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Bleed and joint protection with ELOCTATE®1

With ELOCTATE prophylaxis, adult and adolescent patients experienced a decrease in ABR over 5 years of clinical data1-3

Over 5 years of clinical data, the median overall ABR was 1.6 (0.0-4.7) in A-LONG (n=117) and 0.74 (0.0-2.68) in ASPIRE (n=110). The median joint ABR was 0.0 (0.0-1.7) in A-LONG and 0.0 (0.0-0.71) in ASPIRE. Over 5 years of clinical data, the median overall ABR was 1.6 (0.0-4.7) in A-LONG (n=117) and 0.74 (0.0-2.68) in ASPIRE (n=110). The median joint ABR was 0.0 (0.0-1.7) in A-LONG and 0.0 (0.0-0.71) in ASPIRE.

In the A-LONG study, of 117 patients enrolled in the individualized prophylaxis arm, 112 were treated for ≥6 months. Dosing intervals were evaluated during the last 3 months of the study. Number of infusions may vary per individual. Individualized prophylaxis regimen: 25 IU/kg and 50 IU/kg of ELOCTATE on the first and fourth days of the week, respectively. Dose adjustments (25 to 65 IU/kg) and interval adjustments (every 3 to 5 days) were allowed based on a subject’s PK data and observed bleeding pattern.1

In the ASPIRE study, the individualized prophylaxis regimen was 25 to 65 IU/kg every 3 to 5 days or twice weekly (20 to 65 IU/kg on Day 1, 40 to 65 IU/kg on Day 4).2

Nearly 100% of target joints were resolved with ELOCTATE prophylaxis2‡

  • In 111 adult and adolescent patients taking ELOCTATE prophylaxis, 234 out of 235 target joints were resolved
  • In 13 pediatric patients taking ELOCTATE prophylaxis, 9 out of 9 target joints were resolved

With ELOCTATE individualized prophylaxis, children <12 experienced a decrease in ABR over 4 years of clinical data1,2,5

Over 4 years of clinical data, the median overall ABR was 2.0 (0.0-4.0) in Kids A-LONG (n=69). In ASPIRE (n=59), the median overall ABR was 1.18 (0.60-2.37) for patients aged <6 years (n=29) and 1.59 (0.55-3.55) in patients aged 6 to <12 years (n=30). The median joint ABR was 0.0 (0.0-0.0) in Kids A-LONG. In ASPIRE, the median joint AsBR was 0.0 (0.0-0.55) in patients aged <6 years and 0.0 (0.0-0.55) in patients aged 6 to <12 years. Over 4 years of clinical data, the median overall ABR was 2.0 (0.0-4.0) in Kids A-LONG (n=69). In ASPIRE (n=59), the median overall ABR was 1.18 (0.60-2.37) for patients aged <6 years (n=29) and 1.59 (0.55-3.55) in patients aged 6 to <12 years (n=30). The median joint ABR was 0.0 (0.0-0.0) in Kids A-LONG. In ASPIRE, the median joint AsBR was 0.0 (0.0-0.55) in patients aged <6 years and 0.0 (0.0-0.55) in patients aged 6 to <12 years.

In the Kids A-LONG study, individualized prophylaxis regimen: 25 IU/kg and 50 IU/kg of ELOCTATE on the first and fourth days of the week, respectively. Adjustments in dose (25 to 80 IU/kg) and interval (every 2 days or longer) were allowed based on a subject’s available PK data and observed bleeding pattern.1

In the ASPIRE study, the individualized prophylaxis regimen was 25 to 65 IU/kg every 3 to 5 days, or twice weekly (20 to 65 IU/kg on Day 1, 40 to 65 IU/kg on Day 4). In subjects <12 years of age, dose adjustments were made up to a maximum of 80 IU/kg up to every 2 days, if necessary.6

Nearly 100% of target joints† were resolved with ELOCTATE prophylaxis2‡

  • In 111 adult and adolescent patients taking ELOCTATE prophylaxis, 234 out of 235 target joints were resolved
  • In 13 pediatric patients taking ELOCTATE prophylaxis, 9 out of 9 target joints were resolved

With ELOCTATE prophylaxis, adult and adolescent patients experienced a decrease in ABR over 5 years of clinical data1-3

