Latest Scientific Update in Management of Hemophilia

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Latest Scientific Update in Management of Hemophilia

23 Jul, 1:30 PM

[Music] good evening everyone on behalf of tequila medical team myself doctor uh i would like to warm welcome all of you a wam welcome uh dr vijay kumar who is esteemed speaker with us today and regarding our today's session that is on latest scientific update on management of hemophilia warm welcome sir and warm welcome all the participants who have joined us from the busy schedule and we are covering uh with today's session uh objective of the session is to cover unmet medical needs to raise scientific awareness on recent trends in hemophilia care as uh healthcare professionals who are treating hemophilic patients so objective of session is to raise awareness on recent trends in hemophilic hemophilic uh for hemophilic patients treatment so request to audience if you are having any questions or comments kindly drop your questions or comments in chat box and now let me introduce dr vijay kumar our steam speaker asari's medical officer in charge regional dialysis center at hemophilia treatment center aloe vera kerala doctor and vijay kumar is in charge of the only nap credited regional blood transfusion center in kerala from 1997 till date sir has published many research papers in pediatrics and applied clinical nutrition in a national international journals sir is pioneer in establishing the only comprehensive care center in kerala state 2014 for more than thousand patients with hemophilia and allied bleeding gandra disorders sir has received several awards my words are not sufficient here so many awards are credited to name of dr vijay kumar like the best doctor award 1999 government of kerala professional and organizational excellence award indian society of blood transfusion and immunohematology blood cross society stable award consortium of social service organizations kerala code governance award uh ernakulam district administration presented by honorable chief minister of kerala sheri ak antoni award of honor kerala government medical officers association award of honor indian medical association on doctor's day many other awards are credited to name of dr vijay kumar now without any further delay uh i would like to invite dr vijay kumar for beginning to begin our session over to you sir thank you so much sir for joining us today thank kind words of introduction ah okay fine and i i i i must thank you for giving me an opportunity to be with the esteemed audience this fine evening to give an update in the management of hemophilia with stress on extended half-life factors as we all know hemophilia is a common hereditary coagulation disorder due to the deficiency or reduced activity of clotting fat rate called classical hemophilia or hemophilia a core clotting factor 9 or christmas disease it's an excellent recessive disorder where males are patients and females are carriers incidence of symptomatic area females and homozygous female sufferers is rare but is important both f factor 8 gene and factor 9 genes are prone to new mutations and as many as 33 percent of all cases are the result of spontaneous mutation where there is no prior family history the hemophilia treatment has evolved over the years right from whole blood to cryoprecipitate and fresh frozen plasma then plasma derived factor concentrate followed by recombinant ones and recombinant ones also have been have come from the first generation second generation third generation and now in 2015 to the fourth generation recombinant factors these plasmid plasma and cryo precipitate treatment had caused havoc leading to several aids cases in europe especially in france which led to uh actually in fact that cost um the import that raised the importance of having safe factor concentrates for the treatment of hemophilia patients it was in 1970s that we have we started producing safe plasma derived concentrates and in early 1980s we had factory in fact nine genes cloning and the first generation of a recombinant factor eight was available in 1992 second generation in 2001 third generation 2003 and uh fourth generation recombinant one became available in 2015. now conscience this this shows the difference between hemophilia and hemophilia b the incidence 80 percent of cases belong to hemophilia and incidence is one in 5 000 male birth in hemophilia and one and twenty thousand nuclear b uh in fact uh our uh the identification of hemophilia cases in india has suffered a lot because the lack of laboratory facilities till 2020 we had identified only 17 6006 hemophilia in 2750 hemophilia b and severe forms of the disease are also nine point five one hundred thousand in hemophilia one point five is hundred thousand hemophilia b the most common gene mutation in factor eight is null mutation whereas hemophilia b is nissan uh mutation as you all know a factor rate um molecular weight is uh very high 293 kilo dalton whereas hemophilia beat is 65 kilo diamond and half life of factory eight is eight equal hours whereas uh hemophilia b is 18 to 34 hours and the incidence of inhibitors also is very high in hemophilia compared to hemophilia now the laboratory based classification into mild moderate and severe mild is um between 5 and 40 percent moderate is between you know one and five and severe is less than one percent severe cases bleed spontaneously and has an annual bleed rate of around 24 whereas annual blade rate of about 24 to 28 per year whereas in moderate cases it comes to only four to six per year and the mild cases do not bleed on its own the uh as i said even the hemophiliacs are identified only when they are subjected to major trauma in the case of mild hemophilia whereas in the case of moderate ones also minor trauma will cause