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Rudy Afriant

Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Andalas, RSUP Dr. M. Djamil, Padang 25163, Indonesia

Author-ID : 4089893

Biochemistry, Genetics & Molecular Biology Computer Science & IT Dentistry Economics, Econometrics & Finance Engineering Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary Other

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Low-Dose Prophylaxis versus On-Demand Therapy in Hemophilia Management: A Systematic Review and Meta-Analysis of Clinical Outcomes and Cost-Effectiveness in Resource-Limited Settings Rijalun Arridho; Rudy Afriant
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.859

Hemophilia A and B impose a catastrophic burden in resource-limited settings (RLS), where the standard of care—high-dose primary prophylaxis—remains economically inaccessible. Consequently, patients rely on episodic (on-demand) therapy, which fails to prevent the debilitating cascade of hemophilic arthropathy. This study aims to validate Low-Dose Prophylaxis (LDP) as a superior standard of care by synthesizing real-world clinical data. We conducted a systematic review and meta-analysis of pivotal studies published between 2011 and 2025, encompassing cohorts from India, Indonesia, China, Pakistan, and Ivory Coast in accordance with PRISMA guidelines. Interventions included low-dose Factor VIII/IX (10–25 IU/kg), Extended Half-Life (EHL) factors, and Emicizumab. Primary outcomes were Annualized Bleeding Rate (ABR) and Hemophilia Joint Health Score (HJHS). The clinical meta-analysis included 127 pediatric and adolescent subjects. LDP demonstrated a statistically significant reduction in ABR compared to on-demand therapy (Pooled Mean Difference: -8.14; 95% CI: -10.5 to -5.7; p<0.001). EHL prophylaxis reduced mean ABR from 6.0 to 0.07. Joint health improved significantly, with HJHS scores decreasing from 5.42 to 2.28 (p=0.0013) post-intervention. Quality of life metrics, including school absenteeism, showed profound improvements. In conclusion, low-dose prophylaxis is a clinically superior and viable strategy in RLS, effectively arresting the progression of arthropathy and improving functional independence. Healthcare policy in developing nations must prioritize prophylactic models over episodic care to prevent irreversible musculoskeletal disability.

Intravenous Iron Therapy Reverses Myocardial Iron Deficiency and Improves Functional Capacity in Non-Anemic Heart Failure: A Meta-Analysis of Randomized Controlled Trials Siswanto; Rudy Afriant
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1592

Background: Iron deficiency is a profound metabolic comorbidity in chronic heart failure, driving deleterious consequences on patient prognosis and functional independence. Crucially, these detriments manifest entirely independently of circulating hemoglobin. While guidelines advocate for intravenous iron in symptomatic heart failure patients, the isolated efficacy and underlying mechanisms in the strictly non-anemic demographic remain subjects of clinical scrutiny. Methods: A systematic review and meta-analysis of randomized controlled trials was executed, adhering to PRISMA guidelines. We aggregated data from 10 trials (such as FAIR-HF, CONFIRM-HF, HEART-FID, FAIR-HF2). The primary endpoint was functional capacity improvement, evaluated via the Standardized Mean Difference of the Six-Minute Walk Test distance and Peak Oxygen Consumption. Secondary endpoints incorporated skeletal/myocardial energetics and heart failure hospitalizations. Data from non-anemic subgroups were extracted. Pooled effects were derived using a DerSimonian and Laird random-effects model, accompanied by sensitivity and safety analyses. Results: Ten trials encompassing 7,545 patients were included, isolating approximately 4,120 individuals within the non-anemic, iron-deficient sub-stratum. Intravenous iron significantly improved functional capacity in non-anemic patients compared to placebo (Standardized Mean Difference: 0.42, 95% Confidence Interval: 0.28 to 0.56, p < 0.001). Mechanistic data revealed significant reductions in phosphocreatine recovery half-times, objectively signifying restored mitochondrial oxidative phosphorylation. Furthermore, intravenous iron yielded a significant reduction in cumulative heart failure hospitalizations within this subgroup (Risk Ratio: 0.81, 95% Confidence Interval: 0.72 to 0.91, p = 0.003). Safety profiles indicated a slightly elevated risk of transient hypophosphatemia with specific formulations, though severe adverse events were comparable to placebo. Conclusion: Intravenous iron therapy successfully reverses the metabolic detriments of myocardial iron deficiency in heart failure patients devoid of anemia, translating into substantial enhancements in exercise capacity and attenuation of morbidity. Routine biochemical screening for iron deficiency should be universally prioritized regardless of baseline hemoglobin.

Intravenous Iron Therapy Reverses Myocardial Iron Deficiency and Improves Functional Capacity in Non-Anemic Heart Failure: A Meta-Analysis of Randomized Controlled Trials Siswanto; Rudy Afriant
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1592

Background: Iron deficiency is a profound metabolic comorbidity in chronic heart failure, driving deleterious consequences on patient prognosis and functional independence. Crucially, these detriments manifest entirely independently of circulating hemoglobin. While guidelines advocate for intravenous iron in symptomatic heart failure patients, the isolated efficacy and underlying mechanisms in the strictly non-anemic demographic remain subjects of clinical scrutiny. Methods: A systematic review and meta-analysis of randomized controlled trials was executed, adhering to PRISMA guidelines. We aggregated data from 10 trials (such as FAIR-HF, CONFIRM-HF, HEART-FID, FAIR-HF2). The primary endpoint was functional capacity improvement, evaluated via the Standardized Mean Difference of the Six-Minute Walk Test distance and Peak Oxygen Consumption. Secondary endpoints incorporated skeletal/myocardial energetics and heart failure hospitalizations. Data from non-anemic subgroups were extracted. Pooled effects were derived using a DerSimonian and Laird random-effects model, accompanied by sensitivity and safety analyses. Results: Ten trials encompassing 7,545 patients were included, isolating approximately 4,120 individuals within the non-anemic, iron-deficient sub-stratum. Intravenous iron significantly improved functional capacity in non-anemic patients compared to placebo (Standardized Mean Difference: 0.42, 95% Confidence Interval: 0.28 to 0.56, p < 0.001). Mechanistic data revealed significant reductions in phosphocreatine recovery half-times, objectively signifying restored mitochondrial oxidative phosphorylation. Furthermore, intravenous iron yielded a significant reduction in cumulative heart failure hospitalizations within this subgroup (Risk Ratio: 0.81, 95% Confidence Interval: 0.72 to 0.91, p = 0.003). Safety profiles indicated a slightly elevated risk of transient hypophosphatemia with specific formulations, though severe adverse events were comparable to placebo. Conclusion: Intravenous iron therapy successfully reverses the metabolic detriments of myocardial iron deficiency in heart failure patients devoid of anemia, translating into substantial enhancements in exercise capacity and attenuation of morbidity. Routine biochemical screening for iron deficiency should be universally prioritized regardless of baseline hemoglobin.

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