According to research published in Blood, the magnitude of increased FVIII activity (FVIII:C) was similar following a moderate-intensity aerobic exercise regimen and intranasal desmopressin in adolescent male patients with mild hemophilia A (HA), but more sustained improvement was associated with desmopressin use than aerobic exercise.
The researchers conducted a randomized trial comparing the change in FVIII:C and hemostatic parameters with intranasal desmopressin vs a standardized, moderate-intensity aerobic exercise regimen in adolescents with mild HA (ClinicalTrials.gov Identifier: NCT03379974; NCT03136003).
Patients were randomly assigned to receive desmopressin followed by exercise, desmopressin alone, exercise followed by desmopressin, or exercise alone. The researchers obtained blood work at baseline and at 4 subsequent timepoints (30±10 min, 45±10 min, 75±10 min, and 135±10 min). The exercise regimen included cycling on an ergometer for approximately 12 minutes with standard weight-based dosing of desmopressin.
A total of 32 eligible adolescent male patients with mild HA at the Hospital for Sick Children, Toronto, Canada, and Nationwide Children’s Hospital, Columbus, Ohio, were included in the study. Patients had a mean age of 16.1±2.6 years and mean baseline FVIII:C of 27.9±18.4%.
The researchers found that the mean immediate increase in FVIII:C was 1.7-fold with exercise compared with 1.9-fold with desmopressin (noninferiority P =.04). They observed that improvement in hemostatic parameters, including FVIII:C, induced by exercise was shorter than that see with desmopressin. They also showed that more than 60% of participants randomized to receive both exercise and desmopressin achieved >50% FVIII:C, which is within the normal range at 75 and 135 minutes.
Limitations of the study included a sample size powered only to investigate the primary objective, restriction of the reported trial to males, and exposure of patients enrolled at Nationwide Children’s to “superpotent” desmopressin; subgroup analysis demonstrated that FVIII:C was increased 2.4-fold in these patients compared with 1.3-fold in the Canadian patients (P =.06), which could be a clinically relevant difference.
Kumar R, Dunn A, Schneiderman JE, et al. Moderate-intensity aerobic exercise versus desmopressin in adolescent males with mild hemophilia A: a randomized trial. Published online July 15, 2022. doi:10.1182/blood.2022016146