electricity bleeding as you all know hemophilia and 80 percent have hemophilia here there is currently no definitive cure for hemophilia except except gene therapy which is prohibitively costly current treatment includes replacement therapy with plasma divide or recombinant plotting factor concentrates where we give on-demand treatment for acute bleeding or prophylactic to prevent bleeding the problem with hemophilia is high cost and lifelong therapy 20 percent have regular access to treatment in fact uh 80 of the hemophiliac in the world lack optimum treatment 30 percent of hemophilia develop inhibitory antibodies those who do not have access to regular replacement therapy are liable to experience repeated bleeds spontaneous or otherwise into soft tissues muscle joints and potentially into the brain this will result in severe pain joint destruction and lifelong disability or even death these are these are the pictures of some of our patients who unfortunately did not have the privilege of getting the right treatment optimum treatment in time so a prophylaxis several studies have shown that full dose ah or intermittent handed half life can considerably reduce joint blades and overall blades this led world partition hemophilia to declare that regular long term prophylaxis is the standard of care everywhere in the world not only in developed countries but also in undeveloped countries for countries with significant resource constraints very low dose prophylaxis may be adopted ensuring availability for on-demand treatment previously in the in the second edition the very low dose prophylaxis was not included only in the recently in 2020 very low dose prophylaxis was accepted on demand treatment of course helps to erase bleeds but will not delay join them it's a very important point mild or moderate hemophiliacs this severe bleeding phenotype also need to be covered by prophylaxis now wfsh guidelines for the management of hemophilia third edition that is 2020 which has been endorsed by the national hemophilia foundation united states and european hemophilia consortium this was by a team chaired by alex rybastova dr luke shiva professor of clinical hematology christian medical college fellow the world federation recommends for patients with hemophilia a or hemophilia b it is severe bleeding phenotype wfh strongly recommends that such patients be on prophylaxis sufficient to prevent bleeds at all times the world federation recommends early initiation of prophylaxis with plotting factor concentrates standard or extended half-life factor eight or factor nine or other hemostatic agents this has been included only recently previously in the finished prophylaxis it was the regular replacement of clotting factor concentrates now that new hemostatic agents have come to the picture the definition has been modified that is the initiation of prophylaxis plotting factor concentrate standard or extended half life eight or nine or other hemostatic agent prior to the onset of joint disease and ideally before the age of 3 years and again now recognizing that with the one percent drop level patients remain at risk of bleeding most clinicians would prefer to target higher trough level is more than five more than three to five percent or higher recent studies have shown that such trough levels achieve less bleeding here we have in the graph we have shown both patient relevant outcomes as well as level of protection with regard to patient relevant outcomes it is the health equity it prevents premature death that happens in the infant then improved quality of life participation activities of daily living that is with minimal joint impairment then freedom from spontaneous bleeds allows ability to engage in low risk activities and normal mobility allows participation in work career and family with family life without restriction and ability to sustain minor trauma helps them to adopt a more unrestricted lifestyle then replacement helps them to undergo surgery or major trauma without additional intervention that is non-dependent on healthcare and finally normal hemostasis optimized health and well-being now prophylaxis is the goal of therapy for people with hemophilia since prophylaxis prevents bleeding and joint destruction it should be the goal of therapy in order to preserve normal musculoskeletal function prophylaxis is cost effective in the long term as it eliminates the high cost associated with management of damaged joints and improves the quality of life now comparison of prophylaxis and on demand on demand we find we have seen from several studies that it increases the bleeding episodes it corrects the bleeds but uh it does not reduce the number of episodes annual blade rate remains the same the bleed severity of the bleeding is increased joint deformities as you have seen episodic treatment will not will not in any way improve the joint outcomes quality of life is considerably reduced because increased whole absenteeism and work absenteeism on the part of the children and parents and reduce life expectancy and the cost of treatment is also high whereas if you give prophylaxis the regular replacement therapy the bleeding episodes are reduced bleed severity is reduced joint mobility is increased quality of life improves life expectancy grows and costs also prophylaxis is the standard of care and better long-term clinical outcome and improved quality of life so prophylaxis is highly effective and an annual bleed rate of zero is possible it is not it is possible and um there is a this is a study from blanchett it shows the subjects on standard prophylaxis 21 modified prophylaxis 37 and on demand five number of subjects experiencing bleeds or 28.6 percent with standard salary prophylaxis 24.3 with modified prophylaxis and 80 percent on demand so median annual joint aj annual abr