Evaluation of MixPro® among users and nurses

Open access


Management of haemophilia involves on-demand or prophylactic intravenous administration of recombinant or plasma-derived replacement clotting factors or bypassing agents. These products are provided as lyophilised powder and diluent, which need to be mixed to produce a solution for infusion. While this process has previously involved multiple time-consuming steps, several reconstitution systems are now available to make mixing easier and more convenient. This study aimed to investigate experience of use and perceptions of the Novo Nordisk MixPro® mixing device among patients and carers using activated recombinant factor VII (rFVIIa) or recombinant factor VIII (rFVIII) with MixPro, and nurse specialists who were either familiar or unfamiliar with MixPro. Nurses were asked to simulate the preparation of an inactive solution using MixPro. Semi-structured interviews were used to gain insight into participants’ opinions of mixing systems in general and their perceptions of MixPro. Likert scales were used to rate the performance of MixPro against predefined characteristics of mixing systems, and the importance of the predefined characteristics to the design of a mixing system. Patients/carers and unfamiliar nurses identified low contamination risk when mixing as the most important characteristic of a mixing system; the most important criterion for familiar nurses was confidence that patients/carers could prepare the system correctly. MixPro was perceived to perform very well overall, particularly in parameters identified as most important. It was described as being user-friendly, simple and quick; its compactness and portability were highlighted as advantages for storage and travel. The main disadvantages reported related to its small components. The majority of nurses said that they were highly likely to recommend MixPro to their patients.

1 Cancio MI, Reiss UM, Nathwani AC, Davidoff AM, et al. Developments in the treatment of hemophilia B: focus on emerging gene therapy. Appl Clin Genet 2013; 6: 91-101.

2 Mannucci PM, Franchini M. Is haemophilia B less severe than haemophilia A? Haemophilia 2013; 19(4): 499-502.

3 Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, et al. Guidelines for the management of hemophilia. Haemophilia 2013; 19(1): e1-47.

4 Chalmers, A. Haemophilia A and B: disease differences and the use of prophylactic therapy. Available from http://www.hemophiliareport.com/pdf/HEMR0101.pdf (accessed 11 October 2017).

5 Furlan R, Krishnan S, Vietri J. Patient and parent preferences for characteristics of prophylactic treatment in hemophilia. Patient Prefer Adherence 2015; 9: 1687-94.

6 Pabinger-Fasching I. The story of a unique molecule in hemophilia A: recombinant single-chain factor VIII. Thromb Res 2016; 141 Suppl 3: S2-S4.

7 Shima M, Lillicrap D, Kruse-Jarres R. Alternative therapies for the management of inhibitors. Haemophilia 2016; 22 Suppl 5: 36-41.

8 Saxena K. Barriers and perceived limitations to early treatment of hemophilia. J Blood Med 2013; 4: 49-56.

9 Cimino E, Linari S, Malerba M, Halimeh S, et al. Patient preference and ease of use for different coagulation factor VIII reconstitution device scenarios: a cross-sectional survey in five European countries. Patient Prefer Adherence 2014; 8: 1713-20.

10 Hacker MR, Geraghty S, Manco-Johnson M. Barriers to compliance with prophylaxis therapy in haemophilia. Haemophilia 2001; 7(4): 392-6.

11 Lindvall K, Colstrup L, Wollter IM, Klemenz G, et al. Compliance with treatment and understanding of own disease in patients with severe and moderate haemophilia. Haemophilia 2006; 12(1): 47-51.

12 Vidovic N, Musso R, Klamroth R, Enriquez MM, et al. Postmarketing surveillance study of KOGENATE Bayer with Bio-Set in patients with haemophilia A: evaluation of patients' satisfaction after switch to the new reconstitution system. Haemophilia 2010; 16(1): 66-71.

13 Khair K, Meerabeau L, Gibson F. Self-management and skills acquisition in boys with haemophilia. Health Expect 2015; 18(5): 1105-13.

14 Schrijvers LH, Beijlevelt-van der Zande M, Peters M, Schuurmans MJ, et al. Learning intravenous infusion in haemophilia: experience from the Netherlands. Haemophilia 2012; 18(4): 516-20.

15 Riva S, Nobili A, Djade CD, Mancuso ME, et al. Cognitive and psychological profiles in treatment compliance: a study in an elderly population with hemophilia. Clin Interv Aging 2015; 10: 1141-6.

16 European Medicines Agency. NovoEight: EPAR - product information. Available from http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002719/WC500157553.pdf. Accessed 24 February 2017).

17 European Medicines Agency. NovoSeven: EPAR - product information. Available from http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000074/WC500030873.pdf (accessed 24 February 2017).

18 Munn J, Khair K, Scott A, Shoemark R, et al. Patient and caregiver perceptions of a pre-filled diluent syringe (MixPro). J Haem Pract 2016; 3(1): doi: 10.17225/jhp00073.

19 European Medicines Agency. Refixia: EPAR - product information. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/004178/WC500232816.pdf (accessed 11 October 2017).

20 Makwana S, Basu B, Makasana Y, Dharamsi A. Prefilled syringes: an innovation in parenteral packaging. Int J Pharm Investig 2011; 1(4): 200-6.

21 Zadbuke N, Shahi S, Gulecha B, Padalkar A, et al. Recent trends and future of pharmaceutical packaging technology. J Pharm Bioallied Sci 2013; 5(2): 98-110.

22 Khair K. Evaluating a self infusion device for children with haemophilia. Paediatr Nurs 2006; 18(10): 19-20.

23 Fernandez-Arias I, Kim HK. Factor VIII delivery devices in haemophilia A. Barriers and drivers for treatment adherence. Farm Hosp 2016; 40(n06): 579-603.

24 Musso R, Santoro R, Coppola A, Marcucci M, et al. Patient preference for needleless factor VIII reconstitution device: the Italian experience. Int J Gen Med 2010; 3: 203-8.

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