{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:10:20Z","timestamp":1772795420572,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Dutch federation of academic hospitals"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,11]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Emicizumab effectively prevents bleeding in people with haemophilia A (PwHA), but is a burden for national healthcare budgets and consequently may limit access. According to the drug label, dosing of emicizumab is based on body weight with fixed intervals of 7, 14 or 28 days, which leads to mean plasma concentrations of 55\u2009\u00b5g\/mL (SD 15\u2009\u00b5g\/mL). However, a moderate variability of concentrations and a minimal effective concentration of 30\u2009\u00b5g\/mL have been suggested in studies. Therefore, a dose of emicizumab that targets a trough concentration of 30\u2009\u00b5g\/mL is hypothesised to be equally effective as conventional dosing in the prevention of bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We designed a phase IV, multicentre, open-label, crossover study to evaluate non-inferiority of bleed control of \u22656 months on conventional dosing in comparison to \u22656 months on dose intervention. This dose intervention consists of reducing the dose of emicizumab to target a trough concentrations of 30\u2009\u00b5g\/mL using individual pharmacokinetic (PK) parameters. Ninety-five PwHA aged &gt;1 years who received conventional dosing of emicizumab for \u226512 months with good bleeding control during the last 6 months will be recruited from all Dutch haemophilia treatment centres. The study is powered to detect a clinically relevant decrease (risk difference) of 15% in the proportion of patients without treated bleeds during follow-up. Secondary endpoints are spontaneous joint or muscle bleeds, and annualised treated bleeding rates (using negative binomial regression). Cost-effectivity between conventional dosing and individualised PK-guided dosing of emicizumab will be compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The DosEmi study was approved by the Medical Ethics Review Committee NedMec of the University Medical Center of Utrecht, The Netherlands. Study results will be communicated through publications in international scientific journals and presentations at (inter)national conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      EUCTR2021-004039-10-NL at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/trialsearch.who.int\">https:\/\/trialsearch.who.int<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Protocol version<\/jats:title>\n                    <jats:p>V.4.1 on 28 October 2022 (DosEmi protocol_V4.1; NL81112.041.22).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072363","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T23:56:03Z","timestamp":1687823763000},"page":"e072363","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["DosEmi study protocol: a phase IV, multicentre, open-label, crossover study to evaluate non-inferiority of pharmacokinetic-guided reduced dosing compared with conventional dosing of emicizumab in people with haemophilia A"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8147-013X","authenticated-orcid":false,"given":"Anouk","family":"Donners","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, University Medical Centre, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad","family":"van der Zwet","sequence":"additional","affiliation":[{"name":"Center for 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Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Math\u00f4t","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy-Clinical Pharmacology, Amsterdam University Medical Centres, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4118-4670","authenticated-orcid":false,"given":"Ilmar","family":"Kruis","sequence":"additional","affiliation":[{"name":"Netherlands Haemophilia Society, Nijkerk, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marjon H","family":"Cnossen","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Oncology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands"},{"name":"Principal Investigator SYMPHONY NWO-NWA Consortium, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Schutgens","sequence":"additional","affiliation":[{"name":"Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rolf T","family":"Urbanus","sequence":"additional","affiliation":[{"name":"Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathelijn","family":"Fischer","sequence":"additional","affiliation":[{"name":"Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The 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