The European Haemophilia Consortium (EHC) held its 24th Round Table on ‘Product Related risk for inhibitor formation in Haemophilia A’ on Monday 2 March 2015 from 13.30 till 17.30 hrs. The event was held at the Royal Windsor Hotel in Brussels, Belgium. You can consult all of the documents from the event in the library section.
On 2 March 2015, the European Haemophilia Consortium (EHC) hosted its first Round Table of the year at the Royal Windsor Hotel in Brussels. The event aimed to present an overview of the current findings on the risks associated with inhibitor development when using different types of factor concentrates in previously untreated patients (PUPs). The event featured several presentations summing up findings from studies such as the Research Of Determinants of INhibitor Development among PUPs with haemophilia (RODIN), UKHCDO, FranceCoag and the Survey of Inhibitors in Plasma-Product Exposed Toddlers (SIPPET).
Prof Michael Makris, member of the EHC Medical Advisory Group and chair of the event, stated in his opening address that inhibitors are the major challenge in haemophilia care today. In fact, the mechanisms and factors contributing to inhibitor formation are still poorly understood by the medical and scientific community. The development of inhibitors has devastating consequences for patients both physically and emotionally as it leaves people affected by inhibitors at greater risk of disability and death. Furthermore, inhibitors are extremely expensive to treat, which results in even poorer access to treatment in resource-limited countries.
Presentations and discussions during the Round Table showed that inhibitor development is a multi-factorial event in which both genetic and external factors, such as treatment regimens, contribute to inhibitor formation. Professor Pier-Mannuccio Mannucci (University of Milan) discussed the controversial issue of whether recombinant concentrates cause more inhibitors in PUPs than plasma-derived products. He ended by presenting the SIPPET trial, which is examining this issue in a randomised manner and the results of which are awaited with great interest.
Other speakers focused on the issue of whether different recombinant concentrates are associated with different inhibitor risks. Professor Jenny Goudemand (University of Lille) presented the data of the RODIN, UKHCDO and FranceCoag studies, which suggested that second generation concentrates had a higher inhibitor risk in PUPs as compared to third generation concentrates. Dr Kathelijn Fischer (University of Utrecht) showed the EUHASS data, which did not find a difference between different brands of concentrates. Dr Alfonso Iorio (McMaster University) discussed all the studies to date and suggested that the issue may not be as clear-cut as has been suggested because the risk in inhibitor development for both recombinant and plasma-derived coagulation factors varies greatly depending on the study and centre administering the product. Prof Frits Rosendaal (University of Leiden), invoked the in dubio abstine principle of modern medicine and recommended avoiding the use of any product against which concern has been raised, if an alternative is available. Other speakers, however, claimed that the only way to be sure about whether or not a particular product has an increased effect on inhibitor formation is to run a randomised controlled trial.
Speakers included:
- Prof Michael Makris, EHC Medical Advisory Group and University of Sheffield
- Prof Pier-Mannuccio Mannucci, University of Milan
- Prof Jenny Goudemand, University of Lille
- Dr Kathelijn Fischer, University of Utrecht
- Dr Alfonso Iorio, McMaster University
- Prof Frits Rosendaal, Leiden University
- Mr Thomas Sannié, French National Member Organisation (NMO)
Jim is aged 66 and has Haemophilia A with a high titer inhibitor which he developed at age 14.
Maria Elisa Mancuso (MD, PhD) is a Haematologist and works as a Senior Haematology Consultant at the Center for Thrombosis and Haemorrhagic Diseases of IRCCS Humanitas Research Hospital in Rozzano, Milan, Italy. She is Adjunct Clinical Professor at Humanitas University. She obtained a post-degree in Clinical and Experimental Haematology and a PhD in Clinical Methodology. She is involved in clinical research and has published several original articles in peer-reviewed journals a The Lancet, Blood, Journal of Thrombosis and Haemostasis, Haematologica, Thrombosis and Haemostasis, British Journal of Haematology and Haemophilia. She is reviewer for several peer-reviewed journals and member of the Editorial Board of JTH. She is a member of several scientific societies (ISTH, WFH, ASH, EAHAD, SISET, AICE) and was a medical member of the Inhibitor Working Group of the European Hemophilia Consortium. She is co-chair of the ADVANCE Study Group. She has acted also as co-chair of the Scientific and Standardization Subcommittee of ISTH on FVIII, FIX and rare bleeding disorders. She has been involved as principal and co-investigator in several clinical trials, and she takes care of both children and adults with hemophilia and other congenital bleeding disorders with a specific scientific interest in novel therapies, prophylaxis, inhibitors, and chronic hepatitis C.
As a patient with factor II deficiency, the diagnostic and treatment of rare bleeding disorders is a matter dear to my heart. My motivation to participate in the work of the ERIN committee is to improve both diagnostic and treatment for patients with rare bleeding disorders across Europe.
Economist and financial expert by profession, executive coach and trainer by passion and haemophilia advocate by every drop of my blood through my son (who has severe haemophilia A with inhibitors). Bringing a good decade of practical experience from the corporate insurance world, laser focus, growth mindset and resilience from my own experience, offering you anything I can just do, in hope that together we can make life more fulfilled for those impacted by bleeding disorders.
Amy Owen-Wyard is a Registered Mental Health Nurse. With experience working with children, young people, their families and adults with severe and enduring mental health conditions. Amy was also involved in a service improvement to provide a holistic care approach for those in general hospitals to support both their mental and physical health, whilst sharing her expertise and knowledge in mental health with the wider multidisciplinary team.
