Document Detail


Prophylaxis for severe haemophilia: clinical challenges in the absence as well as in the presence of inhibitors.
MedLine Citation:
PMID:  18510542     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Prophylaxis is defined as the regular administration of clotting factor concentrates to prevent bleeding. Extensive data from observational studies and a recent randomized controlled trial (have established that early prophylactic treatment prevents bleeds and arthropathy in boys with severe haemophilia. The initiation of prophylaxis in young children remains challenging. To prevent arthropathy, prophylaxis should be started early, before the onset of joint damage. Alternative strategies of starting include starting before the age of 2 years, or starting before the third joint bleed. Dose and frequency vary between the original Swedish regime of 20-40 IU kg(-1) three times per week and lower dosed and step up regimes starting with 50 IU kg(-1) once weekly and rapidly increasing dose and frequency in case of bleeds. In the second decade, most patients on prophylaxis learn self-infusion. Self-management warrants confirmation of adequate knowledge of the disease. Increasing self-management concurring with major physical and psychological changes may cause reduced adherence. The challenge is to promote adherence and continue to prevent bleeds during this important period of rapid growth. The third decade of life often represents a change in lifestyle. Patients may get a job and periods of physical activity may be more confined. About two thirds of patients experiment with discontinuing prophylaxis in their early twenties, and 20-30% with mild bleeding patterns switch to on-demand treatment for prolonged periods or even permanently. The challenge is to optimize efficiency by individualizing prophylactic dose and frequency according to lifestyle and bleeding pattern. Inhibitors may develop in up to 30% of patients with severe haemophilia. Especially those with high titre inhibitors are at increased risk of developing target joints and severe arthropathy. The use of prophylactic treatment with bypassing agents in inhibitor patients is increasing. Early studies report in a significant reduction of bleeds, including intracranial bleeds, and improvement in quality of life. Data on results of primary prophylaxis in patients with inhibitors to prevent arthropathy are not yet available.
Authors:
K Fischer; L Valentino; R Ljung; V Blanchette
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Haemophilia : the official journal of the World Federation of Hemophilia     Volume:  14 Suppl 3     ISSN:  1365-2516     ISO Abbreviation:  Haemophilia     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-05-30     Completed Date:  2008-12-04     Revised Date:  2009-10-21    
Medline Journal Info:
Nlm Unique ID:  9442916     Medline TA:  Haemophilia     Country:  England    
Other Details:
Languages:  eng     Pagination:  196-201     Citation Subset:  IM    
Affiliation:
Van Creveldkliniek, Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands. k.fischer@umcutrecht.nl
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Cohort Studies
Drug Administration Schedule
Factor IX / administration & dosage*
Factor VIII / administration & dosage*
Hemarthrosis / complications*,  drug therapy,  prevention & control
Hemophilia A / complications,  drug therapy*
Humans
Male
Patient Compliance / psychology
Quality of Life / psychology
Randomized Controlled Trials as Topic
Treatment Outcome
Chemical
Reg. No./Substance:
9001-27-8/Factor VIII; 9001-28-9/Factor IX

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Haemophilia in the first years of life.
Next Document:  Genetic imprinting of autoantibody repertoires in systemic lupus erythematosus patients.