Current issues in inhibitors
New panel discussion: Current Issues in Inhibitor Surveillance, does collaborative data gathering hold the key?
With the exception of lack of access to care and treatment, inhibitors are recognized as the most serious challenge in hemophilia care. A multidisciplinary panel of international experts discusses what the WFH, regulators, pharmaceutical companies, physicians, and patients must do to address this issue.
The opinions expressed in this video are those of the individual panelists and not the official position of the World Federation of Hemophilia.
Despite a lack of evidence, there has been a reluctance to switch clotting factor concentrates because of a perceived greater inhibitor risk after switching. This concern is despite the fact that many patients today are using a different concentrate from the one they first started using. The extremely low rate of inhibitors in previously treated patients per year makes it difficult to study and compare rates among different products in a robust way.
Read Alfonso Iorio, Paolo Puccetti, and Mike Makris’ Blood paper on clotting factor concentrate switching and inhibitor development in hemophilia A.
There are questions as to whether recombinant clotting factor concentrates carry a higher inhibitor risk than plasma-derived concentrates. Currently regulators at the European Medicines Agency and the US Food and Drug Administration have not agreed that there is evidence of a higher risk. Recently, three publications have suggested that one currently available second-generation recombinant clotting factor concentrate may be associated with higher risk in previously untreated patients. For more information, see the WFH communiqué on the subject.
Read state-of-the-art papers on inhibitors from the WFH 2014 World Congress including:
- Epidemiological aspects of inhibitor development redefine the clinical importance of inhibitors (H. M. van den Berg)
- Inhibitors – cellular aspects and novel approaches for tolerance (D. W. Scott)
- Inhibitors – genetic and environmental factors (D. Lillicrap, K. Fijnvandraat, and E. Santagostino)
- Laboratory testing for factor inhibitors (E. J. Favaloro, B. Verbruggen, and C. H. Miller)
Updated March 2016