Rurioctocog Alfa Pegol vs. Non-factor Therapy – Report from Real Clinical Practice
The standard treatment for hemophilia A is the prophylactic administration of coagulation factor VIII (FVIII) concentrate. Recently, some hemophiliacs have also been switched to prophylaxis with so-called non-factor therapy, specifically emicizumab. A recently published report from the USA shows a comparison of these two modalities in real clinical practice.
Evaluated Data
This involves data from pharmacy databases gathered between July 2017 and May 2020. It pertains to patients with hemophilia A without inhibitors who were switched to prophylaxis with pegylated FVIII concentrate (rurioctocog alfa pegol), a product from the extended half-life (EHL) factor range, or to emicizumab, after a prior minimum 6-month prophylactic treatment with another FVIII product. Evaluated were weekly consumption, dosing frequency, amount of unused treatment, and bleeding episodes expressed as annual bleeding rate (ABR).
Results
The average weekly consumption after switching to new treatment was 6224 IU/kg for rurioctocog alfa pegol and 109 mg for emicizumab. Emicizumab was administered once weekly in 48.2% of patients and once every 14 days in 40% of patients. Most of those receiving rurioctocog alfa pegol applied the medication twice weekly (83.3%).
The average unused (unsadministered and discarded) amount of medication was significantly higher for emicizumab (8.4%) compared to rurioctocog alfa pegol (−0.3%; p < 0.001). The average annual unused amount of emicizumab reached 330.82 mg, while for rurioctocog alfa pegol it was −974.8 IU.
The average change in ABR was not significantly different between patients treated with emicizumab (−1.05) and rurioctocog alfa pegol (−1.53).
Conclusion
In patients with hemophilia A requiring prophylactic treatment, after switching to rurioctocog alfa pegol or emicizumab, the annual bleeding rate did not differ significantly according to these findings. However, the rate of unused medication was significantly higher for emicizumab, which may be an important consideration for healthcare payers.
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Source: Sun S. X., Frick A., Balasa V., Roberts J. C. Real-world study of rurioctocog alfa pegol and emicizumab in US clinical practice among patients with hemophilia A. Expert Rev Hematol 2022 Oct; 15 (10): 943–950, doi: 10.1080/17474086.2022.2112171.
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