Concizumab for the management of heavy menstrual bleeding in a woman with mild hemophilia A

Background

Heavy menstrual bleeding (HMB) is a common bleeding manifestation in women with hemophilia A and may impair quality of life. Key clinical question: Can concizumab control refractory HMB in a woman with mild hemophilia A who cannot tolerate conventional therapies? Clinical approach: An 18-year-old woman with mild hemophilia A had prolonged menstruation. Combined oral contraceptives improved bleeding but were discontinued because of mood-related adverse effects. Extended half-life factor (F)VIII concentrates shortened menstruation but caused significant burden due to repeated venipuncture. Following shared decision making, subcutaneous concizumab was initiated. During concizumab treatment, menstrual duration was generally maintained at 7 to 11 days per cycle. Menstrual control deteriorated after temporary concizumab dose reduction and remained inadequate despite the addition of tranexamic acid, prompting restoration of the previous concizumab dose. Subsequent concizumab concentration and D-dimer levels were within their respective target or reference ranges.