Publications by authors named "D'Oiron R"

Background: A unique form of hemophilia B (HB) is HB Leyden. We evaluated the international Pediatric Network on Hemophilia Management Registry (PedNet) database to explore the natural history of HB Leyden, investigate genotype-phenotype associations, and guide clinical decision-making.

Objectives: To assess the association between genetic variants, endogenous factor (F)IX levels over time, treatment, and bleeding phenotype in children with HB Leyden.

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Introduction: The 2024 ISTH clinical practice guideline (CPG) for treatment of congenital haemophilia, the NBDF-McMaster Guideline on Care Models for Haemophilia Management, and ASH ISTH NBDF WFH guidelines on the diagnosis and management of VWD all utilised GRADE methodology.

Aim: Discuss missed opportunities and the methodological approach of the ISTH Guideline in contrast to how GRADE was previously applied in rare diseases.

Methods: Critically analyse the methodology of each guideline along with best practices in the use of GRADE.

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Introduction: Evidence-based clinical practice guidelines drive optimal patient care and facilitate access to high-quality treatment. Creating guidelines for rare diseases such as haemophilia, where evidence does not often come from randomized controlled trials but from non-randomized and well-designed observational studies and real-world data, is challenging. The methodology used for assessing available evidence should consider this critical fact.

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Objectives: To assess the real-world efficacy and safety of recombinant factor IX albumin fusion protein (rIX-FP) in patients with hemophilia B (HB) in France.

Methods: Data on dosing frequency, weekly consumption, and bleeds before-and-after switching to rIX-FP, were collected from December 2021 to February 2024. Annualized (spontaneous) bleeding rates [A(s)BRs] were calculated only in patients on prophylaxis with a follow-up ≥ 6 months.

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  • * A study involving 2,727 children showed that ICH occurred in 2.2% of cases, mostly before the age of one, with a significantly higher incidence in hemophilia A compared to hemophilia B.
  • * Early diagnosis of hemophilia is crucial, as 40% of ICH cases happened before the diagnosis, and preventive treatment could potentially lower the incidence of ICH if initiated promptly.
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Background: Platelet transfusion is considered the standard treatment for preventing or controlling severe haemorrhage in Glanzmann thrombasthenia (GT). However, platelet transfusion can have detrimental effects, including the production of anti-GPIIb/IIIa isoantibodies or anti-HLA antibodies (Ab) and platelet transfusion refractoriness. Recombinant activated factor VII (rFVIIa) has been proposed as an alternative treatment to platelet transfusion.

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Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against factor VIII, with a high mortality risk. It should be suspected in subjects with abnormal bleedings, especially subcutaneous bleed associated with prolonged activated partial thromboplastin time (aPTT). AHA is often idiopathic but is associated with autoimmune diseases, malignancies, pregnancy and postpartum period or drugs.

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  • Once-weekly efanesoctocog alfa was tested in a phase 3 study for children under 12 with severe hemophilia A, showing promising results in preventing bleeding and maintaining factor VIII activity.
  • The study enrolled 74 patients, none of whom developed factor VIII inhibitors, and most experienced non-serious adverse events during the treatment.
  • With low annualized bleeding rates and a significant percentage of patients experiencing no bleeding episodes, efanesoctocog alfa demonstrated safety and effectiveness for this age group.
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  • Factor XI deficiency is a rare bleeding disorder, and it's hard to predict how much a person will bleed based on their Factor XI levels.
  • A study looked at pregnant women with low Factor XI levels to see how they were managed during childbirth and their experiences with pain relief methods like epidurals and spinals.
  • The results showed that a lot of women had successful pain relief procedures without complications, and it was suggested that it's safe to use these methods if Factor XI levels are above 30 IU/dL.
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  • Type 2 Normandy von Willebrand disease (VWD2N) is generally seen as a mild bleeding disorder treatable with desmopressin (DDAVP), but the genetic variations among patients, especially the common variant p.Arg854Gln (R854Q), can significantly influence disease severity and treatment response.
  • A study involving 123 VWD2N patients analyzed their phenotype and DDAVP response based on genotype, revealing that those with R854Q alleles exhibited different clinical outcomes and bleeding symptoms compared to those without.
  • The findings indicate that genetic factors, particularly the presence of the R854Q variant, affect factor VIII levels and the efficacy of DDAVP, highlighting the importance of tailored treatment approaches for V
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Introduction: Advances in haemophilia treatment have resulted in a near-normal life expectancy, lower burden of bleeding and treatment, and improved quality of life in high-income countries. Bleeding rate is approaching zero and novel parameters should be evaluated to assess the efficacy of treatment not only from the clinical point of view by using new methodologies (e.g.

