Moderate-intensity aerobic exercise vs desmopressin in adolescent males with mild hemophilia A: a randomized trial.

Abstract

Persons with mild hemophilia A (HA) may use intranasal desmopressin prior to sports participation. Desmopressin is expensive and can cause vomiting, headache, palpitation, and occasionally seizures. Our group has previously documented a 2.3-fold increase in factor VIII activity (FVIII:C) in adolescents with mild HA after moderate-intensity aerobic exercise. Herein, we report principal findings of a randomized trial of intranasal desmopressin vs a standardized, moderate-intensity aerobic exercise regimen in adolescents with mild HA. Our primary objective was to compare the change in FVIII:C associated with these 2 interventions. We also examined changes in hemostatic parameters arising from their sequential administration. The study was conducted simultaneously at the Hospital for Sick Children, Canada, and Nationwide Children's Hospital, USA. Thirty-two eligible male adolescents (mean age ± standard deviation: 16.1 ± 2.6 years) with mild HA (mean baseline FVIII:C: 27.9% ± 18.4%) were randomized to 1 of 4 study arms (desmopressin followed by exercise, desmopressin alone, exercise followed by desmopressin, and exercise alone). Blood work was obtained at baseline and at 3 subsequent time-points. Participants randomized to exercise cycled on an ergometer for approximately 12 minutes, with the final 3 minutes at 85% of their predicted maximum heart rate. Standard weight-based dosing of desmopressin was used. Mean immediate increase in FVIII:C was 1.7-fold with exercise compared with 1.9-fold with desmopressin (noninferiority, P = .04). Exercise-induced improvement in hemostatic parameters including FVIII:C was brief compared with more sustained improvements seen with desmopressin. More than 60% of participants randomized to receive both exercise and desmopressin achieved normal (>50%) FVIII:C, 75 and 135 minutes into the study protocol.

• Authors: Riten Kumar, Amy L Dunn, Jane E Schneiderman, Anne Gonzales, Vanessa Bouskill, Pamela Widener, Joseph Stanek, Fred G Pluthero, Amanda Waller, Cristina Tarango, Sanjay Ahuja, Bryce A Kerlin, Walter H A Kahr, Margaret L Rand, David Lillicrap, Manuel Carcao
• Journal: Blood (Blood) Vol. 140 Issue 10 Pg. 1156-1166 (09 08 2022) ISSN: 1528-0020 [Electronic] United States
• PMID: 35839450 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2022 by The American Society of Hematology.

Chemical References

• Hemostatics
• Factor VIII
• Deamino Arginine Vasopressin

Topics

• Adolescent
• Deamino Arginine Vasopressin (therapeutic use)
• Exercise Therapy
• Factor VIII (therapeutic use)
• Hemophilia A (drug therapy)
• Hemostatics (therapeutic use)
• Humans
• Male