Continuous infusion (CI) is an alternative to the traditional intermittent bolus injections (BI). The rationale behind CI is to administer the factor Paclitaxel molecular weight concentrate at a rate corresponding to its elimination thus maintain steady factor levels. CI offers an improved hemostatic control and has a potential to reduce markedly factor consumption and thereby treatment costs, especially if the dose is adjusted according to the actual daily levels and clearance. The adjusted dose CI introduced in the early 1990s, during the last two decades has gained increased interest and acceptance among hemophilia treaters. Currently, CI is used particularly for the management of major bleeds and surgery, including the most demanding
surgical procedures such as total joint replacements. This chapter reviews actual issues of CI therapy in hemophilia. “
“Summary. Replacement therapy using factor VIII (FVIII) elicits FVIII-specific antibodies (abs) in about 25% of the patients. A majority of such abs are directed towards specific FVIII regions in which major epitopes have been identified (C-terminal end of the C2 domain, the N-terminal
end of the A2 domain and C1 domain in cases of mild/moderate haemophilia A). We derived five human monoclonal abs (mabs) that react with Cisplatin high affinity to the FVIII C1, C2 or A2 domains respectively and are representative of most of the specific inhibitors observed in haemophilia A patients. We generated mouse anti-idiotypic mabs (anti-Ids) against the paratope of each of the inhibitors. We demonstrated that a combination of these anti-Ids (anti-anti-A2, -C1, -C2) had the ability to neutralize the inhibitory properties of human polyclonal abs in plasma. In 16 of the 18 plasmas
tested, the inhibiting FVIII activity was neutralized up to 100% by the anti-Ids mixture with restoration of full FVIII activity. These data allow us to conclude that polyclonal Fludarabine high-affinity FVIII inhibitors could be neutralized with an anti-Ids mixture and that only a limited number of anti-Ids were required for inhibitor neutralization in 90% of the patients. We also demonstrated that anti-Id Abs bound to anti-FVIII human B cell line produced the corresponding anti-FVIII Ab and that this binding was followed by surface capping of complexes. Data obtained in vitro at monoclonal and polyclonal level, confirmed by in vivo assays, and the preliminary results obtained at BCR level, indicate that anti-id mixture made of only a limited number of anti-Ids could be useful in the restoration of haemostasis in haemophilia patients with inhibitor. Administration of factor VIII (FVIII) to haemophilia A patients elicits an immune response that includes Abs inhibiting FVIII cofactor activity (referred to as inhibitors). The prevalence of inhibitors varies from one study to another, but a consensus value of ±25% is generally accepted.