Semin Thromb Hemost 1995; 21(4): 382-389
DOI: 10.1055/s-2007-1000659
Copyright © 1995 by Thieme Medical Publishers, Inc.

Factor VIII Inhibitors in Patients with Hemophilia A: Epidemiology of Inhibitor Development and Induction of Immune Tolerance for Factor VIII

Wolfhart Kreuz, Sabine Becker, Elisabeth Lenz, Inmaculada Martinez-Saguer, Carmen Escuriola-Ettingshausen, Markus Funk, Silke Ehrenforth, Günther Auerswald* , Bernhard Kornhuber
  • From the Zentrum für Kinderheilkunde, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt/Main, and
  • *Prof. Hess-Klinik, Bremen, Germany.
Further Information

Publication History

Publication Date:
08 February 2008 (online)

Abstract

Factor (F) VIII inhibitor development remains one of the most serious complications in the treatment of hemophilia A. Former and recent studies on inhibitor development revealed that patients with severe hemophilia A and positive inhibitor family history are at highest risk of developing an inhibitor. Comparison of recent inhibitor incidence studies on previously untreated patients indicate that the risk of inhibitor development under treatment with recombinant FVIII concentrates is comparable to the inhibitor incidence under FVIII substitution by plasma-derived concentrates. However, longer observation periods are necessary to draw final conclusions. Since inhibitor development may result in inefficacy of FVIII concentrates in the treatment of severe bleedings, the induction of immune tolerance (IT) is still of main concern. Various regimens to induce IT by application of FVIII concentrates have been conducted up to now. Success rate appears to be influenced by low to high responder status, number of exposure days before onset of treatment, and dosage of therapeutic regimen. Especially, discontinuation of IT therapy seems to be associated with failure of therapy. Taking into account available data on IT therapy, we recommend early onset of a high dosage regimen in high responder patients as soon as possible after inhibitor detection, as this is associated with higher success rate and shorter elimination time.