Repeated Desmopressin Dosing Yielded Decreasing Responses in Nonsevere Hemophilia A

Repeated desmopressin administration after perioperative use in patients with severe hemophilia A may result in tachyphylaxis. Results of a recently published study showed reduction in factor VIII:C response after the second and third administrations of desmopressin compared with the initial dose.

“Repeated desmopressin administration should be considered as a treatment modality in the perioperative setting in persons with nonsevere hemophilia A, but more pronounced tachyphylaxis should be anticipated,” study researchers wrote. “Our results may have important implications for monitoring repeated desmopressin treatment when used perioperatively.”

The study included 17 patients with nonsevere hemophilia A enrolled in the DAVID and Little DAVID studies. Patients were administered desmopressin before surgery and on day one and day two after surgery.

Prior to surgery, the median absolute factor VIII:C increase was 0.50 IU/mL, with an increased from 0.20 to 0.72 IU/mL; at D1 the median increase was 0.21 IU/mL and at D2 it was 0.23 IU/mL.

Compared with before surgery, the percentage of factor VIII increase at day one was only 42.9% and was even lower on day two at 36.4%.

“In this substudy, patients also had received FVIII concentrate before the trough measurements on [day one] and [day two],” the researchers noted. “As a consequence, these measured trough levels are higher than possibly expected.”

The researchers also assessed the reproducibility of presurgery response in comparison to an earlier performed desmopressin test. Factor VIII:C desmopressin response presurgery was reproducible to desmopressin test factor VIII:C response in 74% of patients, which the researchers wrote “underscores, as reported earlier, that a desmopressin test is an important and reliable tool to predict the preoperative desmopressin response” and “emphasizes the role of desmopressin as a low-cost treatment modality with high convenience (ie, intranasal spray) in persons with nonsevere hemophilia A with an adequate response.”

Reference

Romano LGR, Schutte LM, van Hest RM, et al. Tachyphylaxis and reproducibility of desmopressin response in perioperative persons with nonsevere hemophilia A: implications for clinical practice. Res Pract Thromb Haemost. 2024. doi:10.1016/j.rpth.2024.102367