Over 5 years of clinical data, the median overall ABR was 1.6 (0.0-4.7) in A-LONG (n=117) and 0.74 (0.0-2.68) in ASPIRE (n=110). The median joint ABR was 0.0 (0.0-1.7) in A-LONG and 0.0 (0.0-0.71) in ASPIRE. Over 5 years of clinical data, the median overall ABR was 1.6 (0.0-4.7) in A-LONG (n=117) and 0.74 (0.0-2.68) in ASPIRE (n=110). The median joint ABR was 0.0 (0.0-1.7) in A-LONG and 0.0 (0.0-0.71) in ASPIRE.

In the A-LONG study, of 117 patients enrolled in the individualized prophylaxis arm, 112 were treated for ≥6 months. Dosing intervals were evaluated during the last 3 months of the study. Number of infusions may vary per individual. Individualized prophylaxis regimen: 25 IU/kg and 50 IU/kg of ELOCTATE on the first and fourth days of the week, respectively. Dose adjustments (25 to 65 IU/kg) and interval adjustments (every 3 to 5 days) were allowed based on a subject’s PK data and observed bleeding pattern.1

In the ASPIRE study, the individualized prophylaxis regimen was 25 to 65 IU/kg every 3 to 5 days or twice weekly (20 to 65 IU/kg on Day 1, 40 to 65 IU/kg on Day 4).2

Nearly 100% of target joints were resolved with ELOCTATE prophylaxis2‡

  • In 111 adult and adolescent patients taking ELOCTATE prophylaxis, 234 out of 235 target joints were resolved
  • In 13 pediatric patients taking ELOCTATE prophylaxis, 9 out of 9 target joints were resolved

With ELOCTATE individualized prophylaxis, children <12 experienced a decrease in ABR over 4 years of clinical data1,2,5

Over 4 years of clinical data, the median overall ABR was 2.0 (0.0-4.0) in Kids A-LONG (n=69). In ASPIRE (n=59), the median overall ABR was 1.18 (0.60-2.37) for patients aged <6 years (n=29) and 1.59 (0.55-3.55) in patients aged 6 to <12 years (n=30). The median joint ABR was 0.0 (0.0-0.0) in Kids A-LONG. In ASPIRE, the median joint AsBR was 0.0 (0.0-0.55) in patients aged <6 years and 0.0 (0.0-0.55) in patients aged 6 to <12 years. Over 4 years of clinical data, the median overall ABR was 2.0 (0.0-4.0) in Kids A-LONG (n=69). In ASPIRE (n=59), the median overall ABR was 1.18 (0.60-2.37) for patients aged <6 years (n=29) and 1.59 (0.55-3.55) in patients aged 6 to <12 years (n=30). The median joint ABR was 0.0 (0.0-0.0) in Kids A-LONG. In ASPIRE, the median joint AsBR was 0.0 (0.0-0.55) in patients aged <6 years and 0.0 (0.0-0.55) in patients aged 6 to <12 years.

In the Kids A-LONG study, individualized prophylaxis regimen: 25 IU/kg and 50 IU/kg of ELOCTATE on the first and fourth days of the week, respectively. Adjustments in dose (25 to 80 IU/kg) and interval (every 2 days or longer) were allowed based on a subject’s available PK data and observed bleeding pattern.1

In the ASPIRE study, the individualized prophylaxis regimen was 25 to 65 IU/kg every 3 to 5 days, or twice weekly (20 to 65 IU/kg on Day 1, 40 to 65 IU/kg on Day 4). In subjects <12 years of age, dose adjustments were made up to a maximum of 80 IU/kg up to every 2 days, if necessary.6

Nearly 100% of target joints† were resolved with ELOCTATE prophylaxis2‡

  • In 111 adult and adolescent patients taking ELOCTATE prophylaxis, 234 out of 235 target joints were resolved
  • In 13 pediatric patients taking ELOCTATE prophylaxis, 9 out of 9 target joints were resolved

ELOCTATE clinical trial experience demonstrated safety and efficacy in previously-treated patients1

