Von Willebrand Diseases
Conditions
Brief summary
The purpose of this study is to prospectively obtain reliable data on the bleeding and treatment pattern of patients with VWD undergoing on-demand treatment with a VWF-containing product over a period of 6 months. The data obtained will be used as a basis for historical comparisons with the bleeding and treatment pattern obtained from a clinical study on the efficacy of prophylactic treatment with a VWF/FVIII concentrate.
Interventions
Active substances: VWF concentrates, VWF/FVIII concentrates, Cryoprecipitate VWF-containing products licensed in each participating country
Sponsors
Study design
Eligibility
Inclusion criteria
Patients who meet all of the following criteria are eligible for the study: * Male or female patients aged ≥5.5 years at the time of enrolment * VWD type 1 (baseline von Willebrand factor activity \[VWF:RCo\], \<30 IU/dL), 2A, 2B, 2M, or 3 according to medical history requiring substitution therapy with a VWF-containing product to control bleeding * Currently receiving frequent on-demand treatment with a VWF-containing product * In female patients of child-bearing potential using hormonal contraception, the medication class should remain unchanged for the duration of their study participation * Voluntarily given, fully informed written and signed consent obtained before collection of any patient data
Exclusion criteria
Patients who meet any of the following criteria are not eligible for the study: * Patients currently on prophylaxis for VWD (except for perioperative prophylaxis) as well as patients having received treatment once a month for menstrual bleeding, but not for any other bleeds * Patients whose VWD treatment is planned to be switched from on-demand to prophylactic treatment in the next 6 months * History, or current suspicion, of VWF or FVIII inhibitors * Medical history of a thromboembolic event within 6 months before enrolment * Severe liver or kidney diseases as described in the medical records * Female patients with an existing or suspected pregnancy or who are breast-feeding at the time of enrolment * Change in hormonal contraception within 6 months before enrolment * Cervical or uterine conditions causing abnormal uterine bleeding (including infection or dysplasia) * Other coagulation disorders or bleeding disorders due to anatomical reasons * Participation in an interventional clinical study during the 6-month of study period * Inability to complete the patient diary to reliably evaluate the type, frequency, and treatment of BEs during the 6-month study period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Annualized Bleeding Rate (TABR) | Screening through study completion (6 months) | The total annualized bleeding rate (TABR) will be calculated as the total number of spontaneous bleeds, traumatic BEs, and other BEs occurring in the time period between the start of data collection for each patient and the Study Completion Visit, divided by the duration (in years) between the start of data collection and the Study Completion Visit. Surgery periods, and BEs occurring within these surgery periods, will be excluded from the calculation of TABR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Consumption of the VWF-containing Product | Screening through study completion (6 months) | Data on the consumption of the VWF-containing product (VWF/FVIII IU/kg per month per patient) used for routine on-demand treatment |
| Number of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | Screening through study completion (6 months) | The efficacy assessment of bleeding episodes at the end of a BE was evaluated on a 4 point scale by the patient/legal guardian (together with the Investigator in case of on-site treatment) including the four items 'excellent,' 'good,' moderate,' and 'none.' The assessment was excellent when bleeding was completely stopped within 3 days in case of minor bleed, within 7 days in case of major bleed, and within 10 days in case of gastrointestinal bleed; Good when bleeding was completely stopped, but time and/or dose slightly exceeded expectations ; Moderate when bleeding could be stopped only by significantly exceeding time and/or dose expectations; and None when bleeding could be stopped only by using other VWF-containing products. |
| Number of Surgery With Successful/Unsuccessful Efficacy Assessment | From start of surgery until end of post-operative period (within 8 days after surgery) | Effectiveness of VWF-containing product in surgical prophylaxis based on the proportion of surgeries successfully treated. Overall treatment efficacy will be assessed at the end of the postoperative period by the treating physician using predefined criteria of 'Excellent', 'Good', 'Moderate/Poor' or 'None'. |
| Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | At screening visit | QoL assessment based on the results from the PROMIS-29 survey to monitor and evaluate the physical, mental, and social health in all patients, using a scale of a minimum score of 0 and a maximum score of 10, with higher scores representing a better outcome. The survey covers seven domains from the most relevant areas of self-reported health (depression, anxiety, physical function, pain interference, fatigue, sleep disturbance and ability to participate in social roles and activities) for the majority of people with chronic illness. PROMIS scores have a mean of 50 and standard deviation (SD) of 10 in a referent population. Full details of cut off points for each domain can be found here: https://www.healthmeasures.net/score-and-interpret/interpret-scores/promis/promis-score-cut-points |
| Spontaneous Annualized Bleeding Rate (SABR) | Screening through study completion (6 months) | Spontaneous annualized bleeding rate (SABR), calculated in analogy with TABR. This includes all bleeding episodes that occurred spontaneously. |
| Quality of Life (QoL) Assessed Using a 10-item Short Form Health Survey (SF-10) | At screening | QoL assessment based on the results from a SF-10 parent-completed questionnaire for patients ≥5.5 and \<16 years of age, in order to score physical and psychosocial health. SF-10 uses norm-based scoring where scales have a standardized mean value of 50 and standard deviation of 10. |
| Joint Health Status Assessed Using Hemophilia Joint Health Score (HJHS) | At screening | Joint health status will be assessed using the Hemophilia Joint Health Score (HJHS), which has been specifically validated for the assessment of the clinical outcome in VWD. HJHS evaluates six index joints to produce a score between 0-124. Higher scores indicate worse joint health. |
| Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | Screening through study completion (6 months) | Bleeding information from each menstrual period while in this study will be collected using the Pictorial Blood Loss Assessment Chart (PBAC). The PBAC will be provided to all female patients of child-bearing potential. The data documented in the PBAC and the investigator-calculated final score will be recorded in the eCRF. The PBAC records pad and tampon use (as either light \[1 point\], medium \[5 points\], or heavy \[10 points\] flow), clots (small \[1 point\] or large \[5 points\]), and flooding episodes (1 point each) which can be recorded as many times as necessary any day of the month. The PBAC is scored from 0 (no bleeding) onwards, with a score of \>100 defining abnormal coagulation and heavy menstrual bleeding (corresponds to \>80ml of blood loss per menstrual cycle). |
| Number of Participants With Adverse Drug Reactions (ADRs) Associated With Use of Wilate | Screening through study completion (6 months) | Noxious and unintended reactions arising from the use of Wilate will be monitored throughout the study. |
| Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | At screening visit | QoL assessment based on the results from the SF-36v2 questionnaire to measure functional health and well-being in patients ≥16 years. SF-36v2 ranks 8 different domains using a scale standardized with a scoring algorithm to obtain a score ranging from 0 to 100.The eight health domains include physical functioning (PF), role physical (RP), bodily pain (BP), general health problems (GH), vitality (VT), social functioning (SF), role emotional (RE) and general mental health (MH). Higher scores indicate better health status, and a mean score of 50 has been articulated as a normative value for all scales. |
Countries
Belarus, Bulgaria, Croatia, Hungary, Lebanon, Russia, Ukraine, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product Patients with type 3, type 2 (except 2N), or severe type 1 VWD undergoing routine on-demand treatment with a VWF-containing product over a period of 6 months
VWF-containing products: Active substances: VWF concentrates, VWF/FVIII concentrates, Cryoprecipitate VWF-containing products licensed in each participating country | 56 |
| Total | 56 |
Baseline characteristics
| Characteristic | Patients Undergoing On-demand Treatment With a VWF-containing Product |
|---|---|
| Age, Customized 12-16 years | 16 Participants |
| Age, Customized >16 years | 25 Participants |
| Age, Customized 6-11 years | 15 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 55 Participants |
| Sex: Female, Male Female | 25 Participants |
| Sex: Female, Male Male | 31 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 51 |
| other Total, other adverse events | 0 / 51 |
| serious Total, serious adverse events | 0 / 51 |
Outcome results
Total Annualized Bleeding Rate (TABR)
The total annualized bleeding rate (TABR) will be calculated as the total number of spontaneous bleeds, traumatic BEs, and other BEs occurring in the time period between the start of data collection for each patient and the Study Completion Visit, divided by the duration (in years) between the start of data collection and the Study Completion Visit. Surgery periods, and BEs occurring within these surgery periods, will be excluded from the calculation of TABR.
