Comprehensive Review of rFVIIa Use in a Tertiary-Care Pediatric Center
[This paper shows the extent to which off-label use of NovoSeven has contributed to making the drug a blockbuster—and caused economic disruptions to healthcare providers. A lower-priced product is the goal of GTC’s FVIIa program with LFB.]
Heller M, Lau W, Pazmino-Canizares J, Brandão LR, Carcao M.
Division of Haematology/Oncology, Department of Paediatrics, University of Toronto, Toronto, Canada.
BACKGROUND: Recombinant activated factor VII (rFVIIa) is a hemostatic agent developed for the treatment of bleeds in patients with hemophilia and inhibitors. Case reports/series document its growing use in patients without hemophilia. Such reports however do not accurately describe the proportion of rFVIIa used for various indications. We sought to document the complete use of rFVIIa at our institution over a 6-year period (2000-2005).
PROCEDURE: Using a computerized registry documenting all rFVIIa use in our institution a complete list of patients receiving rFVIIa was generated. Clinical data on these patients was obtained through chart review.
RESULTS: 111 patients received 7,016,400 mcg of rFVIIa over the 6 years: 23 patients had congenital bleeding disorders (10 patients with hemophilia and inhibitors; 7 with congenital FVII deficiency; 6 with platelet function disorders). These 23 patients (21% of all patients receiving rFVIIa) accounted for 79.9% of all rFVIIa used; patients with hemophilia alone accounted for 68.6%. The 88 patients without a congenital bleeding disorder (79% of all patients using rFVIIa) accounted for 20.1% of rFVIIa used. However their annual use of rFVIIa increased 10-fold during the 6 years.
CONCLUSIONS: Patients with hemophilia use massive amounts of rFVIIa repeatedly while patients without hemophilia use rFVIIa infrequently and at smaller doses. The use of rFVIIa in patients without congenital bleeding disorders (all "off-label" use) is rapidly growing in both number of patients and in total use and has likely significant clinical and economic ramifications. <<
Safety Update on NovoSeven for Treatment of Hemophilia with Inhibitors
[This is exactly the indication GTC/LFB hope to address with their own less-costly version of rFVIIa (#msg-27139814, #msg-13763244, #msg-16164190, #msg-30472398). The authors of this paper found that, all told, NovoSeven is a remarkably safe drug.]
Aflac Cancer Center and Blood Disorders Service, Emory University, Atlanta, GA, USA.
Recombinant factor VIIa (rFVIIa, NovoSeven) has been licensed for treatment of haemophilia with inhibitors in Europe since 1996 and in North America since 1999. Overall, approximately 1.5 million doses have since been administered. Safety data from licensure to April 2003 revealed 25 thromboembolic (TE) adverse events (AE) from over 700,000 doses given, a remarkably low incidence of TE events.
Recent reports have cited a higher prevalence of TE events with rFVIIa use, especially when used off-label. This report reviews the TE and fatal events with use of rFVIIa for congenital and acquired haemophilia A or B from May 2003 to December 2006. Approximately 800,000 standard doses of rFVIIa have been administered during this time frame. All clinical trials, spontaneous and solicited reports, as well as a detailed literature review, were included in the data analysis. There were a total of 30 TE events and 6 TE-associated fatal events. Spontaneous reports captured 14/71 (20%) TE/AE and 2/34 TE-associated/total fatal events. From solicited reports, 5/40 (12.5%) were associated with a TE and 1/32 TE-associated fatal events. Literature review revealed 11/19 (58%) TE events and 3/6 TE-associated fatal events.
Despite the use of high-dose rFVIIa (270 mug kg(-1)) in some clinical trials and registries, rFVIIa appears safe, when used for congenital and acquired haemophilia. The prevalence of TE associated with rFVIIa use is less than 4/100,000 and a TE-associated fatal event is also extremely rare. However, use of rFVIIa for off-label indications should continue to be monitored closely via clinical trials and carefully designed registries.‹
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