On-Demand versus Prophylactic Therapy with Factor VIII Concentrate in Patients with Hemophilia A: Differences in Efficacy and Quality of Life: A Multicenter Study

Background: Hemophilia A and B are inherited bleeding disorders in factors VIII and IX. Objectives: The study was to compare between on-demand and prophylactic treatment by factor VIII (FVIII) concentrate of hemophilic patients in Kirkuk, Sulaymaniyah, and Erbil hemophilia centers. Materials and Methods: The study included 45 patients with moderate and severe hemophilia treated with FVIII concentrate in three Iraqi centers (Kirkuk Oncology Center [n: 15], Hiwa Hospital in Sulaimaniya [n: 18], and Nanakali Hospital in Erbil city [n: 12]) and compared two different protocols in prophylactic therapy with FVIII concentrate in 2016 and on-demand treatment with FVIII concentrate in 2018 on the same patients. Comparisons included the number of vials used in two procedures and patient visits to our centers. Results: The survey found that hemophilia patients at Kirkuk Oncology Center are older than those in Sulaimaniya and Erbil. The average number of vials of FVIII concentrate used to treat hemophilia on prophylaxis was 73.58/year and 6.13/month, which was substantially less than in on demand (P < 0.001). The study found that the average number of FVIII concentrate vials used in on-demand hemophilia therapy at Hiwa Hospital was 79.4 vail/year and 6.62 vail/month, compared to 119.7 vail/year and 9.97 vail/month in prophylaxis (P < 0.001). The study also found that the average number of vials used in hemophilia therapy at Kirkuk Oncology Center and Nanakali Hospital in Erbil was lower than in other hospitals (P < 0.001). The study demonstrated that all patients in the on-demand hemophilia treatment program were dissatisfied, but their views improved after treatment with FVIII concentrate in prophylaxis protocol. Conclusions: We find that prophylactic administration of FVIII concentrate to hemophilia patients is superior than on-demand administration. We urge that future studies improve our results with larger patient groups and clinics in all governorates of Iraq.