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Bleeding Incidence in VWD Patients Undergoing On-Demand Treatment

A Prospective, Multicenter, Non-Interventional Study Evaluating the Bleeding Incidence in Patients With Von Willebrand Disease Undergoing On-Demand Treatment

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT04053699
Enrollment
56
Registered
2019-08-12
Start date
2019-06-25
Completion date
2021-01-31
Last updated
2023-12-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Von Willebrand Diseases

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

DRUGVon Willebrand Factor-Containing Product

Active substances: VWF concentrates, VWF/FVIII concentrates, Cryoprecipitate VWF-containing products licensed in each participating country

Sponsors

Octapharma
Lead SponsorINDUSTRY

Study design

Observational model
COHORT
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
66 Months to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
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

MeasureTime frameDescription
Consumption of the VWF-containing ProductScreening 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 ScaleScreening 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 AssessmentFrom 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 visitQoL 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 screeningQoL 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 screeningJoint 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) ScoreScreening 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 WilateScreening 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 visitQoL 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

ArmCount
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
Total56

Baseline characteristics

CharacteristicPatients 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 typeEG000
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

Primary

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)

ArmMeasureValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductTotal Annualized Bleeding Rate (TABR)29.13 Bleeding events per yearStandard Deviation 22.925
Secondary

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

ArmMeasureValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductConsumption of the VWF-containing Product77.94 IUs per kg per month per patientStandard Deviation 67.898
Secondary

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

ArmMeasureValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductJoint Health Status Assessed Using Hemophilia Joint Health Score (HJHS)6.76 Units on a scaleStandard Deviation 14.611
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC01521.7 Units on a scaleStandard Deviation 790.96
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC02279.2 Units on a scaleStandard Deviation 219.69
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC03311.0 Units on a scaleStandard Deviation 261.98
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC04408.8 Units on a scaleStandard Deviation 471.92
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC05289.9 Units on a scaleStandard Deviation 267.53
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC06330.4 Units on a scaleStandard Deviation 327.02
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC07411.6 Units on a scaleStandard Deviation 314.99
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC08348.5 Units on a scaleStandard Deviation 102.53
Patients Undergoing On-demand Treatment With a VWF-containing ProductMenstrual Bleeding Assessed Using Pictorial Blood Loss Assessment Chart (PBAC) ScoreMC09361.5 Units on a scaleStandard Deviation 400.93
Secondary

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

ArmMeasureGroupValue (NUMBER)
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Bleeding Episodes (BEs) Based on a 4-point Efficacy ScaleExcellent450 Number of Bleeding Episodes
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Bleeding Episodes (BEs) Based on a 4-point Efficacy ScaleGood6 Number of Bleeding Episodes
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Bleeding Episodes (BEs) Based on a 4-point Efficacy ScaleModerate1 Number of Bleeding Episodes
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Bleeding Episodes (BEs) Based on a 4-point Efficacy ScaleNone0 Number of Bleeding Episodes
Secondary

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

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Participants With Adverse Drug Reactions (ADRs) Associated With Use of Wilate0 Participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Surgery With Successful/Unsuccessful Efficacy AssessmentExcellent7 Surgeries
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Surgery With Successful/Unsuccessful Efficacy AssessmentGood0 Surgeries
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Surgery With Successful/Unsuccessful Efficacy AssessmentModerate0 Surgeries
Patients Undergoing On-demand Treatment With a VWF-containing ProductNumber of Surgery With Successful/Unsuccessful Efficacy AssessmentPoor0 Surgeries
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 10-item Short Form Health Survey (SF-10)Physical Summary Score28.60 Units on a scaleStandard Deviation 14.961
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 10-item Short Form Health Survey (SF-10)Psychosocial Summary Score46.56 Units on a scaleStandard Deviation 9.428
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Bodily Pain49.87 Units on a scaleStandard Deviation 27.304
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)General Health49.45 Units on a scaleStandard Deviation 21.857
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Mental Health62.74 Units on a scaleStandard Deviation 16.923
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Physical Functioning64.03 Units on a scaleStandard Deviation 24.509
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Role Emotional62.63 Units on a scaleStandard Deviation 27.035
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Role Physical51.21 Units on a scaleStandard Deviation 25.435
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Social Functioning64.52 Units on a scaleStandard Deviation 24.173
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using a 36-Item Short Form Health Survey, Version 2 (SF-36v2)Vitality58.06 Units on a scaleStandard Deviation 18.128
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Physical Function47.24 T-ScoresStandard Deviation 7.947
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Anxiety/Fear53.57 T-ScoresStandard Deviation 9.941
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Depression/Sadness49.96 T-ScoresStandard Deviation 9.265
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Fatigue49.77 T-ScoresStandard Deviation 11.202
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Sleep Disturbance49.81 T-ScoresStandard Deviation 10.373
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Ability to Participate in Social Roles/Activities52.78 T-ScoresStandard Deviation 9.817
Patients Undergoing On-demand Treatment With a VWF-containing ProductQuality of Life (QoL) Assessed Using the Patient-Reported Outcomes Measurement Information System (PROMIS-29)Pain Interference53.87 T-ScoresStandard Deviation 11.134
Secondary

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)

ArmMeasureValue (MEAN)Dispersion
Patients Undergoing On-demand Treatment With a VWF-containing ProductSpontaneous Annualized Bleeding Rate (SABR)21.19 Bleeding events per yearStandard Deviation 19.337

Source: ClinicalTrials.gov · Data processed: Feb 7, 2026