Immunoadsorption may provide a cost-effective approach to management of patients with inhibitors to FVIII.
BACKGROUND
Immunoadsorption of plasma with Staphylococcal protein A removes immunoglobulins and immune complexes; hence, it should effectively remove inhibitors to FVIII in acquired or congenital hemophilia. The procedure may be cost effective, given the expense of therapies used to treat patients with inhibitors, particularly in an acute setting.


METHODS
Three patients with inhibitors to FVIII were treated with the Excorim Immunosorba system (two columns used in tandem). Costs for immunoadsorption and for other therapeutic products administered to the patients were calculated.


RESULTS
Two patients had acquired hemophilia and severe bleeding associated with low levels of circulating FVIII and high levels of inhibitors to FVIII. They failed to achieve a satisfactory response to management with immunosuppression, pFVIII, recombinant FVIIa or IVIG but responded rapidly, with long-term benefit, to immunoadsorption therapy. The third patient had congenital hemophilia and immunoadsorption was effective in reducing his inhibitor level, allowing him to undergo immune tolerance therapy. Costs of treatment before immunoadsorption were markedly higher than those associated with the immunoadsorption procedures (i.e., >Can 350,000 dollars and >Can 1,000,000 dollars vs. < 20,000 dollars).


CONCLUSIONS
Immunoadsorption appears to be an effective and cost-effective alternative in the management of patients with inhibitors to FVIII.
Freedman
John
J
St. Michael's Hospital and the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. freedman@smh.toronto.on.ca
Rand
Margaret L
ML
Russell
Olive
O
Davis
Carole
C
Cheatley
Patricia L
PL
Blanchette
Victor
V
Garvey
M Bernadette
MB
D000293:Adolescent; D000368:Aged; D001323:Autoantibodies / Q000032:analysis; D003362:Cost-Benefit Analysis; D005169:Factor VIII / Q000276:immunology*; D017048:Health Care Costs; D006467:Hemophilia A / Q000276:immunology* / Q000628:therapy*; D006801:Humans; D007163:Immunosorbent Techniques / Q000191:economics*; D007518:Isoantibodies / Q000032:analysis; D008297:Male; D008875:Middle Aged
D001323:Autoantibodies; D007518:Isoantibodies; D005169:Factor VIII