annual blade rate comes to 0 0 and 13 in the case of on demand there are several studies there are several studies to uh support the profe importance of prophylaxis this finance study shows compared routine prophylaxis with on-demand treatment with recombinant factorate in adults with severe hemophilia so key findings was um [Music] in prophylaxis the median number of total breeding episodes were zero and total bleeding episodes per year was also zero whereas on non-demand cases it was 64.5 in the total breeding episodes and um [Music] 27.9 uh 54.5 million and 27.9 total bleeding edwards events were consistent with established recombinant tracts with a safety profile and no treatment related adverse effects were observed and none of the patients developed developed a factory type inhibitor in a retrospective study published by khadji ah severe hemophilia resulted in only 36 percent of patients with joint blade in a three-year period in comparison patients treated with on-demand therapy are likely to experience 30 to 35 joint blades per year so the early start of prophylaxis continuing into adulthood has been successful in virtually eliminating joint blades and preserving a close to normal joint status simulations with hemophilia again inhibitory incidence incidents incidents in patients receiving prophylaxis and non-demand treatment with severe hemophilia during the first 20 exposure days prophylaxis and on demand treatment for then prophylaxis was associated with a decreased overall inhibitory incidence after 20 exposure rate a days and a patient who started prophylaxis within the first 75 exposure days had a 32 percent lower risk for inhibitor development compared with patients treated with on demand therapy when we started the prophylaxis in our center in 2015 it was so very difficult to get 10 children for prophylaxis because the parents believe that prophylaxis will definitely increase the incidence of inhibitors it is very difficult to get 10 patients and now once they experience the advantages of prophylaxis over six months and then subsequently for one year uh there is a big rush for him for prophylaxis and last year in 2021 the state government has approved has started prophylaxis for under 18 children uh intermediate dose prophylaxis for under 18 children actually prophylaxis um there are three uh regimens right now under the 2020 protocol 2020 protocol the first one is the malmo protocol which goes from 25 to 40 international units per kilogram twice weekly for uh for uh fact uh hemophilia b and price weekly for fact uh hemophilia uh ea uh then is the intermediate uh dutch protocol which gives 15 to 25 units per kilogram twice weekly or twice or twice weekly for hemophilia and once or twice weekly for hemophilia b and recently in 2020 conference they have approved the very low dose prophylaxis which are found to be useful from study from pondicherry china aloha and mumbai they have approved the very low dose protocol which is which definitely is better than on demand treatment with a dosage of 10 to 15 units per kilogram twice daily twice weekly for hemophilia and price weekly for hemophilia extended half-life factor eight now extended halfway products have come both for hemophilia and for hemophilia b they are more useful for hemophilia be because the factor need to be administered only once in 10 days whereas in the case of hemophilia yeah the advantages you can give it twice a week that the number of that is that reduces the number of needles for the patient so uh that increases the compliance this decreases the dose frequency and improve the quality of life without compromising safety and efficacy extended half every common factor uh promise optimal uh optimal uh uh optimal uh prophylaxis uh apart from extended half-life uh factory replacement products non-factor options with improved pharmacokinetic profiles have come and gene therapy aiming for a phenotypic cure has also come to change hemophilia can care dramatically several changes and questions remain regarding the broader applicability long-term safety and which option to follow for each participant next this shows the beneficial effects of extended half-life product in the case of factor 8 the extended half-life product increases the half-life by 1.3 to 1.7 fold it reduces the infusion number from 30 to 50 percent if previously on standard half-life products and improves the trough level to 2 to 3 units per deciliter reduction in the number of infusion higher factor top level and decrease of bleeds with a substantial reduction of abr so patients with severe hemophilia could be converted to moderate phenotype by using a prophylaxis with extended half-life products the world federation hemophilia 2020 recommendations patients with hemophilia who are transitioning from standard half-life plotting factor concentrate to extended half-life plotting factor concentrates would typically require decreased dose frequencies but extended halfway products may also be used to maintain higher top levels to optimize prophylaxis extended half-life products in hemophilia a for patients with hemophilia a or hemophilia b there is no evidence for any clinical safety issues in patients with hemophilia to recommend a preference among the various mechanisms of action as you all know the extension of half-life is is obtained by the pagylation that is a combination of polyethylene glycol fc fusion with antibody or albumin fusion used to extend to a half-life of clotting factor concentrates comparison of new and emerging fat rate replacement products the different factor names are given factor characteristics they're half-life annual believe it in the studies uh uh noted and treatment of bleach optic alpha or add weight is the standard factor concentrate the full length molecule the applied is 8 to 12 hours