Young adult outcomes of childhood prophylaxis for severe hemophilia A: Results of the joint outcome continuation study

Beth Boulden Warren, Dianne Thornhill, Jill Stein, Michael Fadell, J. David Ingram, Sharon Funk, Kristi L. Norton, Heidi D. Lane, Carolyn M. Bennett, Amy Dunn, Michael Recht, Amy Shapiro, Marilyn J. Manco-Johnson

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


The Joint Outcome Study (JOS), a randomized controlled trial, demonstrated that children with severe hemophilia A (HA) initiating prophylactic factor VIII (FVIII) prior to age 2.5 years had reduced joint damage at age 6 years compared with those treated with episodic FVIII for bleeding. The Joint Outcome Continuation Study (JOS-C) evaluated early vs delayed prophylaxis effects on long-term joint health, following JOS participants to age 18 years in an observational, partially retrospective study. Index joint magnetic resonance imaging (MRI) scores of osteochondral (OC) damage (primary outcome), joint physical examination scores, and annualized rates of joint/other bleeding episodes (secondary outcomes) were collected. Thirty-seven of 65 JOS participants enrolled in JOS-C, including 15 randomized to prophylaxis at mean age 1.3 years ("early prophylaxis"); 18 initially randomized to episodic treatment, starting "delayed prophylaxis"at mean age 7.5 years; and 4 with high-titer inhibitors. At JOS-C exit, MRI OC damage was found in 77% of those on delayed and 35% of those on early prophylaxis for an odds ratio of OC damage, in the delayed vs early prophylaxis group, of 6.3 (95% confidence interval, 1.3, 29.9; P 5 .02). Annualized bleeding rates were higher with delayed prophylaxis (mean plus or minus standard deviation, 10.6 6 6.6 vs 3.562.1; P<.001), including when only comparing time periods on prophylaxis (6.26 5.3 vs 3.3 6 1.9; P <.05). In severe HA, early initiation of prophylaxis provided continued protection against joint damage throughout childhood compared with delayed initiation, but early prophylaxis was not sufficient to fully prevent damage.

Original languageEnglish (US)
Pages (from-to)2451-2459
Number of pages9
JournalBlood Advances
Issue number11
StatePublished - Jun 9 2020

ASJC Scopus subject areas

  • Hematology


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