Experts Tackle Best Practices in Prophylactic Treatment of Hemophilia A

During a recent Pharmacy Times® clinical forum titled “Best Practices in the Prophylactic Treatment of Hemophilia A,” experts discussed pharmacists’ involvement in effective management of hemophilia A, focusing on patient-centered care, including disease burden and quality of life, as well as considerations for specialty pharmacies.

Leslie Ward, PharmD, BCPS, BCOP, clinical pharmacist in benign hematology at UVA Health System, moderated the panel.

Treatment Landscape

The panelists discussed starting infants on emicizumab initially. Physicians do this because it is “easier [to] access for the parents [and is] less [traumatic for] the patient, so they don’t start off with that fear of needles when they’re younger,” said Lisa Schrade, clinical pharmacist at Optum Infusion Pharmacies, adding that adherence tends to be much better as they get older.

One big problem for patients who start off with the shorter-acting recombinant products or plasma-derived products is adherence, according to Schrade.

Older individuals typically do not switch from infusion products, as they are most comfortable with them, said Atta Chowdhry, director of the hemophilia program and regional director of operations at Amerita Inc.

When it comes to counseling tips, the focus should be on adherence, but Schrade said storage is another significant factor. The panelists also highlighted the importance of teaching patients how to self-infuse medication when they switch treatment plans, especially if they previously took emicizumab.

All cases should be patient specific, the panelists said. “You can’t just use a trial to determine what kind of therapy is going to be appropriate for that 1 individual, because they’re not cookie cutter,” Schrade said.

Patient-Centered Care

The panelists also discussed patient-centered care, including disease burdens. “I think there’s still a fear of this stigma,” said Kim Epps, PharmD, CSP, vice president and general manager of bleeding disorders at BioMatrix Specialty Pharmacy. “They remember how they were treated and what they went through, and there’s a fear that that’s going to come back.”

Patients also often feel as if they are costing insurance companies too much money, and they are meeting their lifetime caps too soon, Chowdhry said. The disease is draining on families and patients both physically and mentally, Schrade said. Psychosocial support is key for patients, Epps said, adding that her pharmacy conducts many education programs that help ensure social and health care needs are met.

Another critical issue is patient preference, the panelists said, pointing out that sometimes patients don’t want to change their medications.

Specialty Pharmacy Considerations

In addition, the panelists discussed considerations for specialty pharmacies, including best practices, high-lighting that developing relationships between patients and pharmacists is vital. “They don’t want to just be a number,” Schrade said. “They don’t want to be a dollar sign; they’ve been through that, lived through it, [and] they need somebody who’s going to actually care about the concern of their health care.”

The panelists also said that having a good relationship with the physician is essential. Keeping in mind that some want to collaborate more than others, pharmacists should take note of and respect how much communication goes on between patients and physicians.

Furthermore, the panelists spoke about how patients with hemophilia A should become involved in their communities to learn more about the disease from other individuals who have it. There are also many educational programs hosted by care coordinators and nurses that are related to hemophilia A that can help address the needs of individuals with the disease.

Finally, Priti Doshi Shah, PharmD, pharmacist in charge, specialty pharmacist at American Service and Product, Inc, and other panelists discussed educating patients about medications, including why medication for hemophilia A should be individualized.

“Sometimes the dose has to be adjusted from month to month,” Schrade said. “If I see that every May the patient is burning through factor like crazy, I find out well, it’s because they’re going hiking up in the mountains when the weather starts turning better so we need to dose that appropriately so they’re not ending up an emergency room with stress fractures.”