annual blade rate of 6.3 and 93 episodes controlled with one or two doses effort cog alpha is available under the humanitarian aid program of world potential hemophilia the b domain deleted factory fc fusion protein the half life is 19 hours abr is individual individualized prophylaxis 1.3 and 97 8.8 percent beliefs control is one or two risks next is adenovate it's a full-length factory where half-life is 14 or 19.6 annual bleeding was 1.9 five point nine percent blade controlled with one or two doses next uh alpha pagoda again b domain truncated 40 kilo dalton of ah the next is clinical data on extended half-life practice products hemophilia dealing with hemophilia in detail damage to koga alpha pegal that is protect 7 study shows 96 percent reduction in abr nuclear prophylaxis 90.6 of blades are controlled with less than two inclusions and no inhibitors were detected during the study and then in a long study with f morocco alpha 92 in annual platelet individualized properly 76 percent reduction in annual blade rate is weekly prophylaxis 97.8 percent of bleeding episodes receive result with less than two inclusions and no subjects developed inhibitors during the study reactor called alpha pagoda that is prolonged prolonged study 90 in annual blade rate twice weekly prophylaxis 95. percent 96 percent of blades were controlled with less than two inclusions and no subjects developed inhibitors during the study and the last one called alpha pagoda pathfinder study 96 percent reduction in annual blatant with prophylaxis funds every four days 95.5 percent blade resolved business and two inclusions and one patient developed inhibitors after 93 exposure days next is the propel study with phase three prospective randomized multi-center clinical studies comparing their safety and efficacy of acts 855 following pk guided prophylaxis targeting two different factors trough levels in patients with severe hemophilia this shows that the main eligibility criteria for selection of patients are back to eight figure patients less than one person age was between 12 and 65 annual brain weight should be more than two and no present uh presents uh our history of inhibitor and previously treated patients personalized prophylaxis randomized uh factor eight prop level one to three percent factory uh drop level approximately ten percent primary outcome is present for absence of any bleeding in the truth in the second six months study period prospective randomized multi-center clinical study comparing the safety and efficacy of adenoids following pk guided prophylaxis targeting two different factor eight uh attract levels in patients with severe primary and secondary efficacy outcomes of trough level 8 to 12 percent 62 ibr uh spontaneous abr 60 percent factory top level one to three percent of level eight to twelve percent seventy six percent continuous probably the patient is free from me summary of edwards events during the first year of observation period all i do is even top level one to three percent uh patients with adverse events is 34.9 36 then non-serious idols even 97 and 98 percent serious adverse even yeah all serious only five only four in the first place and five in the second key next is the proper results support the concept of targeting higher factory prop level and providing personalized pk based statement option for improved outcome definitely the importance of pk based um profile uh is the empire it is definitely important but then uh the availability of infrastructure to provide a pk based um uh prophylaxis in most of our centers is very limited at least support the concept of targeting higher factor eight prop levels and providing personalized cpds treatment options for improved outcomes pkb's treatment has definitely definitely a claim in the sense that a person's different variations differ from one patient to another in their uh half life within the body propel demand says that factory drop levels of 8 to 12 percent were consistently achievable and clinically meaningful with extended half-life project product targeting zero bleeds was achievable with pk guided dosing targeting between eight and twelve percent factory trough levels including total abr uh and spontaneous abr and spontaneous and annual joint blatant this means proper demand says that optimizing factory profiles through pk driven dosing can help guide clinical practice through personalized uk guided prophylaxis to improve chemotherapy a patient outcome anyway the results are quite good but what extent we can implement in our country now god only knows because um even to achieve a level above one person uh is a dream for us so to go in up to eight to twelve percent i don't know what extent we will be able factor levels at different sampling time points mean factorate levels at three hour time points are congregated around eighty percent for the identity and electric the main track rate level without innovate with this pa however was much higher it knew it continued to show statistically higher mean 5 rate levels however by 48 hours and 72 hours time points there were there were no statistical differences in between adenovate and others coming to pharmacokinetic profiles i denote and allocate half-life using oscillate and gave 15.7 hours and it looked eight point sixteen point one hour there is no significant difference whereas half life using ca browse i didn't know it sixteen hours and it locked it on 18 hours stick to one stage as a because homogeneics is still costlier pk parameters of reactive called alpha pagoda adenomate and electric you know these factors are discussed because it is available under the humanitarian aid program of wfh on half-life clearance size is slightly uh it is slightly higher for adenomate and clinical impact parameters was slightly better than yellow in the initial