Phase II prospective open-label trial of recombinant interleukin-11 in desmopressin-unresponsive von Willebrand disease and mild or moderate haemophilia A

Margaret V. Ragni; Enrico M. Novelli; Anila Murshed; Elizabeth P. Merricks; Mark T. Kloos; Timothy C. Nichols

doi:10.1160/TH12-06-0447

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 109(02): 248-254
DOI: 10.1160/TH12-06-0447

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Phase II prospective open-label trial of recombinant interleukin-11 in desmopressin-unresponsive von Willebrand disease and mild or moderate haemophilia A

Margaret V. Ragni

¹Department of Medicine, Division of Hematology/Oncology and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

²Haemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA

,

Enrico M. Novelli

¹Department of Medicine, Division of Hematology/Oncology and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

²Haemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA

,

Anila Murshed

²Haemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA

,

Elizabeth P. Merricks

³Department of Pathology and Laboratory Medicine/ Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, North Carolina, USA

,

Mark T. Kloos

³Department of Pathology and Laboratory Medicine/ Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, North Carolina, USA

,

Timothy C. Nichols

³Department of Pathology and Laboratory Medicine/ Francis Owen Blood Research Laboratory, University of North Carolina, Chapel Hill, North Carolina, USA

› Author Affiliations

Abstract

Summary

Desmopressin (DDAVP) is the treatment of choice in those with mild von Willebrand disease (VWD), yet 20% are unresponsive to DDAVP, and among the 80% who respond, the response is transient, as endothelial stores are depleted after three days. We, therefore, conducted a single-center Phase II clinical trial to determine safety and biologic efficacy of recombinant interleukin-11 (rhIL-11, Neumega®) in patients with VWD unresponsive or allergic to DDAVP, or mild or moderate haemophilia A (HA). Increases in VWF:RCo were observed by 48 hours after rhIL-11, with a 1.54-fold increase by Day 4, 1.30-fold in VWD and 1.73-fold in HA. Similarly, by 48 hours, increases in VIII:C were observed, with a 1.65-fold increase by Day 4, 1.86-fold in VWD and 1.48-fold in HA. Platelet VWFmRNA expression by qPCR increased 0.81-fold but did not correlate with plasma VWF:Ag responses. rhIL-11 was well tolerated, with grade 1 or less fluid retention, flushing, conjunctival erythema, except for transient grade 3 hyponatraemia in one subject after excess fluid intake for diabetic hyperglycaemia, which resolved with fluid restriction. In summary, rhIL-11 increases VWF levels in two of four DDAVP-unresponsive or allergic VWD and F.VIII levels in four of five mild or moderate haemophilia A subjects, suggesting its potential use in treatment of these disorders.

Keywords

Clinical trial - recombinant interleukin-11 - von Willebrand disease - haemophilia A

Full Text

References

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