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Randomized Controlled Trial
. 2007 Aug 9;357(6):535-44.
doi: 10.1056/NEJMoa067659.

Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia

Marilyn J Manco-Johnson  1 , Thomas C Abshire, Amy D Shapiro, Brenda Riske, Michele R Hacker, Ray Kilcoyne, J David Ingram, Michael L Manco-Johnson, Sharon Funk, Linda Jacobson, Leonard A Valentino, W Keith Hoots, George R Buchanan, Donna DiMichele, Michael Recht, Deborah Brown, Cindy Leissinger, Shirley Bleak, Alan Cohen, Prasad Mathew, Alison Matsunaga, Desiree Medeiros, Diane Nugent, Gregory A Thomas, Alexis A Thompson, Kevin McRedmond, J Michael Soucie, Harlan Austin, Bruce L Evatt
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Free article
Randomized Controlled Trial

Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia

Marilyn J Manco-Johnson et al. N Engl J Med. .
Free article

Abstract

Background: Effective ways to prevent arthropathy in severe hemophilia are unknown.

Methods: We randomly assigned young boys with severe hemophilia A to regular infusions of recombinant factor VIII (prophylaxis) or to an enhanced episodic infusion schedule of at least three doses totaling a minimum of 80 IU of factor VIII per kilogram of body weight at the time of a joint hemorrhage. The primary outcome was the incidence of bone or cartilage damage as detected in index joints (ankles, knees, and elbows) by radiography or magnetic resonance imaging (MRI).

Results: Sixty-five boys younger than 30 months of age were randomly assigned to prophylaxis (32 boys) or enhanced episodic therapy (33 boys). When the boys reached 6 years of age, 93% of those in the prophylaxis group and 55% of those in the episodic-therapy group were considered to have normal index-joint structure on MRI (P=0.006). The relative risk of MRI-detected joint damage with episodic therapy as compared with prophylaxis was 6.1 (95% confidence interval, 1.5 to 24.4). The mean annual numbers of joint and total hemorrhages were higher at study exit in the episodic-therapy group than in the prophylaxis group (P<0.001 for both comparisons). High titers of inhibitors of factor VIII developed in two boys who received prophylaxis; three boys in the episodic-therapy group had a life-threatening hemorrhage. Hospitalizations and infections associated with central-catheter placement did not differ significantly between the two groups.

Conclusions: Prophylaxis with recombinant factor VIII can prevent joint damage and decrease the frequency of joint and other hemorrhages in young boys with severe hemophilia A. (ClinicalTrials.gov number, NCT00207597 [ClinicalTrials.gov].).

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