time points retrospective analysis to evaluate real world dosing patterns of extended half-life three competent fact paid products uh that is 774 uh patients and this is a study from china uh 774 patients are included know it's 26.2 closing frequency and weekly weekly consumption most frequently report regimen was two doses per weekly consumption in patients more than 12 years of age and overall dosing regimen variability tended to be higher for um for f to call alpha compared to reactor cobalt sensitivity analysis were performed on data of complete one year in 2017 after both compounds had been approved for use in the united states for more than one year across all cohorts for patients more than 12 years of age means that standard deviation weekly consumption variability were higher in those who received less more to allocate than uh this program of alpha pagoda apart from the study statistics for patients with severe phenotype of aaa or hemophilia b using extended half-life rate of factor 9 concentration the wfh recommends prophylaxis with extended half-life ortic factor function rate at sufficient doses and dosing interval to prevent hemorthosis and spontaneous and breakthrough bleeding and preserve joint function so this shows the preference to extended half-life product compared to the standard of life products coming to extended half-life product use in india low dose prophylaxis in severe hemophilia in to investigate the effectiveness of low dose secondary or tertiary prophylaxis in serious hemophilia a children and determine improvements in their life uh this is the study from uh mandel uh that is 30 hemophilia children less than 12 years in fact less than two percent and less than two jointly without inhibitors were included prophylaxis with yellow feet we had 10 units per kilogram twice weekly for one year earlier the patients received on-demand treatment for a minimum of six months and median age of patients was 6.5 years after prophylaxis there was 85.76 percent reduction in median annual joint bleeding rate mhjbr and 86 percent in mean school absenteeism there was reduction in the annual consumption of clotting factor concentrates while on profile axis from 1944 units to now 1560 internationals per kilogram in a period of one year so this shows the advantage of prophylaxis over on demand treatment after prophylaxis hemophilia joint health score there was significant improvement 93 per person reduction in hemophilia joint health score after prophylaxis the direct consequence of decrease in number of joint and severe bleeds was a reduction in hospital admission the present study had a fall of mean hospitalization rate from 8.7 to 1.1 90 of the children were compliant with the study so after prophylaxis daily activity score and school activity participation score was ready there was no change in 17 percent mild improvement in 40 percent and moderate improvement in 43 percent improvement in your school activity participation score was some moderate improvement in 38 than mild improvement in so low dose secondary or tertiary prophylaxis is a safe efficacious and cost-effective way of reducing joint bleed and improving activity of children in terms of daily activities and school activity as factor consumption is reduced this has a positive effect on cost benefit and this is a very feasible option in developing countries yeah this is a [Music] reductive and switching to radioactive alpha pagoda prophylaxis from a standard half-life actually reduced abr reduced breakthrough bleeds reduced losing frequency reduced hospital admissions and the ideal treatment and reactor called alpha pagoda prophylaxis targeting factorator of more than one person has shown to be efficacious with an acceptable safety profile in patients with hemophilia a reactor called alpha pagoda shows improved bleeding outcomes due to longer time at higher factor levels and achievement of higher crop parameters and for prophylaxis reducing as compared to various external half-life products it showed higher dosing hemophilia patients so while we have discussed all these things we have to think of normal alternative hemostatic agents for hemophilia we have got coagulation factor mutants or mimics which include by specific antibody mimicking that is already there in the market uh then uh super factors 5a then simogen like factor 10a variant and phase a furion claim factory and natural anticoagulant knocked down products like are not targeting antithrombin efpi and apc specific these are all there yeah in the pipeline uh by specific antibodies already available and so five eight mimic by specific antibody binding factor 9 to fact and factor 10 that is me susima rna targeting anti-chromium is c2 7 anti-tfpi is called system and anti-apc is also coming i'm not going into the details of this or the lack of time but then these we have to be aware of these things i have actually confined myself uh to extended half-life factory product extended half-life factor nine product is more advantageous because it is a long half-life and once in a week or once in 10 days treatment is enough for hemophilia really a great help now so we have the which i cited we had some we had conducted studies in our in our center also first on first in children under 10 years then we uh got results similar to the results which i projected just now you know uh the that is with considerable decrease in annual bleed rate with um improvement in school absenteeism and work absenteeism of parents and overall quality of life amongst the patients with homophilia similarly when they those who are already suffering from joint damage he did not go the dosage was not according to any international studio we just use the number of units which we use for the patients for episodic treatment during the previous six months and administered