Efficacy of subcutaneous versus intravenous administration of desmopressin in patients with von Willebrand disease and hemophilia A in need of COVID-19 vaccination

ABSTRACT

Background: Subcutaneous desmopressin (DDAVP) can be more easily administered than intravenous DDAVP and may be an efficacious alternative for the currently unavailable intranasal DDAVP to treat mild bleedings or for minor invasive procedures in von Willebrand disease (VWD) and hemophilia A. Aim(s) To compare the one-hour response to subcutaneous and intravenous DDAVP in patients with VWD or hemophilia A. Method(s) Patients with hemophilia A (FVIII <=10 IU/dl) or VWD (VWF activity <=10 IU/dl) whose treatment plans include DDAVP and who were to receive a COVID-19 vaccination were eligible to participate. For COVID-19 vaccination, FVIII or VWF activity target levels of >10 IU/dl were pursued according to international guidelines (ISTH). DDAVP was administered subcutaneously 1.5 h before vaccination. FVIII (in hemophilia and VWD) and VWF activity levels (in VWD) were determined prior to (t = 0) and 1 h after DDAVP (t = 1). All patients had a positive historical routine challenge test with intravenous DDAVP. For each participant, absolute and relative changes of FVIII and VWF activity levels 1 h after subcutaneous and intravenous DDAVP (both 0.3 mug/kg) were compared. Result(s) Eleven patients were included Six with hemophilia A, three with VWD type 2M and two with VWD type 2A. Both intravenous and subcutaneous DDAVP increased FVIII and VWF activity levels in all patients. In hemophilia patients, intravenous and subcutaneous DDAVP increased FVIII levels by an average of 3.8-fold and 3.4-fold respectively. Peak FVIII activity levels at t = 1 ranged from 25-62 IU/ dl and 29-51 IU/dl. In VWD patients, intravenous and subcutaneous DDAVP was associated with a 11.4-fold and 5.1-fold mean increase in VWF activity levels respectively. Corresponding peak VWF activity levels ranged from 18-100 IU/dl and 28-74 IU/dl. No bleeding after vaccination was reported. Conclusion(s) Subcutaneous DDAVP appears to be an effective alternative for intravenous DDAVP. Moreover, like intranasal DDAVP, subcutaneous DDAVP allows the possibility of self-administration at home.