High variability in Factor IX one‐stage assay in samples spiked with nonacog beta pegol among different pairs of reagent/detection system

Abstract

AbstractIntroductionHaemophilia B (HB) is an X‐linked hereditary bleeding disorder characterized by coagulation factor IX (FIX) deficiency. To improve the quality of life of patients and adherence to treatment, recombinant factor concentrates modified to extend their half‐life have been developed, called extended half‐life factors (EHL: extended half‐life). Nonacog beta pegol (N9‐GP) is a glycopegylated recombinant human FIX molecule that has a half‐life of 93 h with a single dose and has shown a higher recovery percentage than other molecules. To diagnose and monitor the treatment of haemophiliac patients, FIX activity is determined with the one‐stage clotting assay (OSA) and/or the chromogenic assay. The objective of this work, carried out in three centres, was to measure the recovery of N9‐PG with 10 different activated partial thromboplastin time (APTT) reagents on three platforms, in samples spiked in vitro with N9‐GP, at four different concentration levels.MethodsIt was measured the recovery of N9‐GP with 10 different APTT reagents (polyphenol, ellagic acid, silice dioxide, colloidal silica as APTT activator on three platforms, in sample spiked in vitro with N9‐GP.ResultsThe results show heterogeneity in the activity of N9‐GP measured by OSA with the different APTT reagents when the calibrations were performed with the specific calibrator of each coagulometer. A recovery percentage between 87% and 108% was obtained only with polyphenol and ellagic acid as activator in the three platforms evaluated. The other reagents studied overestimate or underestimate, with no clear profile. When a calibration curve was performed with a calibrator prepared from the N9‐GP vial, all APTT reagents met the established recovery requirement.ConclusionAPTT reagents with polyphenol or ellagic acid as activator would be the only ones appropriate when using the commercially available OSA with specific calibrator to monitor patients treated with N9‐GP.