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Clinical utility and patient perspectives on the use of extended half-life rFIXFc in the management of hemophilia B

Authors Miguelino MG, Powell JS

Received 10 May 2014

Accepted for publication 18 June 2014

Published 8 August 2014 Volume 2014:8 Pages 1073—1083

DOI https://doi.org/10.2147/PPA.S54951

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Maricel G Miguelino, Jerry S Powell

Division of Hematology and Oncology, University of California Davis Medical Center, Sacramento, CA, USA

Abstract: Hemophilia B is an X-linked genetic disease caused by mutation of the gene for coagulation protein factor IX (FIX), with an incidence of approximately once every 30,000 male births in all populations and ethnic groups. When severe, the disease leads to spontaneous life threatening bleeding episodes. When untreated, most patients die from bleeding complications before 25 years of age. Current therapy requires frequent intravenous infusions of therapeutic recombinant or plasma-derived protein concentrates containing FIX. Most patients administer the infusions at home every few days, and must limit their physical activities to avoid abnormal bleeding when the FIX activity levels are below normal. After completing the pivotal Phase III clinical trial, a new therapeutic FIX preparation that has been engineered for an extended half-life in circulation, received regulatory approval in March 2014 in Canada and the US. This new FIX represents a major therapeutic advance for patients with hemophilia B. The half-life is prolonged due to fusion of the native FIX molecule with the normal constant region of immunoglobulin G. This fusion molecule then follows the normal immunoglobulin recirculation pathways through endothelial cells, resulting in prolonged times in circulation. In the clinical trials, over 150 patients successfully used eftrenonacog alfa regularly for more than 1 year to prevent spontaneous bleeding, to successfully treat any bleeding episodes, and to provide effective coagulation for major surgery. All infusions were well tolerated and effective, with no inhibitors detected and no safety concerns. This promising therapy should allow patients to use fewer infusions to maintain appropriate FIX activity levels in all clinical settings.

Keywords: factor IX, hemophilia B, prophylaxis, genetic coagulation defects, extended half-life

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