Monitoring of Anti-TFPI in Hemophilia (EUREKA)

Civil Hospices of Lyon

Status: Enrolling

Conditions: Rebalancing Agents; Prophylaxis; Hemophilia

Treatments: Biological: blood sampling

Study type: Observational

Funder types: Other

Identifiers

NCT07101926

69HCL25_0342

Details and patient eligibility

About

During the development of anti-TFPI antibodies, thrombin generation assay (TGA) was employed using both in vitro measurements (antibodies added to blood samples) and ex vivo approaches (blood samples from patients in phase II and III trials). While a significant improvement in thrombin generation was observed in all samples from patients with severe hemophilia, no correlation with clinical outcomes could be established. Notably, thrombin peak levels were consistently improved even in patients who experienced bleeding episodes. These measurements were conducted in platelet-poor plasma (PPP) with standard reagents, which may not adequately reflect the hemostatic efficacy of anti-TFPI antibodies given their mechanism of action. It is hypothesized that optimizing reagents and utilizing more appropriate biological materials could enhance TGA sensitivity, as previously demonstrated for monitoring emicizumab.

The absence of a laboratory assay to monitor anti-TFPI (tissue factor pathway inhibitor) antibodies poses a significant challenge for managing patients in surgical settings and treating acute severe bleeding. This study aims to develop a reliable assay to evaluate the hemostatic efficacy of anti-TFPI antibodies and their combined procoagulant effect with factor concentrates (FVIII or FIX) or bypassing agents.

Enrollment: 11 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

• Inclusion Criteria :

  • - Male Patient
  • 18 years old
  • severe hemophilia patients A or B (FVIII < 1%,FIX<=2%)
  • on prophylaxis with FVIII or IX concentrates after an adequate washout period of 48h for SHL FVIII molecules, at least 4 days for EHL-FVIII Fc and at least 10 days for EHL-FIX molecules.
  • On prophylaxis with Marstacimab
  • Willing to participate
  • Capable of following protocol procedures under investigator appreciation

• Exclusion Criteria :

  • - patients refusing to provide 4 additional blood tubes for research
  • Patient with an other coagulation disorder
  • patients who received an injection of FVIII or FIX during the required washout period

Trial design

11 participants in 1 patient group

Severe adult haemophilia A or B patient with factor levels ≤2%

Description:

* 6 on prophylaxis with FVIII or FIX concentrates after an adequate washout period of 48h for SHL FVIII molecules, at least 4 days for EHL-FVIII Fc and at least 10 days for EHL-FIX molecules * 5 receiving prophylaxis with marstacimab.

Treatment:

Biological: blood sampling