Effectiveness of Prophylactic Coagulation Factor Replacement Therapy in Patients with Severe Hemophilia A in Taiwan - A Population-Based Study

Purpose: Taiwan launched reimbursement of prophylactic coagulation factor replacement therapy (CFRT) for patients with severe hemophilia type A (severe PWHA) in 2014. However, since then, the effectiveness of prophylactic CFRT in real-world practice has not been evaluated thoroughly. This study aimed to evaluate the effectiveness of prophylactic CFRT in severe PWHA cases on the outcome of bleeding risks.Patients and Methods: We included male, severe PWHA cases from a nationwide, population-based database in Taiwan. Given that the database lacked details of the dosing regimen for prophylactic CFRT, we applied group-based trajectory modeling using the proportion of days covered (PDC) by CFRT from 2014 to 2015 in order to classify patients. A high PDC level corresponded to a greater proportion of time under CFRT, thus implying that the patient was probably receiving prophylactic therapy. We followed up patients from January 01, 2016 until occurrence of any bleeding events, death or December 31st 2017.Results: We identified a total of 420 severe PWHA and classified them into high-(n = 88), medium-(n = 181) and low-(n = 151) PDC groups. The mean (+/- SD) PDC values of the three groups were 0.78 (+/- 0.1), 0.40 (+/- 0.1) and 0.12 (+/- 0.1), respectively. Using Cox regression models with propensity score adjustment, we found patients with medium-(hazard ratio: 0.69; 95% CI: 0.56-0.89) or high -PDC (0.45; 0.36-0.68) under CFRT had reduced risks of any bleeding, compared to the low PDC group.Conclusion: The findings demonstrated the effectiveness of prophylactic CFRT in the prevention of bleeding events in real-life severe PWHA.