Drug‐Induced Antifactor VIII Antibodies

Franchini, Massimo; Capra, Franco; Nicolini, Nicoletta; Veneri, Dino; Manzato, Franco; Baudo, F.; Lippi, Giuseppe

doi:10.1002/chin.200745229

Cited by 44 publications

(71 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6 In approximately 50% of cases, FVIII autoantibodies occur in patients lacking any relevant concomitant disease, while the remaining cases may be associated with postpartum period, autoimmune diseases, underlying hematologic or solid cancers, infections, or use of medications (Table 1). [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The bleeding pattern of acquired hemophilia A is rather different from that of congenital hemophilia A. Thus, most patients with FVIII autoantibodies have hemorrhages into the skin, muscles or soft tissues, and mucous membranes (eg, epistaxis, gastrointestinal and urologic bleeds, retroperitoneal hematomas, postpartum bleeding), whereas hemarthroses, a typical feature of congenital factor VIII deficiency, are uncommon.…”

Section: Introductionmentioning

confidence: 99%

Acquired factor VIII inhibitors

Franchini

Lippi

2008

Blood

Self Cite

248

321

View full text Add to dashboard Cite

Acquired hemophilia A is a rare bleeding diathesis caused by autoantibodies directed against clotting factor VIII and associated with an increased morbidity and mortality. This autoimmune disorder most commonly occurs in the elderly. Although it may be associated with several underlying pathologies, up to 50% of reported cases remain idiopathic. In contrast with congenital hemophilia, which is commonly characterized by hemarthroses, hemorrhages in patients with acquired hemophilia involve most frequently soft tissues. The 2 treatment priorities are to arrest the acute bleeding and to eradicate the factor VIII autoantibody. Acute bleeding episodes in patients with low-titer inhibitors can be treated using human factor VIII concentrates, whereas factor VIII bypassing agents, such as activated prothrombin complex concentrates or recombinant activated factor VII, are effective for the treatment of those with hightiter inhibitors. An analysis of the literature shows that the most effective first-line treatment for the eradication of factor VIII autoantibodies is the combination of steroids and cyclophosphamide. However, there is increasing evidence on the effectiveness of other treatment approaches, such as immune tolerance regimens and rituximab. If confirmed by large controlled studies, these innovative therapies might become a valid option for long-term eradication of factor VIII inhibitors. (Blood. 2008;112:250-255)

show abstract

Section: Introductionmentioning

confidence: 99%

Acquired factor VIII inhibitors

Franchini

Lippi

2008

Blood

Self Cite

248

321

View full text Add to dashboard Cite

show abstract

“…For TPP derived from a human endogenous counterpart such as cytokines or enzyme replacement therapies, the low endogenous levels of these proteins expressed in specialized tissues may not result in the induction of complete central tolerance. Evidence for incomplete tolerance exists for Factor VIII, where antiFactor VIII antibodies have been observed in otherwise healthy individuals as a result of tissue damage or trauma [71][72][73]. Development of immunogenicity against these TPP is likely due to a patient specific breakage of peripheral tolerance, central tolerance or due to antigenic differences between endogenous and replacement factor TPPs.…”

Section: Factors That Influence Immunogenicitymentioning

confidence: 95%

Therapeutic outcomes, assessments, risk factors and mitigation efforts of immunogenicity of therapeutic protein products

Yin

Chen

Vicini

et al. 2015

Cellular Immunology

View full text Add to dashboard Cite

“…Drug-associated AHA is quite rare, and therefore little is known about its natural history [11]. The analysis of the literature available however provides evidence that these cases have a quite good prognosis, and in most cases, spontaneous remission after suspension of the involved agent or after immunosuppressive treatment is seen, with a rate of complete remission in about 83% of cases.…”

Section: Clinical Picture Of Acquired Hemophilia Amentioning

confidence: 95%

Diagnosis, laboratory aspects and management of acquired hemophilia A

Toschi

Baudo

2010

Intern Emerg Med

Self Cite

View full text Add to dashboard Cite

Acquired hemophilia A (AHA) is a rare autoimmune disease, characterized by severe, often life-threatening hemorrhages in patients without a prior history of bleeding disorder. It most frequently occurs in the elderly, and may be associated with other clinical conditions, such as cancer, autoimmune diseases, pregnancy or without a relevant cause. Diagnosis and correct therapy are crucial for the patient's outcome. Management of the disease consists of gaining immediate control of acute bleeding and the starting of an immunosuppressive therapy in order to eradicate the anti-factor VIII autoantibody. Factor VIII bypassing agents, such as prothrombin complex concentrates or recombinant activated factor VII, have proven effective in bleeding control, whereas the combined therapy of cyclophosphamide and corticosteroids seems to be, at present, the best immunosuppressive option. Other treatments including Rituximab, immunoadsorption or induction of immune tolerance are still experimental, and need to be validated through controlled clinical trials.

show abstract

Drug‐Induced Antifactor VIII Antibodies

Cited by 44 publications

References 0 publications

Acquired factor VIII inhibitors

Acquired factor VIII inhibitors

Therapeutic outcomes, assessments, risk factors and mitigation efforts of immunogenicity of therapeutic protein products

Diagnosis, laboratory aspects and management of acquired hemophilia A

Contact Info

Product

Resources

About