Background: Product switches can be extremely challenging for Haemophilia care providers, requiring intensive planning and organisation between multiple stakeholders. In October 2019, Emicizumab became available for prophylaxis in People with Severe Haemophilia A (PWSHA) without inhibitors in Ireland.

Aims: To develop a pathway to identify and assess patients who are eligible to consider a switch to Emicizumab and to ensure that switching is undertaken in an efficient, safe and cost effective manner.

Methods: A management pathway (table 1) was developed for each stage of the evaluation and switching process.
Pathway to Switch to Emicizumab

Results: To date, 35 PWSHA have been reviewed at clinic, of whom 25 have switched to Emicizumab prophylaxis. Missed, incorrect or delayed doses occurred on eight occasions and were more common in people using a fortnightly maintenance dosing schedule and in the first six weeks of switching. An additional follow up phone call with the Clinical Nurse Specialists at week three was implemented when the time of transition to maintenance dosing was identified as a risk period for incorrect dosing.
One episode of product wastage occurred due to incorrect storage of Emicizumab post switch. There was no wastage of rFVIII concentrate associated with the switchover process.

Conclusions: Successful switching of patients to Emicizumab, with low incidence of incorrect dosing or product wastage, is achieved with a well-coordinated and collaborative multidisciplinary approach.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-devil-is-in-the-detail-an-irish-approach-to-switching-to-emicizumab-prophylaxis-in-an-adult-comprehensive-care-centre-ccc/