A-LONG Pivotal Trial1,3

  • Multicenter, prospective, open-label, phase 3 study that evaluated the safety, efficacy, and PK of ELOCTATE for prophylaxis, treatment of acute bleeding, and perioperative hemostatic control
  • The primary endpoints were the safety and tolerability of ELOCTATE, and the efficacy for prophylaxis, on-demand treatment, and during surgery; key secondary endpoints were the PK profile of ELOCTATE, as well as the range of doses and schedules required to adequately prevent bleeding in a prophylaxis regimen, maintain hemostasis in a surgical setting, or treat bleeding episodes
  • Enrolled a total of 165 previously treated males aged 12 to 65 years with severe hemophilia A
    • – 118 patients received ELOCTATE twice-weekly with 25 IU/kg on day 1 and 50 IU/kg on day 4 to start, followed by 25–65 IU/kg every 3–5 days
    • – 24 patients received ELOCTATE 65 IU/kg once weekly. Patients in the weekly prophylaxis arm experienced a statistically significant reduction of 76% in mean overall ABR compared with that of the on-demand arm
    • – 23 patients received ELOCTATE 10–50 IU/kg on demand, depending on bleeding severity
  • Included 113 patients with ≥1 target joint at baseline
  • 6.0 prestudy median ABR among patients treated with prophylaxis

Kids A-LONG Pediatric Trial1,5

  • Multicenter, open-label, phase 3 study that evaluated the safety and efficacy of ELOCTATE for prophylaxis, treatment of acute bleeding, and perioperative hemostatic control
  • The primary endpoints were the development of inhibitors; key secondary endpoints included the PK profile of ELOCTATE, ABR, dose administered for treatment of a bleeding episode, and patients’ rating of response to ELOCTATE for the treatment of bleeding
  • Enrolled a total of 71 previously treated males aged <12 years with severe hemophilia A; 69 patients (1–5 years of age, n=35; 6–11 years of age, n=34) were evaluable for safety and efficacy; 61 patients (88.4%) had >50 ELOCTATE exposure days (EDs) on study
  • Included 13 patients with target joints

ASPIRE Extension Trial2,6

  • Open-label, multicenter, nonrandomized evaluation of ELOCTATE in 150 previously treated males ≥12 years of age and 61 previously treated males <12 years of age with severe hemophilia A who completed the A-LONG or Kids A-LONG pivotal trials
  • The primary endpoint was development of inhibitors (neutralizing antibodies). Key secondary endpoints included ABR, EDs, and subject’s assessment of response to treatment of a bleeding episode
  • The median duration of treatment from the beginning of A-LONG to the end of ASPIRE was 4.19 (0.003–5.86) years
  • The median duration of treatment from the beginning of Kids A-LONG to the end of ASPIRE was 3.41 (0.04–4.40) years

Additional ABR Cohorts

Median ABRs among adult and adolescent patients over 5 years of clinical data1-3

A-LONG Individualized prophylaxis (n=117) ASPIRE Individualized prophylaxis (n=110) A-LONG
On demand (n=23)
ASPIRE
On demand (n=13)
Overall ABR 1.6 (0.0–4.7) 0.74 (0.00–2.68) 33.6 (21.1–48.7) 19.10 (15.12–30.46)
Spontaneous ABR 0.0 (0.0–2.0) 0.10 (0.00–1.06) 20.2 (12.2–36.8) 14.61 (10.88–16.37)
Joint ABR 0.0 (0.0–3.1) 0.49 (0.00–1.70) 22.8 (15.1–39.0) 13.05 (7.35–26.97)
A-LONG Individualized prophylaxis (n=117) ASPIRE Individualized prophylaxis (n=110)
Overall ABR 1.6 (0.0–4.7) 0.74 (0.00–2.68)
Spontaneous ABR 0.0 (0.0–2.0) 0.10 (0.00–1.06)
Joint ABR 0.0 (0.0–3.1) 0.49 (0.00–1.70)
A-LONG on demand (n=23) ASPIRE on demand (n=13)
Overall ABR 33.6 (21.1–48.7) 19.10 (15.12–30.46)
Spontaneous ABR 20.2 (12.2–36.8) 14.61 (10.88–16.37)
Joint ABR 22.8 (15.1–39.0) 13.05 (7.35–26.97)