Time frame: Screening through study completion (6 months)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Total Annualized Bleeding Rate (TABR) | 29.13 Bleeding events per year | Standard Deviation 22.925 |
Consumption of the VWF-containing Product
Data on the consumption of the VWF-containing product (VWF/FVIII IU/kg per month per patient) used for routine on-demand treatment
Time frame: Screening through study completion (6 months)
Population: Four subjects were not treated with VCP, for two subjects the dose administered is unknown for all infusions
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Consumption of the VWF-containing Product | 77.94 IUs per kg per month per patient | Standard Deviation 67.898 |
Joint Health Status Assessed Using Hemophilia Joint Health Score (HJHS)
Joint health status will be assessed using the Hemophilia Joint Health Score (HJHS), which has been specifically validated for the assessment of the clinical outcome in VWD. HJHS evaluates six index joints to produce a score between 0-124. Higher scores indicate worse joint health.
Time frame: At screening
Population: 37 patients from 42 patients in the PP set completed HJHS
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Joint Health Status Assessed Using Hemophilia Joint Health Score (HJHS) | 6.76 Units on a scale | Standard Deviation 14.611 |
Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score
Bleeding information from each menstrual period while in this study will be collected using the Pictorial Blood Loss Assessment Chart (PBAC). The PBAC will be provided to all female patients of child-bearing potential. The data documented in the PBAC and the investigator-calculated final score will be recorded in the eCRF. The PBAC records pad and tampon use (as either light \[1 point\], medium \[5 points\], or heavy \[10 points\] flow), clots (small \[1 point\] or large \[5 points\]), and flooding episodes (1 point each) which can be recorded as many times as necessary any day of the month. The PBAC is scored from 0 (no bleeding) onwards, with a score of \>100 defining abnormal coagulation and heavy menstrual bleeding (corresponds to \>80ml of blood loss per menstrual cycle).
Time frame: Screening through study completion (6 months)
Population: All subjects of child bearing potential who experienced menstrual cycle
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC01 | 521.7 Units on a scale | Standard Deviation 790.96 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC02 | 279.2 Units on a scale | Standard Deviation 219.69 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC03 | 311.0 Units on a scale | Standard Deviation 261.98 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC04 | 408.8 Units on a scale | Standard Deviation 471.92 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC05 | 289.9 Units on a scale | Standard Deviation 267.53 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC06 | 330.4 Units on a scale | Standard Deviation 327.02 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC07 | 411.6 Units on a scale | Standard Deviation 314.99 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC08 | 348.5 Units on a scale | Standard Deviation 102.53 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Menstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) Score | MC09 | 361.5 Units on a scale | Standard Deviation 400.93 |
Number of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale
The efficacy assessment of bleeding episodes at the end of a BE was evaluated on a 4 point scale by the patient/legal guardian (together with the Investigator in case of on-site treatment) including the four items 'excellent,' 'good,' moderate,' and 'none.' The assessment was excellent when bleeding was completely stopped within 3 days in case of minor bleed, within 7 days in case of major bleed, and within 10 days in case of gastrointestinal bleed; Good when bleeding was completely stopped, but time and/or dose slightly exceeded expectations ; Moderate when bleeding could be stopped only by significantly exceeding time and/or dose expectations; and None when bleeding could be stopped only by using other VWF-containing products.
Time frame: Screening through study completion (6 months)
Population: 39 patients who received VWF-containing product in the treatment of BEs
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | Excellent | 450 Number of Bleeding Episodes |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | Good | 6 Number of Bleeding Episodes |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | Moderate | 1 Number of Bleeding Episodes |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Bleeding Episodes (BEs) Based on a 4-point Efficacy Scale | None | 0 Number of Bleeding Episodes |
Number of Participants With Adverse Drug Reactions (ADRs) Associated With Use of Wilate
Noxious and unintended reactions arising from the use of Wilate will be monitored throughout the study.
Time frame: Screening through study completion (6 months)
Population: All participants that were treated with at least one dose of a VWF-containing product
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Participants With Adverse Drug Reactions (ADRs) Associated With Use of Wilate | 0 Participants |
Number of Surgery With Successful/Unsuccessful Efficacy Assessment
Effectiveness of VWF-containing product in surgical prophylaxis based on the proportion of surgeries successfully treated. Overall treatment efficacy will be assessed at the end of the postoperative period by the treating physician using predefined criteria of 'Excellent', 'Good', 'Moderate/Poor' or 'None'.
