title: When should prophylaxis therapy in inhibitor patients be considered?
abstract: Currently, patients with severe haemophilia can expect to lead a relatively normal life including prevention of disabling arthropathy as a result of the development of factor replacement therapy and advances in the understanding of the use of such therapy given prophylactically. Unfortunately, a subset of patients develops neutralizing antibodies termed inhibitors rendering such therapy ineffective. These patients frequently develop recurrent joint bleeding resulting in arthropathy. Until recently, prophylactic therapy was not considered for patients with inhibitors because of the perceived lack of an effective therapeutic agent. However, an accumulation of case reports and a recent prospective study have suggested that prophylaxis with the currently available bypassing agents could be effective and appears to be safe in selected cases. This report will review the current data on prophylaxis with bypassing agents and suggest specific situations in which prophylaxis in inhibitor patients could be considered.
authors.affiliation: Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. gyoung@chla.usc.edu
authors.forename: G
authors.initials: G
authors.lastname: Young
authors.forename: G
authors.initials: G
authors.lastname: Auerswald
authors.forename: V
authors.initials: V
authors.lastname: Jimenez-Yuste
authors.forename: B A
authors.initials: BA
authors.lastname: Konkle
authors.forename: T
authors.initials: T
authors.lastname: Lambert
authors.forename: M
authors.initials: M
authors.lastname: Morfini
authors.forename: E
authors.initials: E
authors.lastname: Santagostino
authors.forename: V
authors.initials: V
authors.lastname: Blanchette
mesh_terms: D019774:Blood Coagulation Factor Inhibitors / Q000097:blood; D001779:Blood Coagulation Factors / Q000276:immunology / Q000627:therapeutic use*; D015942:Factor VIIa / Q000627:therapeutic use*; D006395:Hemarthrosis / Q000517:prevention & control; D006467:Hemophilia A / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; C103587:recombinant FVIIa; C065655:anti-inhibitor coagulant complex; D015942:Factor VIIa