Independent adjudicator assessments of platelet refractoriness and rFVIIa efficacy in bleeding episodes and surgeries from the multinational Glanzmann's thrombasthenia registry

Michael Recht, Madhvi Rajpurkar, Meera Chitlur, Roseline d'Oiron, Rainer Zotz, Giovanni Di Minno, David L. Cooper, Man Chiu Poon

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Glanzmann's thrombasthenia (GT) is a rare congenital bleeding disorder associated with decreased platelet aggregation due to qualitative/quantitative deficiencies of the fibrinogen receptor. Severe bleeding episodes and perioperative bleeding are typically managed with platelet transfusions, although patients can develop anti-platelet antibodies or experience clinical refractoriness. The GT Registry (GTR) was established to collect efficacy/safety data on hemostatic treatments for GT, including recombinant factor VIIa (rFVIIa). At the request of the United States Food and Drug Administration, three hematology experts evaluated platelet refractoriness, antibody status, and rFVIIa efficacy data on a case-by-case basis to support a potential indication for rFVIIa in GT. Adjudication included 195 patients with 810 events (619 severe bleeding episodes, 192 surgeries), and a consensus algorithm was developed to describe adjudicators' coding of refractoriness and antibody status based on treatment patterns over time. Most rFVIIa-treated events were in patients without refractoriness or antibodies. Adjudicators rated most rFVIIa-treated bleeding episodes as successful (251/266, 94.4%; rFVIIa only, 101/109, 92.7%; rFVIIa ± platelets ± other agents, 150/157, 95.5%); efficacy was consistent in patients with platelet refractoriness ± antibodies (75/79, 94.9%), antibodies only (10/10, 100.0%), and neither/unknown (166/177, 93.8%). Adjudicators also rated most rFVIIa-treated surgeries as successful (159/160, 99.4%; rFVIIa only, 65/66, 98.5%; rFVIIa ± platelets ± other agents, 94/94, 100.0%); efficacy was consistent in patients with platelet refractoriness ± antibodies (69/70, 98.6%), antibodies only (24/24, 100.0%), and neither/unknown (66/66, 100.0%). Unblinding the adjudicators to investigator efficacy ratings changed few assessments. Doses of rFVIIa were narrowly distributed, regardless of other hemostatic agents used.

Original languageEnglish (US)
Pages (from-to)646-652
Number of pages7
JournalAmerican Journal of Hematology
Volume92
Issue number7
DOIs
StatePublished - Jul 1 2017

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Thrombasthenia
Registries
Blood Platelets
Hemorrhage
Antibodies
Hemostatics
recombinant FVIIa
Fibrinogen Receptors
Congenital, Hereditary, and Neonatal Diseases and Abnormalities
Platelet Transfusion
Hematology
United States Food and Drug Administration
Platelet Aggregation
Anti-Idiotypic Antibodies

ASJC Scopus subject areas

  • Hematology

Cite this

Independent adjudicator assessments of platelet refractoriness and rFVIIa efficacy in bleeding episodes and surgeries from the multinational Glanzmann's thrombasthenia registry. / Recht, Michael; Rajpurkar, Madhvi; Chitlur, Meera; d'Oiron, Roseline; Zotz, Rainer; Di Minno, Giovanni; Cooper, David L.; Poon, Man Chiu.

In: American Journal of Hematology, Vol. 92, No. 7, 01.07.2017, p. 646-652.

Research output: Contribution to journalArticle

Recht, Michael ; Rajpurkar, Madhvi ; Chitlur, Meera ; d'Oiron, Roseline ; Zotz, Rainer ; Di Minno, Giovanni ; Cooper, David L. ; Poon, Man Chiu. / Independent adjudicator assessments of platelet refractoriness and rFVIIa efficacy in bleeding episodes and surgeries from the multinational Glanzmann's thrombasthenia registry. In: American Journal of Hematology. 2017 ; Vol. 92, No. 7. pp. 646-652.
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abstract = "Glanzmann's thrombasthenia (GT) is a rare congenital bleeding disorder associated with decreased platelet aggregation due to qualitative/quantitative deficiencies of the fibrinogen receptor. Severe bleeding episodes and perioperative bleeding are typically managed with platelet transfusions, although patients can develop anti-platelet antibodies or experience clinical refractoriness. The GT Registry (GTR) was established to collect efficacy/safety data on hemostatic treatments for GT, including recombinant factor VIIa (rFVIIa). At the request of the United States Food and Drug Administration, three hematology experts evaluated platelet refractoriness, antibody status, and rFVIIa efficacy data on a case-by-case basis to support a potential indication for rFVIIa in GT. Adjudication included 195 patients with 810 events (619 severe bleeding episodes, 192 surgeries), and a consensus algorithm was developed to describe adjudicators' coding of refractoriness and antibody status based on treatment patterns over time. Most rFVIIa-treated events were in patients without refractoriness or antibodies. Adjudicators rated most rFVIIa-treated bleeding episodes as successful (251/266, 94.4{\%}; rFVIIa only, 101/109, 92.7{\%}; rFVIIa ± platelets ± other agents, 150/157, 95.5{\%}); efficacy was consistent in patients with platelet refractoriness ± antibodies (75/79, 94.9{\%}), antibodies only (10/10, 100.0{\%}), and neither/unknown (166/177, 93.8{\%}). Adjudicators also rated most rFVIIa-treated surgeries as successful (159/160, 99.4{\%}; rFVIIa only, 65/66, 98.5{\%}; rFVIIa ± platelets ± other agents, 94/94, 100.0{\%}); efficacy was consistent in patients with platelet refractoriness ± antibodies (69/70, 98.6{\%}), antibodies only (24/24, 100.0{\%}), and neither/unknown (66/66, 100.0{\%}). Unblinding the adjudicators to investigator efficacy ratings changed few assessments. Doses of rFVIIa were narrowly distributed, regardless of other hemostatic agents used.",
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