Physician Views: Hemlibra secures early US approval – is it practice changing?

Roche's Hemlibra (emicizumab-kxwh) has been approved by the FDA for adults and children with haemophilia A with factor VIII inhibitors and is awaiting a regulatory decision in the EU. We are snap-polling US and EU5 haematologists to gauge reaction to its labelling and potential utilisation.  

In the Phase III HAVEN 1 study, patients 12 years and older who received Hemlibra prophylaxis had a reduction in treated bleeds of 87 percent compared to those who received no prophylaxis. Hemlibra prophylaxis also reduced treated bleeds by 79 percent compared to previous treatment with bypassing agent (BPA) prophylaxis collected in a non-interventional study (NIS) prior to enrolment. Interim results from the pivotal HAVEN 2 study in children younger than 12 years showed that 87 percent who received Hemlibra prophylaxis experienced zero treated bleeds.

How compelling are these efficacy data?

Not compelling

Marginally compelling

Moderately compelling

Very compelling

Extremely compelling

Labelling for Hemlibra includes a boxed warning with the following "cases of thrombotic microangiopathy and thrombotic events were reported when on average a cumulative amount of >100 U/kg/24 hours of activated prothrombin complex concentrate (aPCC) was administered for 24 hours or more to patients receiving HEMLIBRA prophylaxis. Monitor for the development of thrombotic microangiopathy and thrombotic events if aPCC is administered. Discontinue aPCC and suspend dosing of HEMLIBRA if symptoms occur."

To what extent will this warning (and assuming a very similar warning on EU labelling) impede utilisation of Hemlibra?

None

Marginally

Moderately

Significantly

Very significantly

How comfortable would you be switching a typical haemophilia A with factor VIII inhibitors patient from their existing treatment to Hemlibra (note also: the most common adverse events occurring in 10 percent or more of people treated with Hemlibra in pooled studies were injection site reactions, headache and joint pain. Hemlibra can be self-administered once weekly by subcutaneous injection).

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

As a result of its boxed warning (and assuming EU labelling is similar) and based on your anticipated utilisation of Hemlibra, what effect will it have on your utilisation of aPCC/FEIBA?

No material impact

Marginal decline in use

Moderate decline in use

Significant decline in use

Very significant decline in use

Do you perceive Hemlibra to be practice changing for the treatment of haemophilia A with factor VIII inhibitors?

Yes – in the short term

Yes – in the medium term

Yes – in the long term

No

Results and related analysis will shortly be published for FirstWord Pharma PLUS subscribers to read, with the opportunity for non-FirstWord Pharma PLUS subscribers to purchase these findings. To be notified when poll results and analysis become available, please click here.

As always, FirstWord would very much like to receive your feedback and suggestions. Note: FirstWord Polls are powered by Medefield MedePolls, a fast-turnaround service to conduct instant polls of up to five questions with guaranteed samples that include physicians from dozens of specialties and over 100 markets. To conduct this poll with a different audience, or an entirely different poll, contact us at info@firstwordpharma.com.

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