New predictive approaches for ITI treatment

G. D. Minno, E. Santagostino, K. Pratt, C. Königs

Research output: Contribution to journalArticle

Abstract

Immune tolerance induction (ITI) therapy in patients with haemophilia A and inhibitors constitutes a huge burden for affected patients and families and poses a large economic burden for a chronic disease. Concerted research efforts are attempting to optimize the therapeutic approach to the prevention and eradication of inhibitors. The Italian ITI Registry has provided data on 110 patients who completed ITI therapy as at July 2013. Analysis of independent predictors of success showed that, together with previously recognized factors - namely inhibitor titre prior to ITI, historical peak titre and peak titre on ITI - the type of causative FVIII gene mutation also contributes to the identification of patients with good prognosis and may be useful to optimize candidate selection and treatment regimens. Numerous studies have demonstrated that inhibitor reactivity against different FVIII products varies and is lower against concentrates containing von Willebrand factor (VWF). An Italian study compared inhibitor titres against a panel of FVIII concentrates in vitro and correlated titres with the capacity to inhibit maximum thrombin generation as measured by the thrombin generation assay (TGA). Observations led to the design of the PredictTGA study which aims to correlate TGA results with epitope specificity, inhibitor reactivity against different FVIII concentrates and clinical data in inhibitor patients receiving FVIII in the context of ITI or as prophylactic/on demand treatment. At the immunological level, it is known that T cells drive inhibitor development and that B cells secrete FVIII-specific antibodies. As understanding increases about the immunological response in ITI, it is becoming apparent that modulation of T-cell- and B-cell-mediated responses offers a range of potential new and specific approaches to prevent and eliminate inhibitors as well as individualize ITI therapy.

Original languageEnglish
Pages (from-to)27-43
Number of pages17
JournalHaemophilia
Volume20
Issue numberSUPPL. 6
DOIs
Publication statusPublished - 2014

Keywords

  • Anti-FVIII antibodies
  • B cell response
  • F8 mutations
  • Immune tolerance induction therapy
  • T-cell response
  • Thrombin generation assay

ASJC Scopus subject areas

  • Hematology
  • Genetics(clinical)
  • Medicine(all)

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  • Cite this

    Minno, G. D., Santagostino, E., Pratt, K., & Königs, C. (2014). New predictive approaches for ITI treatment. Haemophilia, 20(SUPPL. 6), 27-43. https://doi.org/10.1111/hae.12467