TY - JOUR
T1 - How we choose factor VIII to treat hemophilia
AU - Mannucci, Pier Mannuccio
AU - Mancuso, Maria Elisa
AU - Santagostino, Elena
PY - 2012/5/3
Y1 - 2012/5/3
N2 - In high-income countries, the large availability of coagulation factors for replacement therapy of patients with hemophilia A has raised the life expectancy of these lifelong bleeders to that of males from the general population. The practicing clinician is offered a multitude of choices among several commercial brands of factor VIII extracted from human plasma or engineered from mammalian cell cultures by means of recombinant DNA technology. This article has the goal to offer our opinions on how to choose among the different products, that we consider interchangeable relevant to their clinical efficacy in the control of bleeding and safety from pathogen transmission. Hence, the main determinants of our choices are price and the risk of occurrence of factor VIII inhibitory alloantibodies. With this as background, we present the rationale underlying the choices for different categories of patients with severe hemophilia A: previously untreated patients, multiply treated patients, and patients undergoing immune tolerance induction with large doses of factor VIII to eradicate inhibitors. Mention is also made to the possible strategies that should be implemented to make available coagulation factors for replacement therapy in developing countries.
AB - In high-income countries, the large availability of coagulation factors for replacement therapy of patients with hemophilia A has raised the life expectancy of these lifelong bleeders to that of males from the general population. The practicing clinician is offered a multitude of choices among several commercial brands of factor VIII extracted from human plasma or engineered from mammalian cell cultures by means of recombinant DNA technology. This article has the goal to offer our opinions on how to choose among the different products, that we consider interchangeable relevant to their clinical efficacy in the control of bleeding and safety from pathogen transmission. Hence, the main determinants of our choices are price and the risk of occurrence of factor VIII inhibitory alloantibodies. With this as background, we present the rationale underlying the choices for different categories of patients with severe hemophilia A: previously untreated patients, multiply treated patients, and patients undergoing immune tolerance induction with large doses of factor VIII to eradicate inhibitors. Mention is also made to the possible strategies that should be implemented to make available coagulation factors for replacement therapy in developing countries.
UR - http://www.scopus.com/inward/record.url?scp=84860767903&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84860767903&partnerID=8YFLogxK
U2 - 10.1182/blood-2012-01-394411
DO - 10.1182/blood-2012-01-394411
M3 - Article
C2 - 22411872
AN - SCOPUS:84860767903
VL - 119
SP - 4108
EP - 4114
JO - Blood
JF - Blood
SN - 0006-4971
IS - 18
ER -