eClinical Reports - Module 2: The Challenge of Managing Hemophilia in Patients With Inhibitors”

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Release Date: November 26, 2013
Expiration Date: December 7, 2014
Estimated Time to Complete Activity: 75 minutes
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Target Audience
This activity has been designed to meet the educational needs of hematologists/oncologists, hemophilia treatment center (HTC) clinicians, registered nurses, and other healthcare providers interested in managing patients with hemophilia.

Statement of Need/Program Overview
Prophylaxis in patients with hemophilia is considered one of the most important management decisions for clinicians, one that has paved the way for patients to lead as close to normal lives as possible by avoiding or decreasing the morbidity associated with joint bleeds as well as life-threatening bleeding. Prophylaxis also reduces the frequency and intensity of bleeding events at other sites.

There is debate, nevertheless, on the optimal regimen for prophylaxis—whether one should follow the standard Swedish Malmö approach, the tailored dose-escalation Canadian approach, or other current or emerging models of prophylaxis.

Additionally, there is ongoing clinical discussion about using prophylactic bypassing therapy in patients with inhibitors to reduce their bleeding frequency either before or during immune tolerance induction.

Clearly the benefits obtained by instituting prophylaxis may be offset by the higher costs of early full-dose prophylaxis; the difficulty of venous access, especially in very young children; the varying effects on patient quality of life; and the development of neutralizing antibodies.

Educational Objectives
After completing this activity, the participant should be better able to:
  • Discuss published data and expert opinion on the rationale for and appropriate use of prophylactic bypassing therapy in patients with hemophilia and inhibitors
  • Apply case-based learning to the management of hemophilia patients with inhibitors
  • Evaluate the risks and benefits of immune tolerance induction therapy as a means to eradicate inhibitors in patients with hemophilia A or B
  • Provide appropriate care and counsel for patients with hemophilia and their families
Chairman
Jerry S. Powell, MD
Professor of Hematology and Oncology
University of California Davis School of Medicine
Director
Hemophilia and Thrombosis Center
University of California Davis Medical Center
Sacramento, California

Faculty
Miguel A. Escobar, MD
Department of Pediatrics and Internal Medicine
Division of Hematology
Associate Professor
University of Texas Health Science Center at Houston and MD Anderson Cancer Center
Medical Director
Gulf States Hemophilia and Thrombophilia Center
Houston, Texas

Steven W. Pipe, MD
Professor of Pediatrics and Pathology
C.S. Mott Children's Hospital
University of Michigan
Ann Arbor, Michigan

Physician Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of .75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education
Credit Designation
This educational activity for .80 contact hours is provided by Postgraduate Institute for Medicine.

Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Method of Participation
During the period of November 27, 2013, through November 27, 2014, participants must:
  • Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form
A statement of credit will be issued automatically upon successfully completing the posttest with a score of 70% or better and submitting the activity evaluation.

Fee Information
There is no fee for this educational activity.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter Reported Financial Relationship
Miguel A. Escobar, MD Consulting Fees: Alnylam, Baxter, Biogen, Grifols, Kedrion, Novo Nordisk, Pfizer; Contracted Research: Baxter, Biogen, Novo Nordisk
Steven W. Pipe, MD Consulting Fees: Baxter, Biogen Idec, CSL Behring, Novo Nordisk, Pfizer; Other Research Grants: Baxter, Pfizer
Jerry S. Powell, MD Has no real or apparent conflicts of interest to report
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Name of Planner or Manager Reported Financial Relationship
PIM Clinical Reviewers: Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CCMEP; and Jan Schultz, RN, MSN, CCMEP Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Managing Director; Jodi Andrews, Senior Director, Educational Programs; Laurel Ranger, Editorial Services Have no real or apparent conflicts of interest to report.


Media
Internet

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

This activity is supported by an educational grant from Novo Nordisk, Inc.