Document Detail

Factor VIII products and inhibitor development in severe hemophilia A.
MedLine Citation:
PMID:  23323899     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: For previously untreated children with severe hemophilia A, it is unclear whether the type of factor VIII product administered and switching among products are associated with the development of clinically relevant inhibitory antibodies (inhibitor development).
METHODS: We evaluated 574 consecutive patients with severe hemophilia A (factor VIII activity, <0.01 IU per milliliter) who were born between 2000 and 2010 and collected data on all clotting-factor administration for up to 75 exposure days. The primary outcome was inhibitor development, which was defined as at least two positive inhibitor tests with decreased in vivo recovery of factor VIII levels.
RESULTS: Inhibitory antibodies developed in 177 of the 574 children (cumulative incidence, 32.4%); 116 patients had a high-titer inhibitory antibody, defined as a peak titer of at least 5 Bethesda units per milliliter (cumulative incidence, 22.4%). Plasma-derived products conferred a risk of inhibitor development that was similar to the risk with recombinant products (adjusted hazard ratio as compared with recombinant products, 0.96; 95% confidence interval [CI], 0.62 to 1.49). As compared with third-generation full-length recombinant products (derived from the full-length complementary DNA sequence of human factor VIII), second-generation full-length products were associated with an increased risk of inhibitor development (adjusted hazard ratio, 1.60; 95% CI, 1.08 to 2.37). The content of von Willebrand factor in the products and switching among products were not associated with the risk of inhibitor development.
CONCLUSIONS: Recombinant and plasma-derived factor VIII products conferred similar risks of inhibitor development, and the content of von Willebrand factor in the products and switching among products were not associated with the risk of inhibitor development. Second-generation full-length recombinant products were associated with an increased risk, as compared with third-generation products. (Funded by Bayer Healthcare and Baxter BioScience.).
Samantha C Gouw; Johanna G van der Bom; Rolf Ljung; Carmen Escuriola; Ana R Cid; Ségolène Claeyssens-Donadel; Christel van Geet; Gili Kenet; Anne Mäkipernaa; Angelo Claudio Molinari; Wolfgang Muntean; Rainer Kobelt; George Rivard; Elena Santagostino; Angela Thomas; H Marijke van den Berg;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  368     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-17     Completed Date:  2013-01-23     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  231-9     Citation Subset:  AIM; IM    
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MeSH Terms
Antibodies / blood*
Factor VIII / immunology,  therapeutic use*
Hemophilia A / immunology,  therapy*
von Willebrand Factor / analysis,  immunology
Reg. No./Substance:
0/Antibodies; 0/recombinant factor VIII SQ; 0/von Willebrand Factor; 9001-27-8/Factor VIII
C Altisent / ; G Auerswald / ; M Carcao / ; E Chalmers / ; H Chambost / ; A Cid / ; S Claeyssens / ; N Clausen / ; K Fischer / ; Ch van Geet / ; K Peerlinck / ; G Kenet / ; R Kobelt / ; W Kreuz / ; C Escuriola / ; K Kurnik / ; R Liesner / ; R Ljung / ; A Mäkipernaa / ; A Molinari / ; W Muntean / ; B Nolan / ; J Oldenburg / ; R Pérez Garrido / ; P Petrini / ; H Platokouki / ; A Rafowicz / ; G Rivard / ; E Santagostino / ; M E Mancuso / ; A Thomas / ; M Williams / ; S C Gouw / ; J G van der Bom / ; H M van den Berg /
Comment In:
N Engl J Med. 2013 Apr 11;368(15):1456   [PMID:  23574132 ]
N Engl J Med. 2013 Apr 11;368(15):1457   [PMID:  23574131 ]
Haemophilia. 2014 Jul;20(4):e351-2   [PMID:  24827780 ]

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