International Society on Thrombosis and Haemostasis Clinical Practice Guideline for Treatment of Congenital Haemophilia—A Critical Appraisal
(2024) In Haemophilia- Abstract
Introduction: Evidence-based clinical practice guidelines drive optimal patient care and facilitate access to high-quality treatment. Creating guidelines for rare diseases such as haemophilia, where evidence does not often come from randomized controlled trials but from non-randomized and well-designed observational studies and real-world data, is challenging. The methodology used for assessing available evidence should consider this critical fact. In formulating guidelines, it is essential to include treatment goals and patient preference. Aim: This paper comprehensively critiques, against this background, the recommendations of the ISTH clinical practice guidelines for the treatment of haemophilia. Methods: Each recommendation was... (More)
Introduction: Evidence-based clinical practice guidelines drive optimal patient care and facilitate access to high-quality treatment. Creating guidelines for rare diseases such as haemophilia, where evidence does not often come from randomized controlled trials but from non-randomized and well-designed observational studies and real-world data, is challenging. The methodology used for assessing available evidence should consider this critical fact. In formulating guidelines, it is essential to include treatment goals and patient preference. Aim: This paper comprehensively critiques, against this background, the recommendations of the ISTH clinical practice guidelines for the treatment of haemophilia. Methods: Each recommendation was critically reviewed against available evidence as well as existing guidelines and commented upon for its scientific validity, impact on clinical practice and access to care globally. The validity of the way in which the GRADE methodology was applied to existing evidence was also assessed. Results: The critique provided shows that these recommendations have major limitations: they did not state treatment goals and contradict existing guidelines; opportunities for providing access to innovation were missed when the therapeutic benefits of the products approved in the last decades were not included. A major reason for this is the inappropriate adoption of the GRADE methodology without adaptations and without considering treatment goals and patient-relevant outcomes. Conclusion: These recommendations may mislead healthcare professionals, payers and governments and therefore cannot serve the patient community well. They setback the advances made in haemophilia care because they overlook important available evidence and do not guide clinical practice to contemporary standards.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- evidence-based medicine, GRADE, guideline, haemophilia, ISTH, WFH
- in
- Haemophilia
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:39642092
- scopus:85211600710
- ISSN
- 1351-8216
- DOI
- 10.1111/hae.15135
- language
- English
- LU publication?
- yes
- id
- e342f24f-f348-4203-bc3d-ebecce4f0fbf
- date added to LUP
- 2025-01-31 13:02:48
- date last changed
- 2025-07-05 01:46:59
@article{e342f24f-f348-4203-bc3d-ebecce4f0fbf,
abstract = {{<p>Introduction: Evidence-based clinical practice guidelines drive optimal patient care and facilitate access to high-quality treatment. Creating guidelines for rare diseases such as haemophilia, where evidence does not often come from randomized controlled trials but from non-randomized and well-designed observational studies and real-world data, is challenging. The methodology used for assessing available evidence should consider this critical fact. In formulating guidelines, it is essential to include treatment goals and patient preference. Aim: This paper comprehensively critiques, against this background, the recommendations of the ISTH clinical practice guidelines for the treatment of haemophilia. Methods: Each recommendation was critically reviewed against available evidence as well as existing guidelines and commented upon for its scientific validity, impact on clinical practice and access to care globally. The validity of the way in which the GRADE methodology was applied to existing evidence was also assessed. Results: The critique provided shows that these recommendations have major limitations: they did not state treatment goals and contradict existing guidelines; opportunities for providing access to innovation were missed when the therapeutic benefits of the products approved in the last decades were not included. A major reason for this is the inappropriate adoption of the GRADE methodology without adaptations and without considering treatment goals and patient-relevant outcomes. Conclusion: These recommendations may mislead healthcare professionals, payers and governments and therefore cannot serve the patient community well. They setback the advances made in haemophilia care because they overlook important available evidence and do not guide clinical practice to contemporary standards.</p>}},
author = {{Albisetti, Manuela and Ardila, Jesús and Astermark, Jan and Blatny, Jan and Carcao, Manuel and Chowdary, Pratima and Connell, Nathan T. and Crato, Miguel and Dargaud, Yesim and d'Oiron, Roseline and Dunn, Amy L. and Escobar, Miguel A. and Ettingshausen, Carmen Escuriola and Fischer, Kathelijn and Gouider, Emna and Harroche, Annie and Hermans, Cedric and Jimenez-Yuste, Victor and Kaczmarek, Radoslaw and Kenet, Gili and Khoo, Liane and Klamroth, Robert and Langer, Florian and Lillicrap, David and Mahlangu, Johnny and Male, Christoph and Mancuso, Maria Elisa and Matsushita, Tadashi and Meunier, Sandrine and Miesbach, Wolfgang and Nolan, Beatrice and Oldenburg, Johannes and O'Mahony, Brian and Ozelo, Margareth and Pierce, Glenn F. and Ramos, Gloria and Recht, Michael and Romero-Lux, Olivia and Rotellini, Dawn and Santoro, Rita C. and Singleton, Tammuella C. and Skinner, Mark W. and Srivastava, Alok and Susen, Sophie and Talks, Kate and Tran, Huyen and Valentino, Leonard A. and Windyga, Jerzy and Yang, Renchi}},
issn = {{1351-8216}},
keywords = {{evidence-based medicine; GRADE; guideline; haemophilia; ISTH; WFH}},
language = {{eng}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Haemophilia}},
title = {{International Society on Thrombosis and Haemostasis Clinical Practice Guideline for Treatment of Congenital Haemophilia—A Critical Appraisal}},
url = {{http://dx.doi.org/10.1111/hae.15135}},
doi = {{10.1111/hae.15135}},
year = {{2024}},
}