Q&A with a Hematologist

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HEMATOLOGIST Q&A

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Are there any special things inhibitor patients should do to take extra care?

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The safety concerns for people with inhibitors are almost the same as those for other people with hemophilia—with a little extra caution.

Changes like wearing protective pads are an easy way for families and patients to lower the risk of bleeding. Over time, patients become used to changes in playtime or sports, and the changes become normal for them.

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How do patients and caregivers deal with inhibitors?

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It depends a lot on a patient's age. For toddlers, protection such as knee pads, elbow pads, and soft helmets is an easy way to start lowering the risk of bleeding. Caregivers should also be careful that toddlers don't play too rough.

For kids in school, their teachers should be educated to make sure they know about their students' hemophilia and inhibitors.

Adolescents are often trying to find their place in life, and they sometimes take risks. It can be helpful for them to see role models who control their condition and still have fun hobbies and interests.

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How does a hematologist explain inhibitors to patients and their families?

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Sometimes hematologists call the inhibitors 'erasers' that 'erase' the factor in a patient's therapy. At first, most families feel helpless, but hematologists help them see that inhibitors can be managed with the right therapy.

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How does FEIBA help patients with inhibitors?

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FEIBA is an effective treatment for hemophilia patients with inhibitors. When a patient has hemophilia with inhibitors, the most important thing is to stop bleeding. Everything else comes after that.

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How important is family support in dealing with inhibitors?

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Family communication is very important. Parents and children both feel more comfortable when they talk about the things they need to do. Also, kids who have hemophilia with inhibitors should spend time with peers and friends to keep from feeling alone.

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How can patients have an active life?

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Staying active is important. Patients just have to learn what to expect. Kids can play sports like swimming and golf instead of wrestling or football. Fitness is helpful and good for everyone. Hiking and yoga are other examples of sports that can help patients stay active while keeping the risk of bleeding low. Not all sports, games, and exercises are right for all people. Talk to your healthcare provider or nurse to find out which activities are better for you to engage in, and what special care you should take for certain sports or exercises.

Want to find other types of support? Check out our Patient Stories section.

FEIBA [Anti-Inhibitor Coagulant Complex]
Indications and Detailed Important Risk Information for Patients

Indications for FEIBA

FEIBA is an Anti-Inhibitor Coagulant Complex approved for use in hemophilia A and B patients with inhibitors for:

  • Control and prevention of bleeding episodes
  • Use around the time of surgery
  • Routine prophylaxis to prevent or reduce the frequency of bleeding episodes.

FEIBA is NOT for use in the treatment of bleeding episodes resulting from coagulation factor deficiencies without inhibitors to factor VIII or factor IX.

Detailed Important Risk Information for FEIBA

WARNING: EVENTS INVOLVING CLOTS THAT BLOCK BLOOD VESSELS

  • Blood clots that block blood vessels and their effects have been reported during post-marketing surveillance following infusion of FEIBA, particularly following administration of high doses (above 200 units per kg per day) and/or in patients at risk for forming blood clots.
  • If you experience any of these side effects, call your doctor right away.

Who should not use FEIBA?

You should not use FEIBA if:

  • You had a previous severe allergic reaction to the product
  • You have Disseminated Intravascular Coagulation (DIC), or signs of small blood vessel clots throughout the body
  • You have sudden blood vessel clots or blocked blood vessels, (such as, heart attack or stroke)

What other important information should I know about FEIBA?

Events involving blood clots blocking blood vessels (such as blood clot in vein, blood clot in the lung, heart attack, and stroke) can occur with FEIBA, particularly after receiving high doses (above 200 units per kg per day) and/or in patients with risk factors for clotting.

Events of thrombotic microangiopathy (TMA), a condition where blood clots and damage occur in small blood vessels, were reported in an emicizumab (Hemlibra®) clinical trial where patients received FEIBA with emicizumab as part of a treatment plan for breakthrough bleeding. The safety and efficacy of FEIBA for breakthrough bleeding in patients receiving emicizumab has not been established. If you take, or anticipate taking, FEIBA with emicizumab, tell your doctor, since they will need to closely monitor you.

At first sign or symptom of a sudden blood vessel clot or blocked blood vessel (such as chest pain or pressure, shortness of breath, fever, altered consciousness, vision, or speech, limb or abdomen swelling and/or pain), stop FEIBA administration right away and seek immediate emergency medical treatment.

Infusion of FEIBA should not exceed a single dose of 100 units per kg body weight and daily doses of 200 units per kg of body weight. Maximum injection or infusion rate must not exceed 2 units per kg of body weight per minute.

Allergic reactions, including severe, sometimes fatal allergic reactions that can involve the whole body, can occur following the infusion of FEIBA. Stop using FEIBA promptly and call your doctor or get emergency treatment right away if you get a rash, hives or welts, experience itching, tightness of the throat, vomiting, abdominal pain, chest pain or tightness, difficulty breathing, lightheadedness, dizziness, nausea or fainting.

Because FEIBA is made from human plasma it may carry a risk of transmitting infectious agents, such as viruses, variant Creutzfeldt-Jakob disease (vCJD) and, theoretically, the Creutzfeldt-Jakob disease (CJD).

What are the possible side effects of FEIBA?

The most common side effects observed during the prophylaxis clinical study were low number of red blood cells, diarrhea, bleeding into a joint, positive test for hepatitis B surface antibodies, nausea, and vomiting.

The serious side effects seen with FEIBA are allergic reactions and clotting events involving blockage of blood vessels, which include stroke, blockage of the main blood vessel to the lung, and deep vein blood clots.

Call your doctor right away about any side effects that bother you during or after you stop taking FEIBA.

What other medications might interact with FEIBA?

Talk with your doctor about the possibility of formation of blood clots when taking drugs that may prevent clot breakdown such as tranexamic acid, and aminocaproic acid. There have not been adequate studies of the use of FEIBA and rFVIIa (NovoSeven®), or emicizumab together, or one after the other. Use of drugs that may prevent clot breakdown within approximately 6 to 12 hours after the administration of FEIBA is not recommended.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088

Please see FEIBA full Prescribing Information, including BOXED WARNING on blood clots, and discuss with your doctor.