Median ABRs among pediatric patients over 4 years of clinical data1,2,5

Kids A-LONG (n=69) ASPIRE (n=59)
<12 years <6 years 6 to <12 years
Overall ABR 2.0
(0.0–4.0)
1.18
(0.60–2.37)
1.59
(0.55–3.55)
Spontaneous ABR 0.0
(0.0–0.0)
0.56
(0.00–0.85)
0.30
(0.00–0.89)
Joint ABR 0.0
(0.0–2.0)
0.55
(0.00–1.30)
0.66
(0.00–1.67)

Bleed Control

Nearly all bleeds were controlled with ≤2 infusions of ELOCTATE1,2

Perioperative Management

In 100% of assessed surgeries, hemostatic response with ELOCTATE was rated as “excellent” or “good”1,2*

  • For 41 major surgeries in 29 patients from A-LONG or ASPIRE, hemostatic response was assessed and rated as excellent in 38 (93%) surgeries and good in 3 (7%) surgeries
  • In 72 minor surgical procedures in 59 patients from all 3 studies, all (100%) had excellent response (61 of 72; 84.7%) or good response (11 of 72; 15.3%)

Major surgeries from A-LONG3,6

Number of Procedures Hemostatic Responseb
Type of Surgery (Number of Patients) Excellent Good
Major surgery 23a (22) 19 3
Arthrodesis 1 (1) 1
Ankle fusion 2 (2) 2
Appendectomy 1 (1) 1
Arthroscopy 2 (2) 2
Ventriculostomy 1 (1) 1
Laparoscopic hernia surgery 2 (2) 1 1
Discopathy repair 1 (1) 1
Decompression of spine stenosis 1 (1) 1
Arthroplastyc 11 (10) 9 1
Knee arthroplasty converted to amputation 1 (1) 1

aAcross A-LONG and ASPIRE, 22 patients underwent 24 major surgeries. One surgery was not evaluable because the patient received a nonstudy drug.

bResults based on a 4-point scale of excellent, good, fair, and poor/none. The median dose per infusion was 58.3 IU/kg (range, 45–102 IU/kg). The total dose on the day of surgery ranged from 50.8 to 126.6 IU/kg.

cOne surgical rating was not available.

Major Surgeries: Hemostasis was assessed in 45 surgeries in 32 subjects from the A-LONG and ASPIRE studies. There were no major surgeries in the Kids A-LONG study. Of the 45 major surgeries, 36 surgeries (80.0%) required a single perioperative dose to maintain hemostasis. Of the 42 major surgeries treated with at least one dose, the median average dose per injection to maintain hemostasis during surgery was 59.1 IU/kg (range: 35–111). On the day of surgery, most subjects received a second injection. The total dose on the day of surgery ranged from 37.6–157.9 IU/kg.1

Minor Surgeries: A hemostatic assessment of 72 minor surgical procedures in 59 subjects from all 3 studies was conducted. “Excellent” was defined as intraoperative and postoperative blood loss similar to (or less than) the nonhemophilic patient. No extra doses of rFVIIIFc needed, and blood component transfusions required are similar to nonhemophilic patient. “Good” was defined as intraoperative and/or postoperative bleeding slightly increased over expectations for the nonhemophilic patient, but the difference was not clinically significant. Intraoperative blood loss no more than 250 mL greater than expected for a nonhemophilic patient, no extra doses of rFVIIIFc needed, and blood component transfusions required are similar to nonhemophilic patient.1

ABR=annualized bleed rate; AsBR=annualized spontaneous bleed rate; PK=pharmacokinetics.

*ELOCTATE has been proven to help patients prevent bleeding episodes using a prophylaxis regimen.1

A target joint is defined as a major joint with ≥3 bleeding episodes in a consecutive 6-month period. Target joint resolution is defined as ≤2 spontaneous bleeds in a 12-month period.2

Data are from the third interim cut of ASPIRE taken on January 11, 2016. Forty-eight adult and adolescent, and 7 pediatric, patients had no target joint bleeding episodes.2

Improved joint health in subjects with severe haemophilia A treated prophylactically with recombinant factor VIII Fc fusion protein

Oldenburg J, Kulkarni R, Srivastava A, et al. Haemophilia. 2018;24(1):77-84.