it as prophylaxis in the subsequent six months and found that the annual blade and it amounted to only six to eight units per kilogram but still in spite of that he found that the annual blade rate came down by 70 percent so even whatever it is uh prophylaxis is the order of the day where if we can't afford the full prophylaxis or the intermediate life at least you should go in for the very low dose prophylaxis definitely we have a positive effect and brings smiles to hemophiliacs lives this is uh the hemophilia day celebrations last year this year thank you very much for the patient listening thank you sir thank you so much it was a wonderful talk sir we are having one hand raised i would request luchali to help us please yes yes i've accepted it doctor sumit you could switch on your audio video and this is sumit tavi cardio specialist thank you thank you to dr which is the test for hemophilia patients can you actually hemophilia patients hemophilia patients actually we have we go by prothrombin time and partial thromboplastin time in these disorders in and hemophilia b partial thromboplastin time is prolonged then we go to mixing studies and then we go to factories there are three steps first is protrum in time and partial thromboplastin time so thrombin time is the reflection of factor seven in fact um our partial thromboplasty time is a reflection of the levels of factor uh eight factor nine or fond deliverance factor so we actually if the aptt is prolonged then we go in for a mixing study to find out which factors are missing uh factor eight or factor nine or one millimeter then we go to factor assay which factors i hope i am i have clarified your phone yes sir yes yes sir thank you sir thanks a lot actually thank you because previously uh unfortunately in our place also all the surgeons observations they went for btct which is an obsolete test now actually they should be the order of the day everybody every patient antenatal as well as pre-operative should undergo a test of the apt as a screening test so that the underlying bleeding disorders will be detected because mild patients you will never know whether a patient is deficient in any fat thank you thank you for the question okay thanks a lot sir sir uh but those of prophylaxis with the ehl can be practiced in india for patients with hemophilia if the cause comes down definitely we can but unfortunately external products no their prohibitively costly right now but definitely starting the recombinant itself was very costly but now it has come down to the level of class for derived one i hope that external oblique first of all prophylaxis should be the policy that is the most important thing prophylaxis is the standard of care anywhere in the world and that has to be accepted and implemented in our country also and now first once that is accepted then the uh second question comes how how will you go about it so prophylaxis standard of a product is inadequate with external half-life product will be adequate so it is our duty and responsibility to provide optimum player to the patient even if it is a bit more costly in that case extended half-life products will come to there was no factor at all available from the government it in another three or four years i hope so thank you thank you sir so thank you so much for watching all right someone more question we received like since very few studies of ehl in india are available and so do you think more real world evidence is needed [Music] no real world evidence for exam you know extended halfway products we have no not we have used in india extensively because we are one of the largest beneficiaries of the humanitarian aid program so external affairs products have been in india for quite long especially for surgeries we get lots of them so extended our play products are definitely useful there is no question about it it's the only all no publications uh definitely definitely it will be very useful especially factor nine thank you sir thank you so much for addressing this question uh so i think we have learned with our timing thank you thank you so much sir and thank you i would like to express my gratitude for your presence sir right and thank you so much for your great contributions science and clinical practice for hemophilic patients answer your dedicated work it's a wonderful job sir i i have no words in one slide but it's uh i think you have done wonderful you are doing great work sir and i would like to express my gratitude for all the participants who have joined our today's session and uh in the end dr bhushali with the technical team support who supported us today for this session and thank you so much for all to all the participants who have joined us and have a wonderful day ahead thank you thank you so much dr vijra kumar thank you for being a part of netflix webinar and thank you doctor thanks for your sales and technical teams this is the first time that i am appearing on this platform and i was worried how i go about it thanks the technical team helped a lot thanks a lot thank you first time thank you i'm sure you enjoyed your experience have a great day great evening thank you thank you thank you thank you so much


Progress in hemophilia therapy has been remarkable in the first 20 years of the third millennium, but the innovation started with the fractionation of plasma in 1946. Over the past 75 years, the life expectancy and quality of life of people living with hemophilia has improved dramatically, and their life is approaching that of their unaffected peers. Novel therapies offer an arsenal of treatment options and could revolutionise the future of haemophilia management. Learn live with this educative session on Medflix about the latest updates in management of hemophilia.


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