PB0547 - A Canadian Roundtable Discussion of the Peri-operative Use of Nonacog beta pegol (N9-GP) for Persons with Moderate to Severe Hemophilia B

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

NP

Natasha Pardy

Director, Adults Bleeding Disorders Clinic
Newfoundland and Labrador Health Services, Memorial University
St, John's, Newfoundland and Labrador, Canada
Jerome Teitel

Medical Director of the Haemophilia Treatment Programme and Professor of Medicine
St Michael's Hospital Haemophilia Treatment Centre, University of Toronto
Tortonto, Ontario, Canada
JS

Jean St-Louis

Professor
University of Montreal and Hôpital Maisonneuve-Rosemont
Montreal, Quebec, Canada
KS

Karen Strike

Advanced Practice Physiotherapist
Hamilton Niagara Regional Hemophilia Centre, McMaster Children's Hospital, Assistant Clinical Professor (Adjunct), McMaster University
Hamilton, Ontario, Canada
KL

Karl Lalonde

Orthopedic Surgeon
University of Ottawa and the Ottawa Hospital
Ottawa, Ontario, Canada
MI

Marc Isler

Chef du Département de Chirurgie
University of Montreal and Hôpital Maisonneuve-Rosemont
Montreal, Quebec, Canada
AI

Alfonso Iorio

Professor
McMaster University
Hamilton, Ontario, Canada
KD

Kay Decker

Nurse Coordinator
Hamilton Niagara Regional Hemophilia Centre, McMaster Children's Hospital, McMaster University
Hamilton, Ontario, Canada
GB

Greig Blamey

Physiotherapy Consultant
Manitoba Adult Inherited Bleeding Disorders Program. University of Manitoba
Winnipeg, Manitoba, Canada
LT

Lisa Thibeault

Nurse Coordinator
Southeastern Ontario Regional Inherited Bleeding Disorders Program, Kingston Health Sciences Centre, Queen’s University
Kingston, Ontario, Canada

Presenting Author(s)

MP

Man-Chiu Poon

Professor
University of Calgary
Calgary, Alberta, Canada

Background: Nonacog beta pegol (N9-GP), an extended half-life recombinant factor (F)IX, has been used for prophylaxis management of Canadian Hemophilia B patients since 2018. There is a relative lack of experience using N9-GP for major surgery in Canada, a large, sparsely populated country with free access to N9-GP (in 9 of 10 provinces) but variable local access to pegylated clotting factor laboratory monitoring

Aims: To develop guidance for the use of N9-GP for major surgery in Canada

Methods: A panel of hematologists, nurses, surgeons, and physiotherapists with expertise in hemophilia from across Canada met in Toronto in April 2022. They formed two teams, each providing independent management opinions on 3 hypothetical cases of severe or moderate hemophilia B, N9-GP experienced or naïve, undergoing elective or emergency orthopedic or general surgery. They reconvened for a roundtable discussion to develop consensus guidance for management in Canada.

Results: The panel favored dosing for higher target FIX perioperative (~120 IU/dL) and trough levels (~80 IU/dL) than WFH guidelines recommendations, for bleed prevention and facilitation of post-operative physiotherapy/rehabilitation. They emphasized individualization taking into consideration patient- and surgical-factors, and post-operative rehabilitation needs.

Conclusion(s): The prolonged N9-GP half-life enables maintenance of higher trough levels and potential reduction in associated healthcare systems and patient-related costs. While the teams agreed on many common principles, opinions varied among others. Given the heterogeneous expertise and experience of the individual practitioners, surgical indications and complexity, and patient functional status and comorbidities, the panel emphasized that individualized planning was key to effective and safe management. They endorsed communication and planning between multidisciplinary team members and the establishment of an N9-GP major surgery registry to inform real-world experiences to guide practice. The panel encouraged developing N9-GP pharmacokinetics (e.g. PK in bleeding state, or adaptation of PK in non-bleeding state) for surgical use.