PB1179 - Efficacy of subcutaneous versus intravenous administration of desmopressin in patients with von Willebrand disease and hemophilia A in need of COVID-19 vaccination

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Dominique P.M.S.M. Maas, MD

Resident internal medicine and PhD student
Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands. Hemophilia Treatment Center Nijmegen – Eindhoven – Maastricht, The Netherlands
Nijmegen, Gelderland, Netherlands

Co-Author(s)

Jv

Johanna van Wanroij

Nurse practitioner
Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands
Nijmegen, Gelderland, Netherlands
NB

Nicole M.A. Blijlevens

Internist-hematologist, Professor
Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
Nijmegen, Gelderland, Netherlands
CK

Cornelis Kramers

Internist, clinical pharmacologist
Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands; Department of Pharmacology-Toxicology, Radboud university medical center, Nijmegen, The Netherlands; Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
Nijmegen, Gelderland, Netherlands
BL

Britta Laros-van Gorkom

Hematologist
Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands; Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, The Netherlands
Nijmegen, Gelderland, Netherlands
DM

Daniëlle Meijer

Clinical chemist
Department of Laboratory Medicine, Laboratory of Hematology, Radboud university medical center, Nijmegen, the Netherlands
Nijmegen, Gelderland, Netherlands
Wv

Waander L. van Heerde

Biochemist, Coagulation Physiologist, Chief Scientific Officer Enzyre BV
Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands. Hemophilia Treatment Center Nijmegen – Eindhoven – Maastricht, The Netherlands. Enzyre BV, Novio Tech Campus, Nijmegen, The Netherlands.
Nijmegen, Gelderland, Netherlands
SS

Saskia E.M. Schols

Internist-hematologist
Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands. Hemophilia Treatment Center Nijmegen – Eindhoven – Maastricht, The Netherlands
Nijmegen, Gelderland, Netherlands

Background: Subcutaneous desmopressin (DDAVP) can be more easily administered than intravenous DDAVP and may be an efficacious alternative for the currently unavailable intranasal DDAVP to treat mild bleedings or for minor invasive procedures in von Willebrand disease (VWD) and hemophilia A.

Aims: To compare the one-hour response to subcutaneous and intravenous DDAVP in patients with VWD or hemophilia A.

Methods: Patients with hemophilia A (FVIII ≤10 IU/dL) or VWD (VWF activity ≤10 IU/dL) whose treatment plans include DDAVP and who were to receive a COVID-19 vaccination were eligible to participate. For COVID-19 vaccination, FVIII or VWF activity target levels of >10 IU/dL were pursued according to international guidelines (ISTH). DDAVP was administered subcutaneously 1.5 hours before vaccination. FVIII (in hemophilia and VWD) and VWF activity levels (in VWD) were determined prior to (t=0) and 1 hour after DDAVP (t=1). All patients had a positive historical routine challenge test with intravenous DDAVP. For each participant, absolute and relative changes of FVIII and VWF activity levels 1 hour after subcutaneous and intravenous DDAVP (both 0.3 µg/kg) were compared.

Results: Eleven patients were included: six with hemophilia A, three with VWD type 2M and two with VWD type 2A. Both intravenous and subcutaneous DDAVP increased FVIII and VWF activity levels in all patients. In hemophilia patients, intravenous and subcutaneous DDAVP increased FVIII levels by an average of 3.8-fold and 3.4-fold respectively. Peak FVIII activity levels at t=1 ranged from 25-62 IU/dL and 29-51 IU/dL. In VWD patients, intravenous and subcutaneous DDAVP was associated with a 11.4-fold and 5.1-fold mean increase in VWF activity levels respectively. Corresponding peak VWF activity levels ranged from 18-100 IU/dL and 28-74 IU/dL. No bleeding after vaccination was reported.

Conclusion(s): Subcutaneous DDAVP appears to be an effective alternative for intravenous DDAVP. Moreover, like intranasal DDAVP, subcutaneous DDAVP allows the possibility of self-administration at home.