Back to Search
Start Over
Immune Tolerance Induction in Hemophilia A: A Review
- Source :
- Seminars in Thrombosis and Hemostasis. 29:069-076
- Publication Year :
- 2003
- Publisher :
- Georg Thieme Verlag KG, 2003.
-
Abstract
- In this article, a comparative analysis of the data stemming from the studies conducted in the field of immune tolerance treatment (ITT) of hemophilia A was attempted. Comparisons are difficult because previous studies differ in many respects, including the dosage of factor (F) VIII, the number of FVIII administrations per day, the association with immunosuppressive drugs (prednisone, cyclophosphamide), and, most importantly, the definition of success in terms of the reacquisition of tolerance. However, a number of variables consistently influenced outcome: the inhibitor titer, either the maximum one or the one assayed before immune tolerance (IT) start and age. As to the FVIII dose, results are contrasting, even though the overall impression is that high dosages are associated with higher success rates. Treatment duration analyses appear to be fairly consistent in all the studies, with 1 year as the crucial time period useful in predicting outcome. Preliminary data suggest that concentrates containing von Willebrand factor may increase the success rate and allow patients refractory to IT procedures carried out with ultrapure or recombinant concentrates to become tolerant in the end. These data need to be formally confirmed in trials that compare the different brands. In the studies published so far, a common language and widely accepted definitions of the variables have emerged, which are important in setting up the controlled trials and improving the comparison among published data.
- Subjects :
- Adult
medicine.medical_specialty
Time Factors
Adolescent
Dose
Cyclophosphamide
Hemophilia A
Immune tolerance
Von Willebrand factor
Prednisone
Internal medicine
Immune Tolerance
Coagulopathy
Humans
Medicine
Child
Factor VIII
biology
business.industry
Infant
Hematology
medicine.disease
Recombinant Proteins
Kinetics
Treatment Outcome
Child, Preschool
Immunology
Chemoprophylaxis
biology.protein
Cardiology and Cardiovascular Medicine
business
Bypassing agent
medicine.drug
Subjects
Details
- ISSN :
- 10989064 and 00946176
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Seminars in Thrombosis and Hemostasis
- Accession number :
- edsair.doi.dedup.....995f31c84a7a801a4e6d5a9d3b2f1e91
- Full Text :
- https://doi.org/10.1055/s-2003-37941