allergic disorders and asthma, are allowed. Data Collection System - All data collected will be entered into electronic case report forms (eCRFs) within the secure ATHN Study Manager system. Subject Identifiers (IDs) will be generated in Clinical Manager. - Reimbursement will be managed by each participating HTC. Most study centers will reimburse study subjects for travel and parking, but this varies by center.

Clinical Study Identifier: NCT02546622

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Annette Von Drygalski, MD

University of California San Diego (UCSD)
San Diego, CA United States
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Michael Wang, MD

University of Colorado Denver Hemophilia and Thrombosis Center
Aurora, CO United States
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Salley Pels, MD

Yale Hemophilia Treatment Center
New Haven, CT United States
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Michael Guerrera, MD

Children's National Medical Center
Washington, D.C., United States
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Irmel Ayala, MD

Johns Hopkins All Children's Hospital
Saint Petersburg, FL United States
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Erin Cockrell, DO

St. Joseph's Children's Hospital
Tampa, FL United States
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Robert Sidonio, MD

Children's Healthcare of Atlanta
Atlanta, GA United States
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Michael Tarantino, MD

Bleeding and Clotting Disorders Institute
Peoria, IL United States
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Amy Shapiro, MD

Indiana Hemophilia and Thrombosis Center (IHTC)
Indianapolis, IN United States
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Tamuella Singleton, MD

Louisiana Center for Bleeding and Clotting Disorders
New Orleans, LA United States
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Eric Larsen, MD

Maine Hemophilia and Thrombosis Center
Scarborough, ME United States
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Cliff Takemoto, MD

Johns Hopkins University Medical Center
Baltimore, MD United States
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Stacy Croteau, MD

Boston Hemophilia Center at Children's Hospital of Boston
Boston, MA United States
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Steven Pipe, MD

University of Michigan Hemophilia and Coagulation Disorders Program
Ann Arbor, MI United States
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Philip Kuriakose, MD

Henry Ford Hospital Adult Hemophilia and Thrombosis Treatment Center
Detroit, MI United States
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Roshni Kulkarni, MD

Michigan State University Center for Bleeding and Clotting Disorders
East Lansing, MI United States
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Brian Wicklund, MD

Children's Mercy Hospital
Kansas City, MO United States
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Amber Federizo, APRN, FNP

Hemophilia Treatment Center of Nevada
Las Vegas, NV United States
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Debra Ornstein, MD

Dartmouth-Hitchcock Comprehensive Hemophilia and Thrombosis Center
Lebanon, NH United States
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Catherine McGuinn, MD

Weill Cornell Medicine
New York, NY United States
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Peter Kouides, MD

Mary M. Gooley Hemophilia Center
Rochester, NY United States
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Michael Recht, MD

Oregon Health and Science University
Portland, OR United States
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Leslie Raffini, MD

Children's Hospital of Philadelphia (CHOP)
Philadelphia, PA United States
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Adam Cuker, MD

Pennsylvania Comprehensive Hemophilia and Thrombophilia Program / Hospital of the University of Pennsylvania
Philadelphia, PA United States
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Margaret Ragni, MD

The Hemophilia Center of Western Pennsylvania
Pittsburgh, PA United States
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Melissa Lee, PA-C

St Jude Children's Research Hospital
Memphis, TN United States
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Janna Journeycake, MD

UTSW Medical Center at Dallas/Children's Medical Center
Dallas, TX United States
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Gary Woods, MD

Children's Hospital of the Kings Daughters, Inc.
Suffolk, VA United States
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Rebecca Kruse-Jarres, MD

Washington Center for Bleeding Disorders Bloodworks Northwest d/b/a Puget Sound Blood Center
Seattle, WA United States
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Joan Gill, MD

Blood Center of Wisconsin
Milwaukee, WI United States
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