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Background: Hemophilia A (HA) is predominantly associated with males due to X-linked inheritance. Males and females with HA have shared unmet medical needs, highlighting the necessity for comprehensive care irrespective of sex.

Objectives: This analysis investigated the efficacy and safety of emicizumab prophylaxis in 3 females with HA.

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Acquired haemophilia A (AHA) is a rare haemorrhagic disease characterised by new-onset haemorrhagic symptoms associated with a dramatic decrease in factor VIII levels and an anti-factor VIII neutralising autoantibody concentration >0.6 Bethesda units. Elderly people are often affected, whereas children are rarely affected; the paediatric incidence reported in the literature is about 0.

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  • Bleeding risk assessment before surgery in patients with rare inherited bleeding disorders is complex, despite established bleeding scores and clotting factor measurements.
  • A study involving 178 patients with low coagulation levels analyzed how hemostasis experts managed bleeding risks during 207 surgical procedures and the resulting bleeding outcomes.
  • Results showed that most surgeries were performed without factor replacement, particularly in mild deficiencies, and indicated that factor levels and the type of surgery are more critical for deciding perioperative treatment than bleeding scores.
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Introduction: Haemophilia A care has changed with the introduction of emicizumab. Experience on the youngest children is still scarce and clinical practice varies between haemophilia treatment centres.

Aim: We aimed to assess the current clinical practice on emicizumab prophylaxis within PedNet, a collaborative research platform for paediatricians treating children with haemophilia.

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Background: Concizumab is an anti-tissue factor pathway inhibitor monoclonal antibody designed to achieve hemostasis in all hemophilia types, with subcutaneous administration. A previous trial of concizumab (explorer4) established proof of concept in patients with hemophilia A or B with inhibitors.

Methods: We conducted the explorer7 trial to assess the safety and efficacy of concizumab in patients with hemophilia A or B with inhibitors.

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  • The TRANSHEMO project aimed to investigate how well adolescents and young adults with severe haemophilia adhere to healthcare, particularly during their transition from pediatric to adult care, viewing adherence as a key indicator of success in this process.
  • A study conducted from 2017-2019 included 277 participants and found that adolescents had a significantly higher adherence rate (82.2%) compared to young adults (61.2%), with factors like age, academic struggles, and mental health affecting adherence.
  • The findings suggest that tailored support and educational programs could help improve healthcare adherence among young adults with severe haemophilia.
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Glanzmann thrombasthenia (GT) is a genetic bleeding disorder characterised by severely reduced/absent platelet aggregation in response to multiple physiological agonists. The severity of bleeding in GT varies markedly, as does the emergency situations and complications encountered in patients. A number of emergency situations may occur in the context of GT, including spontaneous or provoked bleeding, such as surgery or childbirth.

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Introduction: Dominant-negative effects have been described for 10 F11 variants in the literature.

Aim: The current study aimed at identifying putative dominant-negative F11 variants.

Material And Methods: This research consisted in a retrospective analysis of routine laboratory data.

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Background:  rVIII-SingleChain is a recombinant factor VIII (FVIII) with increased binding affinity to von Willebrand factor compared with other FVIII products. rVIII-SingleChain is indicated for the treatment and prevention of bleeding episodes in patients with hemophilia A.

Objectives:  To collect real-world evidence data from patients treated with rVIII-SingleChain to confirm the efficacy and safety established in the clinical trial program and carry out a population pharmacokinetic (PK) analysis.

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Background: Clinical trial data are scarce for the use of prophylaxis in people with non-severe haemophilia A. The HAVEN 6 study aims to assess safety and efficacy of emicizumab prophylaxis in people with non-severe haemophilia A without factor VIII (FVIII) inhibitors.

Methods: HAVEN 6 is a multicentre, open-label, single-arm, phase 3 study taking place in 22 specialty clinics and hospitals in Europe, North America, and South Africa.

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Diagnosis of young girls and women with congenital bleeding disorders (CBD) is often delayed. The lack of knowledge of the challenges faced during menstrual cycles and childbirth contribute to this situation. Therefore, a better understanding and identification of the barriers to diagnosis become a useful tool for implementing the steps that promote equitable access and appropriate care.

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