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Study Design4

  • This post hoc study assessed change in joint health among 47 adult and adolescent males (≥12 years of age) with severe hemophilia A who were treated with ELOCTATE® prophylaxis
  • Subjects completed the A-LONG pivotal trial, enrolled in the ASPIRE extension study (data cutoff of December 8, 2014), and had available mHJHS data
  • Forty-seven subjects had mHJHS data at all 4 time points (A-LONG baseline, ASPIRE baseline, Year 1, Year 2)
  • Joint health assessments included the change in mHJHS from A-LONG baseline to follow-up visits and comparisons of individual mHJHS domains. In addition, factors such as target joints, weight-bearing and non–weight-bearing joints, and prestudy dosing regimen were assessed for impact on mHJHS. Negative values indicate improvement

Study Limitations4

  • Data are reported from a post hoc analysis that was not powered to show statistical significance. There was a small sample size, no control group, and potential for interobserver variability
  • The mHJHS is not yet a validated tool
  • Further studies are needed to confirm these findings as well as the effect of improvements in joint health on overall improvement in quality of life

Changes in joint health were evaluated in patients ≥12 years4

Improvement in Total mHJHS Was Observed Over Time

Improvement in total mHJHS was observed over time

From A-LONG Baseline to ASPIRE Year 2, patients treated with factor prophylaxis prior to switching to ELOCTATE (n=30) experienced a -2.4 mean (SEM) change in total mHJHS score. Patients treated with factor on-demand prior to switching to ELOCTATE (n=17) experienced a -7.2 mean (SEM) change in total mHJHS score.

Scoring range

Domain HJHS mHJHS
Duration 0-1 0-1
Swelling 0-3 0-3
Muscle atrophy 0-2 0-2
Flexion loss 0-3 0-3
Extension loss 0-3 0-3
Strength 0-4 0-4
Crepitus of motion 0-2 0-1
Joint pain 0-2 0-1
Instabilitya - 0-1
Global gaitb 0-4 0-2
Total scorec 0-124 0-116

aInstability was scored the same as in the old version of the HJHS: 0=none and 1=significant pathologic joint laxity.4

bGlobal gait was scored as follows: 0=no difficulty with walking or climbing up/down stairs; 1=no difficulty with walking, but difficulty with stairs; 2=difficulty with walking and with stairs.4

cJoint scoring was performed separately for 6 joints (left and right ankle, left and right elbow, left and right knee) with a score range of 0 to 19 plus the gait score (0–2). Score of 0=normal; score of 116=most severe disease.4

HJHS=Hemophilia Joint Health Score; mHJHS=modified Hemophilia Joint Health Score.

Improvement in Total mHJHS Was Observed Over Time

Improvement in total mHJHS was observed over time

From A-LONG Baseline to ASPIRE Year 2, patients treated with factor prophylaxis prior to switching to ELOCTATE (n=30) experienced a -2.4 mean (SEM) change in total mHJHS score. Patients treated with factor on-demand prior to switching to ELOCTATE (n=17) experienced a -7.2 mean (SEM) change in total mHJHS score.

Scoring range

Domain HJHS mHJHS
Duration 0-1 0-1
Swelling 0-3 0-3
Muscle atrophy 0-2 0-2
Flexion loss 0-3 0-3
Extension loss 0-3 0-3
Strength 0-4 0-4
Crepitus of motion 0-2 0-1
Joint pain 0-2 0-1
Instabilitya - 0-1
Global gaitb 0-4 0-2
Total scorec 0-124 0-116

aInstability was scored the same as in the old version of the HJHS: 0=none and 1=significant pathologic joint laxity.4

bGlobal gait was scored as follows: 0=no difficulty with walking or climbing up/down stairs; 1=no difficulty with walking, but difficulty with stairs; 2=difficulty with walking and with stairs.4

cJoint scoring was performed separately for 6 joints (left and right ankle, left and right elbow, left and right knee) with a score range of 0 to 19 plus the gait score (0–2). Score of 0=normal; score of 116=most severe disease.4

HJHS=Hemophilia Joint Health Score; mHJHS=modified Hemophilia Joint Health Score.

Swelling, range of motion, and strength components contributed most to changes in joint health scores4

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