39 year old male
Switched to ALTUVIIIO: August 2024
Sean, who had severe hemophilia A, presented for a left total knee arthroplasty (TKA) secondary to joint damage from chronic hemarthroses.
Patient Information
- Diagnosed at age 4 but had intermittent access to factor therapy for many years, leading to multiple joint bleeds
- Used factor on-demand until 2017 due to limited treatment access when growing up outside of the US
- Was enrolled in a gene therapy trial in 2019
- Currently treats with factor-mimetic prophylaxis and on-demand EHL therapy
- Tried EHL prophylaxis prior to current regimen
- Type 2 diabetes
- Hypertension
- Hyperlipidemia
- Obesity
- Beta thalassemia minor
- Surgeries
- Right TKA (2023)
- Right knee radiofrequency ablation (2020, 2021)
- Right knee steroid injection (2020)
- First in family to be diagnosed with hemophilia A
- BP: 148/95
- BMI: 42.3
- HR: 80
- Significant joint deformities in both knees; left knee swollen, warm to touch, and decreased capacity for flexion; and altered gait
- Baseline (diagnosis at age 4) factor level <1%
- 2017: Inhibitor titer negative
- January 2024: Chromogenic level 6.7%
Sean’s Path to High Sustained Factor Replacement Therapy, ALTUVIIIO
Diagnosis
- Sean was diagnosed with hemophilia A (FVIII <1%) at age 4 via a bleeding disorder workup after suffering a swollen knee with bloody arthrocentesis
After diagnosis
- Throughout his life, Sean experienced multiple joint bleeds
- Had limited treatment access, but obtained several boxes of factor (per patient history, factor type is unclear) that he used for on-demand therapy
- Over a span of 5 years, Sean tried multiple therapies:
- 2017-2019: Twice-weekly EHL prophylaxis
- 2019: Gene therapy trial enrollment
- Early 2022: EHL prophylaxis
- Late 2022: Factor-mimetic prophylaxis with on-demand EHL therapy
- His limited access to prophylactic treatment earlier in life ultimately led to arthropathies, severe joint damage, and bilateral TKAs (2023 right TKA, supported by pre- and postoperative EHL therapy)
Before ALTUVIIIO
- Sean presented for left TKA
- Previously treating prophylactically with factor-mimetic therapy and on-demand with EHL therapy
Surgical experience
Acute management
- 3/6/24: Underwent a left TKA
- Infused postoperatively on Day 3 (3/9), Day 5 (3/11), and Day 15 (3/21)
Postoperative clinical course
- 8/19/24: Experienced 2 spontaneous left knee bleeds that were resolved with ALTUVIIIO
After ALTUVIIIO
Switched to ALTUVIIIO: August 2024
- Compared to his first total knee replacement, Sean experienced lower perioperative infusion burden with his first postoperative dose on Day 3
- He completed PT 5 days postoperatively and continued 3 times per week for 8 weeks with no functional limitations
- Five months after surgery, Sean switched from factor-mimetic prophylaxis to once-weekly ALTUVIIIO prophylaxis
- He currently does PT at home and would like to be more active
Do you have patients like Sean?
If so, it may be worth it to consider the following:
How good is good enough?
What considerations would you take into account for perioperative management for a patient like Sean?
Choosing the right treatment
How would you discuss switching to a treatment option like ALTUVIIIO with patients like Sean?
Unlocking high sustained factor levels
Do you think Sean could benefit from perioperative ALTUVIIIO?
BMI=body mass index; BP=blood pressure; EHL=extended half-life; FVIII=Factor VIII; HR=heart rate; PT=physical therapy; SHL=standard half-life; TKA=total knee arthroplasty.
Other ALTUVIIIO patients who made the switch!
Meet Henry
A 14 year old student and avid baseball player with severe hemophilia A, previously treating with factor-mimetic prophylaxis and an on-demand SHL therapy.
Meet Aaron
A 13 year old student and flag-football player with severe hemophilia A previously on SHL prophylaxis therapy.
Indication
Reference: 1. ALTUVIIIO Prescribing Information. Bioverativ Therapeutics Inc. Waltham, MA.
