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      Current and emerging factor VIII replacement products for hemophilia A

      1 , 2
      Therapeutic Advances in Hematology
      SAGE Publications

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          Abstract

          <p class="first" id="d5797041e112">Hemophilia A is a congenital X-linked bleeding disorder caused by coagulation factor VIII (FVIII) deficiency. Routine infusion of factor replacement products is the current standard of care; however, the development of alloantibodies against FVIII remains a challenge. The treatment of hemophilia has undergone major advances over the past century to improve safety, effectiveness, manufacturing, and convenience of factor products. Major recent advances in the treatment of hemophilia A include the emergence of extended half-life products, factor VIII orthologs, and gene therapy products. Extended half-life products were designed to decrease the frequency of infusions, but only modest half-life extension is achieved. Factor VIII orthologs featuring lower cross-reactivity with anti-FVIII antibodies may be less susceptible to inactivation by inhibitors. Meanwhile, gene therapy may potentially provide a cure for hemophilia A, thus abrogating the need for protein-based factor replacement. This review aims to discuss current and emerging FVIII replacement products for hemophilia A. </p>

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          Most cited references48

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          Progress and problems with the use of viral vectors for gene therapy.

          Gene therapy has a history of controversy. Encouraging results are starting to emerge from the clinic, but questions are still being asked about the safety of this new molecular medicine. With the development of a leukaemia-like syndrome in two of the small number of patients that have been cured of a disease by gene therapy, it is timely to contemplate how far this technology has come, and how far it still has to go.
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            Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia.

            Effective ways to prevent arthropathy in severe hemophilia are unknown. We randomly assigned young boys with severe hemophilia A to regular infusions of recombinant factor VIII (prophylaxis) or to an enhanced episodic infusion schedule of at least three doses totaling a minimum of 80 IU of factor VIII per kilogram of body weight at the time of a joint hemorrhage. The primary outcome was the incidence of bone or cartilage damage as detected in index joints (ankles, knees, and elbows) by radiography or magnetic resonance imaging (MRI). Sixty-five boys younger than 30 months of age were randomly assigned to prophylaxis (32 boys) or enhanced episodic therapy (33 boys). When the boys reached 6 years of age, 93% of those in the prophylaxis group and 55% of those in the episodic-therapy group were considered to have normal index-joint structure on MRI (P=0.006). The relative risk of MRI-detected joint damage with episodic therapy as compared with prophylaxis was 6.1 (95% confidence interval, 1.5 to 24.4). The mean annual numbers of joint and total hemorrhages were higher at study exit in the episodic-therapy group than in the prophylaxis group (P<0.001 for both comparisons). High titers of inhibitors of factor VIII developed in two boys who received prophylaxis; three boys in the episodic-therapy group had a life-threatening hemorrhage. Hospitalizations and infections associated with central-catheter placement did not differ significantly between the two groups. Prophylaxis with recombinant factor VIII can prevent joint damage and decrease the frequency of joint and other hemorrhages in young boys with severe hemophilia A. (ClinicalTrials.gov number, NCT00207597 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.
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              A Randomized Trial of Factor VIII and Neutralizing Antibodies in Hemophilia A.

              The development of neutralizing anti-factor VIII alloantibodies (inhibitors) in patients with severe hemophilia A may depend on the concentrate used for replacement therapy.
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                Author and article information

                Journal
                Therapeutic Advances in Hematology
                Therapeutic Advances in Hematology
                SAGE Publications
                2040-6207
                2040-6215
                September 13 2017
                October 2017
                August 26 2017
                October 2017
                : 8
                : 10
                : 303-313
                Affiliations
                [1 ]Department of Hematology and Medical Oncology, Emory University School of Medicine, USA
                [2 ]Department of Hematology and Medical Oncology, Emory University, School of Medicine, 550 Peachtree Street NE, Medical Office Tower, Suite 1035, Atlanta, GA 30308, USA
                Article
                10.1177/2040620717721458
                5638175
                29051801
                03dcc348-4e94-4473-b61f-4adb78ceca83
                © 2017

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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