Hemophilia Clinical Trial
Official title:
A Feasibility Trial Using Extended Half Life Factor Products in the Reduction of Menstrual Bleeding in Symptomatic Hemophilia A and B Carriers
The purpose of this feasibility study is to find out if two clotting factor products, Eloctate [hemophilia A] and Alprolix [hemophilia B], can reduce the amount of menstrual bleeding in female hemophilia A and B carriers (14 years of age or older) who have severe or heavy bleeding. These products are FDA-approved for use in males with hemophilia A and B to prevent and treat bleeding. They are not approved specifically to reduce menstrual bleeding, but may be useful for this purpose. Both products have an "extended half life" which means they circulate in the body longer than other FVIII or FIX products. The study team will gather additional information about the safety of these drugs and how well they work. The results of this feasibility study will provide information for an upcoming larger study.
Hemophilia A or B is caused by defects in the factor VIII or IX gene, respectively, of which
is located on the X chromosome. This disorder exhibits X-linked inheritance, in which
primarily males, with a single X chromosome, are affected and females, with two X
chromosomes, are heterozygotes, or carriers. Hemophilia carriers show a wide distribution of
factor VIII or IX levels with a mean of 50%, which overlaps the distribution of non-carrier
women.
Heavy menstrual bleeding is defined as menstrual bleeding that lasts more than 7 days or more
specifically as the loss of more than 80cc of blood per cycle. Management is critical as it
can lead to iron deficiency anemia, lead to school absence and affects the general quality of
life. There are multiple options to control or reduce menstrual bleeding in hemophilia A and
B carriers, they include but not limited to the following options: Antifibrinolytics
(Aminocaproic acid, Tranexamic acid), Synthetic desmopressin (DDAVP, SQ or IN) or hormonal
therapies (Combined oral contraceptives, Progestin only options, IUD, etc).
The use of recombinant factor replacement has been poorly studied and limited by a relatively
short half-life in relation to the typical length of a menstrual period. The purpose of this
feasibility study is to find out if two clotting factor products, Eloctate [hemophilia A] and
Alprolix [hemophilia B], can reduce the amount of menstrual bleeding in female hemophilia A
and B carriers (14 years of age or older) who have severe or heavy bleeding. These products
are FDA-approved for use in males with hemophilia A and B to prevent and treat bleeding. They
are not approved specifically to reduce menstrual bleeding, but may be useful for this
purpose. Both products have an "extended half life" which means they circulate in the body
longer than other FVIII or FIX products. The study team will gather additional information
about the safety of these drugs and how well they work. Five out of the 16 anticipated
enrolled patients will be approach to request participation in the exploratory aim in which
the subject is taught to perform a hemoglobin check (CBC) every other day using a novel point
of care device (Anemocheck) during 2 consecutive menstrual cycles. In addition, they will
have CBCs drawn within 4-6 hours for comparison and correlation. The study team will also
correlate symptoms of heavy menstrual bleeding with a 2grams drop in the hemoglobin. All the
results of this study will provide information for an upcoming larger study.
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