Time frame: From start of surgery until end of post-operative period (within 8 days after surgery)
Population: 6 patients had 7 surgeries that were treated with VWF
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Surgery With Successful/Unsuccessful Efficacy Assessment | Excellent | 7 Surgeries |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Surgery With Successful/Unsuccessful Efficacy Assessment | Good | 0 Surgeries |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Surgery With Successful/Unsuccessful Efficacy Assessment | Moderate | 0 Surgeries |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Number of Surgery With Successful/Unsuccessful Efficacy Assessment | Poor | 0 Surgeries |
Quality of Life (QoL) Assessed Using a 10-item Short Form Health Survey (SF-10)
QoL assessment based on the results from a SF-10 parent-completed questionnaire for patients ≥5.5 and \<16 years of age, in order to score physical and psychosocial health. SF-10 uses norm-based scoring where scales have a standardized mean value of 50 and standard deviation of 10.
Time frame: At screening
Population: 25 subjects completed SF-10 questionnaire
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 10-item Short Form Health Survey (SF-10) | Physical Summary Score | 28.60 Units on a scale | Standard Deviation 14.961 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 10-item Short Form Health Survey (SF-10) | Psychosocial Summary Score | 46.56 Units on a scale | Standard Deviation 9.428 |
Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)
QoL assessment based on the results from the SF-36v2 questionnaire to measure functional health and well-being in patients ≥16 years. SF-36v2 ranks 8 different domains using a scale standardized with a scoring algorithm to obtain a score ranging from 0 to 100.The eight health domains include physical functioning (PF), role physical (RP), bodily pain (BP), general health problems (GH), vitality (VT), social functioning (SF), role emotional (RE) and general mental health (MH). Higher scores indicate better health status, and a mean score of 50 has been articulated as a normative value for all scales.
Time frame: At screening visit
Population: 31 patients complete SF-36 questionnaire
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Bodily Pain | 49.87 Units on a scale | Standard Deviation 27.304 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | General Health | 49.45 Units on a scale | Standard Deviation 21.857 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Mental Health | 62.74 Units on a scale | Standard Deviation 16.923 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Physical Functioning | 64.03 Units on a scale | Standard Deviation 24.509 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Role Emotional | 62.63 Units on a scale | Standard Deviation 27.035 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Role Physical | 51.21 Units on a scale | Standard Deviation 25.435 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Social Functioning | 64.52 Units on a scale | Standard Deviation 24.173 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2) | Vitality | 58.06 Units on a scale | Standard Deviation 18.128 |
Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)
QoL assessment based on the results from the PROMIS-29 survey to monitor and evaluate the physical, mental, and social health in all patients, using a scale of a minimum score of 0 and a maximum score of 10, with higher scores representing a better outcome. The survey covers seven domains from the most relevant areas of self-reported health (depression, anxiety, physical function, pain interference, fatigue, sleep disturbance and ability to participate in social roles and activities) for the majority of people with chronic illness. PROMIS scores have a mean of 50 and standard deviation (SD) of 10 in a referent population. Full details of cut off points for each domain can be found here: https://www.healthmeasures.net/score-and-interpret/interpret-scores/promis/promis-score-cut-points
Time frame: At screening visit
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Physical Function | 47.24 T-Scores | Standard Deviation 7.947 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Anxiety/Fear | 53.57 T-Scores | Standard Deviation 9.941 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Depression/Sadness | 49.96 T-Scores | Standard Deviation 9.265 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Fatigue | 49.77 T-Scores | Standard Deviation 11.202 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Sleep Disturbance | 49.81 T-Scores | Standard Deviation 10.373 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Ability to Participate in Social Roles/Activities | 52.78 T-Scores | Standard Deviation 9.817 |
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Quality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) | Pain Interference | 53.87 T-Scores | Standard Deviation 11.134 |
Spontaneous Annualized Bleeding Rate (SABR)
Spontaneous annualized bleeding rate (SABR), calculated in analogy with TABR. This includes all bleeding episodes that occurred spontaneously.
Time frame: Screening through study completion (6 months)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patients Undergoing On-demand Treatment With a VWF-containing Product | Spontaneous Annualized Bleeding Rate (SABR) | 21.19 Bleeding events per year | Standard Deviation 19.337 |