Global patterns of hemophilia drug trials, hemophilia care, and health care measures

IF 3.4 3区 医学 Q2 HEMATOLOGY
Stacey A. Fedewa , Leonard A. Valentino , Andee Koo , Lorraine Cafuir , Theresa W. Gillespie , Tyler W. Buckner , Duc Q. Tran , Ana Antun , Christine L. Kempton
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引用次数: 0

Abstract

Background

Drug trials are vital to establish safe and effective treatments for congenital hemophilia, a bleeding disorder that affects about 800,000 males worldwide. The global distribution of hemophilia drug trials (HDTs) and their alignment with hemophilia care is unknown.

Objectives

This study aimed to evaluate the global distribution of HDTs and its association with hemophilia care.

Methods

In this cross-sectional study, HDTs conducted between 2007 and 2022 were selected from the clinicaltrials.gov database. The density of trials per 1000 expected males with hemophilia (eMwH) was assessed according to hemophilia care measures (factor VIII and IX utilization per 1000 eMwH) derived from World Federation of Hemophilia data.

Results

Among 124 trials, 55 countries were represented, with an average of 7.9 countries per trial. Most HDT sites were in high-income (74.4%) or upper middle (20.1%)–income countries. The number of sites in lower-middle–income countries doubled, from 12 in 2007-2011 to 30 in 2017-2022—a nonsignificant increase from 5.8% to 7.0% (P = .53). Factor utilization was substantially reduced in lower-middle (0.4 international units [IUs] per 1000 eMwH) and upper middle (2.8 IUs per 1000 eMwH) compared with high (6.8 IUs per 1000 eMwH) income countries. HDT density was moderately correlated with factor usage (r = 0.436; P ≤ .001).

Conclusion

Most HDT sites were located in high-income countries, although a substantial proportion were in upper middle–income countries. A small but increasing number of trials were conducted in lower-middle–income countries, where factor usage is relatively low. This study provides evidence on the global distribution of HDT and raises questions regarding the generalizability, barriers, opportunities, and ethics of trials for a rare bleeding disorder.

Abstract Image

血友病药物试验、血友病护理和卫生保健措施的全球模式
药物试验对于建立安全有效的先天性血友病治疗方法至关重要,先天性血友病是一种影响全球约80万男性的出血性疾病。血友病药物试验(HDTs)的全球分布及其与血友病治疗的一致性尚不清楚。目的本研究旨在评估HDTs的全球分布及其与血友病护理的关系。方法在这项横断面研究中,从clinicaltrials.gov数据库中选择2007年至2022年进行的HDTs。根据来自世界血友病联合会数据的血友病护理措施(每1000 eMwH因子VIII和IX利用率)评估每1000名预期男性血友病(eMwH)的试验密度。124项试验中,55个国家被纳入,平均每个试验涉及7.9个国家。大多数HDT站点位于高收入(74.4%)或中高收入(20.1%)国家。中低收入国家的站点数量翻了一番,从2007-2011年的12个增加到2017-2022年的30个,从5.8%增加到7.0%,增幅不大(P = 0.53)。与高收入国家(6.8国际单位/ 1000 eMwH)相比,中低收入国家(0.4国际单位/ 1000 eMwH)和中高收入国家(2.8国际单位/ 1000 eMwH)的要素利用率大幅降低。HDT密度与因子使用呈正相关(r = 0.436;P≤0.001)。结论大多数HDT站点位于高收入国家,尽管有相当一部分位于中高收入国家。在要素使用率相对较低的中低收入国家进行了少量但数量不断增加的试验。这项研究为HDT的全球分布提供了证据,并提出了关于一种罕见出血性疾病试验的普遍性、障碍、机会和伦理的问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.60
自引率
13.00%
发文量
212
审稿时长
7 weeks
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