A systematic overview of the first pasteurised VWF/FVIII medicinal product, Haemate^®P/ Humate^®‐P: History and clinical performance

Abstract

Patients with von Willebrand disease (VWD) and haemophilia A (HA) lack, to varying degrees, the von Willebrand factor (VWF) and coagulation factor VIII (FVIII) that are critical for normal haemostasis. These conditions in turn make patients prone to uncontrolled bleeding. Historically, patients with severe forms of VWD or HA were crippled before adulthood and their life expectancy was significantly reduced. Over the past decades, specific coagulation factor replacement therapies including Haemate Ò P, have been developed to help patients achieve and maintain normal haemostasis. Haemate Ò P is a human, plasma-derived VWF ⁄ FVIII medicinal product, which was first licensed in Germany in 1981 for the treatment of HA-associated bleeding. It has since then come to be accepted as the gold standard for both the treatment and prophylaxis of bleeding in VWD, especially in cases where desmopressin [1-deamino-8-D-arginine vasopressin (DDAVP)] has been ineffective. Haemate Ò P was the first effectively virus-inactivated (pasteurisation: 60°C for 10 h in aqueous solution) FVIII product, whereby the risk of potentially threatening infective complications of plasma-derived products was reduced. Haemate Ò P was also shown to have a VWF multimer profile remarkably close to that of normal plasma. This bibliographic review presents previously unpublished clinical data of Haemate Ò P, based upon internal clinical study reports of the proprietor, CSL Behring, in addition to data already presented in other publications. The data demonstrate a predictable and well-characterised pharmacokinetic profile, and a proven record of short-and long-term safety, while effectively correcting the haemostatic defects in VWD and HA. Recently available data have also shown Haemate Ò P to be of haemostatic value in exceptional clinical circumstances including surgical interventions. By virtue of its plasma-derived combination of VWF and FVIII, in addition to its high VWF:FVIII content ratio (2.4:1), Haemate Ò P is also associated with successful immune tolerance induction in those patients developing inhibitor antibodies. Although the theoretical risk of thromboembolic complications does exist while receiving Haemate Ò P, as it does with any FVIII replacement therapy, the incidence of such complications has remained notably low. Given the robust data that have accumulated for the use of Haemate Ò P, dosing recommendations are also described in this review; the recommendations are tailored to patient-specific contexts including baseline VWF and FVIII levels in plasma and the type of surgical intervention being undertaken. A wide variety of studies have also provided data on paediatric and geriatric populations, all of which have suggested that Haemate Ò P can be safely and effectively used in a wide variety of clinical circumstances. Effective haemostasis requires complex bodily processes such as vasoconstriction and blood clotting so as to ensure the integrity of the blood vessel system and to prevent excessive blood loss following injury. B...

Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

“…Plasma-derived or recombinant human FVIII concentrates can be used in patients with low-titer inhibitors, which should be administered at doses sufficient to overwhelm the inhibitor and thus achieve hemostatic levels of factor VIII [2]. Hemostasis can usually be achieved if plasma levels are raised from 30% to 50% [9,10]. Although Humate-P has been used extensively for treatment of von Willebrand disease, experience with its use in factor VIII inhibitor remains very limited [9,10].…”

“…Hemostasis can usually be achieved if plasma levels are raised from 30% to 50% [9,10]. Although Humate-P has been used extensively for treatment of von Willebrand disease, experience with its use in factor VIII inhibitor remains very limited [9,10]. According to recent recommendations, human plasma-derived or recombinant FVIII concentrates can be used in acquired hemophilia for the treatment of minor bleeding manifestations and acute bleeding episodes when the inhibitor titer is low (≤ 5BU) [2], and no bypassing agent is immediately available, as was the case with our patient.…”

[Cost-minimization analysis of replacement therapy in the treatment of von Willebrand disease]

“…Tra i concentrati contenenti FVIII e VWF attualmente disponibili, Haemate P ® , un concentrato plasmaderivato purificato mediante precipitazione multipla e inattivato mediante pastorizzazione, è il prodotto che presenta la più elevata quantità di VWF:RCo (VWF:RCo/FVIII:C = 2.400 UI/1.000 UI) ed è caratterizzato dalla presenza di un'elevata proporzione di multimeri ad alto peso molecolare, che svolgono un ruolo essenziale nell'emostasi primaria, mentre quelli a peso molecolare minore sono funzionalmente meno attivi [11,15]. Sebbene il rischio di complicanze tromboemboliche è da tenere in considerazione durante il trattamento con Haemate P ® , è stato evidenziato che, in virtù dell'elevato rapporto VWF:RCo/FVIII:C, in questi pazienti il rischio di tali complicanze è inferiore rispetto ad altri concentrati [16].…”

Successful Ultrasound-Guided Femoral Nerve Blockade and Catheterization in a Patient with Von Willebrand Disease

“…Humate-P is a human plasma-derived vWF/FVIII concentrate with an extensive, three-decade track record of no thrombosis and no cases of viral transmission [12, 13]. It is recommended for surgical prophylaxis and spontaneous bleeding treatment in all types of vWD and in vWD cases that are refractory to desmopressin.…”