Advanced

Immunosuppressive agents in the treatment of inhibitors in congenital haemophilia A and B - a systematic literature review

Laros-van Gorkom, Britta Antonia Petra; Falaise, Celine and Astermark, Jan LU (2014) In European Journal of Haematology 93. p.26-38
Abstract
The development of inhibitory antibodies to factor VIII (FVIII) or factor IX (FIX) in patients with haemophilia is a serious complication of treatment with coagulation factor concentrates. Antibodies develop in 10-15% of haemophilia A and in up to 5% of haemophilia B patients. Several strategies have been developed over the years to facilitate the eradication of inhibitors and reduce the cost. These include plasmapheresis and/or extracorporeal protein A absorption to remove the inhibitor from the plasma, and immunosuppression and/or immune modulation to suppress the production of inhibitory antibodies. Different immunosuppressive (IS) agents have been described with varying success. To evaluate the outcome of these agents, we performed a... (More)
The development of inhibitory antibodies to factor VIII (FVIII) or factor IX (FIX) in patients with haemophilia is a serious complication of treatment with coagulation factor concentrates. Antibodies develop in 10-15% of haemophilia A and in up to 5% of haemophilia B patients. Several strategies have been developed over the years to facilitate the eradication of inhibitors and reduce the cost. These include plasmapheresis and/or extracorporeal protein A absorption to remove the inhibitor from the plasma, and immunosuppression and/or immune modulation to suppress the production of inhibitory antibodies. Different immunosuppressive (IS) agents have been described with varying success. To evaluate the outcome of these agents, we performed a systematic literature review using the PubMed database. The total number of articles identified was 345; 299 papers were excluded leaving 46 papers to be included in the study. No randomised studies were identified, only case reports and case series. The most frequently used agents in the 46 case reports and cohort studies identified were cyclophosphamide and rituximab. All cases exposed to cyclophosphamide, rituximab and other IS agents had a complete success rate of 40-44%, 40-63% and 33-56%, respectively. However, the definition of success was not consistent among the studies. In conclusion, our review of the literature indicates that IS agents in combination with FVIII or FIX could be an option and may be cost-effective in many patients. The risk of adverse events seems to be relatively low. To fully explore the effect of IS agents, randomised studies are warranted. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
immunosuppression, treatment, inhibitors, haemophilia, cyclophosphamide, rituximab
in
European Journal of Haematology
volume
93
pages
26 - 38
publisher
Wiley-Blackwell
external identifiers
  • wos:000338019900005
  • scopus:84902994409
ISSN
1600-0609
DOI
10.1111/ejh.12372
language
English
LU publication?
yes
id
ba031ae7-92a7-45c6-9a1c-a7f7136bbb16 (old id 4608862)
date added to LUP
2014-09-01 07:38:14
date last changed
2017-05-28 03:08:48
@article{ba031ae7-92a7-45c6-9a1c-a7f7136bbb16,
  abstract     = {The development of inhibitory antibodies to factor VIII (FVIII) or factor IX (FIX) in patients with haemophilia is a serious complication of treatment with coagulation factor concentrates. Antibodies develop in 10-15% of haemophilia A and in up to 5% of haemophilia B patients. Several strategies have been developed over the years to facilitate the eradication of inhibitors and reduce the cost. These include plasmapheresis and/or extracorporeal protein A absorption to remove the inhibitor from the plasma, and immunosuppression and/or immune modulation to suppress the production of inhibitory antibodies. Different immunosuppressive (IS) agents have been described with varying success. To evaluate the outcome of these agents, we performed a systematic literature review using the PubMed database. The total number of articles identified was 345; 299 papers were excluded leaving 46 papers to be included in the study. No randomised studies were identified, only case reports and case series. The most frequently used agents in the 46 case reports and cohort studies identified were cyclophosphamide and rituximab. All cases exposed to cyclophosphamide, rituximab and other IS agents had a complete success rate of 40-44%, 40-63% and 33-56%, respectively. However, the definition of success was not consistent among the studies. In conclusion, our review of the literature indicates that IS agents in combination with FVIII or FIX could be an option and may be cost-effective in many patients. The risk of adverse events seems to be relatively low. To fully explore the effect of IS agents, randomised studies are warranted.},
  author       = {Laros-van Gorkom, Britta Antonia Petra and Falaise, Celine and Astermark, Jan},
  issn         = {1600-0609},
  keyword      = {immunosuppression,treatment,inhibitors,haemophilia,cyclophosphamide,rituximab},
  language     = {eng},
  pages        = {26--38},
  publisher    = {Wiley-Blackwell},
  series       = {European Journal of Haematology},
  title        = {Immunosuppressive agents in the treatment of inhibitors in congenital haemophilia A and B - a systematic literature review},
  url          = {http://dx.doi.org/10.1111/ejh.12372},
  volume       = {93},
  year         = {2014},
}