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Hermans C, Giangrande PLF, O'Mahony B, de Kleijn P, Bedford M, Batorova A, Blatný J, Jansone K. European principles of inhibitor management in patients with haemophilia: implications of new treatment options. Orphanet J Rare Dis 2020; 15:219. [PMID: 32831110 PMCID: PMC7444030 DOI: 10.1186/s13023-020-01511-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium.
| | - P L F Giangrande
- European Haemophilia Consortium, Brussels, Belgium.,University of Oxford, Oxford, UK
| | - B O'Mahony
- European Haemophilia Consortium, Brussels, Belgium.,Trinity College, Dublin, Ireland
| | - P de Kleijn
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Bedford
- Canterbury Christ Church University, Kent, UK
| | - A Batorova
- National Hemophilia Center, Dept. of Hematology and Transfusion Medicine, School of Medicine of Comenius University and University Hospital, Bratislava, Slovakia
| | - J Blatný
- Children's University Hospital and Masaryk University, Brno, Czech Republic
| | - K Jansone
- European Haemophilia Consortium, Brussels, Belgium
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Roca CA, Álvarez-Román MT, Canaro Hirnyk MI, Mingot-Castellano ME, Jiménez-Yuste V, Cid Haro AR, Pérez-Garrido R, Sedano Balbas C, López-Fernández MF. Spanish Consensus Guidelines on prophylaxis with bypassing agents in patients with haemophilia and inhibitors. Thromb Haemost 2017; 115:872-95. [DOI: 10.1160/th15-07-0568] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
Abstract
SummaryProphylaxis with the blood clotting factor, factor VIII (FVIII) is ineffective for individuals with haemophilia A and high-titre inhibitors to FVIII. Prophylaxis with the FVIII bypassing agents activated prothrombin complex concentrates (aPCC; FEIBA® Baxalta) or recombinant activated factor VII (rFVIIa; Novo-Seven®, Novo Nordisk) may be an effective alternative. It was our aim to develop evidence -and expert opinion- based guidelines for prophylactic therapy for patients with high-titre inhibitors to FVIII. A panel of nine Spanish haematologists undertook a systematic review of the literature to develop consensusbased guidance. Particular consideration was given to prophylaxis in patients prior to undergoing immune tolerance induction (ITI) (a process of continued exposure to FVIII that can restore sensitivity for some patients), during the ITI period and for those not undergoing ITI or for whom ITI had failed. These guidelines offer guidance for clinicians in deciding which patients might benefit from prophylaxis with FVIII bypassing agents, the most appropriate agents in various clinical settings related to ITI, doses and dosing regimens and how best to monitor the efficacy of prophylaxis. The paper includes recommendations on when to interrupt or stop prophylaxis and special safety concerns during prophylaxis. These consensus guidelines offer the most comprehensive evaluation of the clinical evidence base to date and should be of considerable benefit to clinicians facing the challenge of managing patients with severe haemophilia A with high-titre FVIII inhibitors.
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