Essentials Recombinant factor VIII (rFVIII) was contrasted with plasma-derived FVIII (pdFVIII). In previously untreated patients with hemophilia A, rFVIII led to more inhibitors than pdFVIII. Inhibitors with rFVIII developed earlier, and the peak rate was higher than with pdFVIII. Inhibitors with rFVIII were more severe (higher titre) than with pdFVIII. Summary: Background The development of neutralizing antibodies (inhibitors) against factor VIII (FVIII) is the most severe complication in the early phases of treatment of severe hemophilia A. Recently, a randomized trial, the Survey of Inhibitors in Plasma-Product Exposed Toddlers (SIPPET) demonstrated a 2-fold higher risk of inhibitor development in children treated with recombinant FVIII (rFVIII) products than with plasma-derived FVIII (pdFVIII) during the first 50 exposure days (EDs). Objective/Methods In this post-hoc SIPPET analysis we evaluated the rate of inhibitor incidence over time by every 5 EDs (from 0 to 50 EDs) in patients treated with different classes of FVIII product, made possible by a frequent testing regime. Results The highest rate of inhibitor development occurred in the first 10 EDs, with a large contrast between rFVIII and pdFVIII during the first 5 EDs: hazard ratio 3.14 (95% confidence interval [CI], 1.01â9.74) for all inhibitors and 4.19 (95% CI, 1.18â14.8) for high-titer inhibitors. For patients treated with pdFVIII, the peak of inhibitor development occurred later (6â10 EDs) and lasted for a shorter time. Conclusion These results emphasize the high immunologic vulnerability of patients during the earliest exposure to FVIII concentrates, with the strongest response to recombinant FVIII products.
Timing and severity of inhibitor development in recombinant versus plasma-derived factor VIII concentrates: a SIPPET analysis / F. Peyvandi, A. Cannavò, I. Garagiola, R. Palla, P.M. Mannucci, F.R. Rosendaal, A. El-Beshlawy, M. Elalfy, V. Ramanan, P. Eshghi, S. Hanagavadi, R. Varadarajan, M. Karimi, M.V. Manglani, C. Ross, G. Young, T. Seth, S. Apte, D.M. Nayak, E. Santagostino, M. Elisa Mancuso, A.C. Sandoval Gonzalez, J.N. Mahlangu, S. Bonanad Boix, M. Cerqueira, N.P. Ewing, C. Male, T. Owaidah, V. Soto Arellano, N.L. Kobrinsky, S. Majumdar, R. Perez Garrido, A. Sachdeva, M. Simpson, M. Thomas, E. Zanon, B. Antmen, K. Kavakl, M.J. Manco-Johnson, M. Martinez, E. Marzouka, M.G. Mazzucconi, D. Neme, A. Palomo Bravo, R. Paredes Aguilera, A. Prezotti, K. Schmitt, B.M. Wicklund, B. Zulfikar. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 16:1(2018), pp. 39-43.
|Titolo:||Timing and severity of inhibitor development in recombinant versus plasma-derived factor VIII concentrates: a SIPPET analysis|
|Parole Chiave:||antibodies; factor VIII; hemophilia A; inhibitor; plasma; Hematology|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
|Data di pubblicazione:||2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/jth.13888|
|Appare nelle tipologie:||01 - Articolo su periodico|
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