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Immunosuppression for acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2)

Fecha de publicación: Fecha Ahead of Print:

Autores de IDIVAL

Autores ajenos al IDIVAL

  • Collins, Peter
  • Baudo, Francesco
  • Knoebl, Paul
  • Levesque, Herve
  • Nemes, Laszlo
  • Pellegrini, Fabio
  • Marco, Pascual
  • Tengborn, Lilian
  • Huth-Kuehne, Angela
  • Aspoeck, Gerold
  • Heistinger, Max
  • Knobl, Paul
  • Makipernaa, Anne
  • Andre, Helene
  • Aouba, A
  • Bellucci, Sylvia
  • Beurrier, Philippe
  • Borg, Jeanne Yvonne
  • Darnige, Luc
  • Devignes, Jean
  • dOiron, Roseline
  • Gautier, Philippe
  • Gay, Valerie
  • Girault, Stephane
  • Gruel, Yves
  • Guerin, Viviane
  • Hezard, Nathalie
  • Khellaf, Mehdi
  • Koenig, Martial
  • Levesque, Herve
  • Lifermann, Francois
  • Marlu, Raphael
  • Ninet, J.
  • Peynet, Jocelyne
  • Quemeneur, Thomas
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  • Schleinitz, Nicolas
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  • Leebeek, Frank W.G.
  • Marten, Nijziel
  • Novakova, Irena
  • Schutgens, Roger
  • van der Linden, P.W.G
  • van Esser, Joost
  • van der Meer, J.
  • Ypma, Paula
  • Campos, Manuel
  • Aguilar, Carlos
  • Altisent, Carmen
  • Bermejo, Nuria
  • Del Campo, Raquel
  • Ferreiro Arguelles, M.
  • Gonzalez Boullosa, Rosario
  • Gutierrez Pimentel, Maria Jose
  • Jimenez-Yuste, Victor
  • Jose-Felix, Lucia
  • Marco, Pascual
  • Mingot, Maria Eva
  • Perez Garrido, Rosario
  • Perez Gonzale, Noelia z
  • Prieto Garcia, Manuel
  • Rodriguez-Huerta, Ana Maria
  • Maranon, HGUG
  • Tolosa Munoz, Alexandra
  • Baghaei, Fariba
  • Tengborn, Lilian
  • Boehlen, Francoise
  • Korte, Wolfgang
  • Chowdary, Pratima
  • Collins, Peter
  • Evans, Gillian
  • Pavord, Suzanne
  • Rangarajan, Savita
  • Wilde, Jonathan
  • EACH2 Registry Collaborators

Abstract

Acquired hemophilia A (AHA) is an autoimmune disease caused by an autoantibody to factor VIII. Patients are at risk of severe and fatal hemorrhage until the inhibitor is eradicated, and guidelines recommend immunosuppression as soon as the diagnosis has been made. The optimal immunosuppressive regimen is unclear; therefore, data from 331 patients entered into the prospective EACH2 registry were analyzed. Steroids combined with cyclophosphamide resulted in more stable complete remission (70%), defined as inhibitor undetectable, factor VIII more than 70 IU/dL and immunosuppression stopped, than steroids alone (48%) or rituximab-based regimens (59%). Propensity score-matched analysis controlling for age, sex, factor VIII level, inhibitor titer, and underlying etiology confirmed that stable remission was more likely with steroids and cyclophosphamide than steroids alone (odds ratio = 3.25; 95% CI, 1.51-6.96; P < .003). The median time to complete remission was approximately 5 weeks for steroids with or without cyclo-phosphamide; rituximab-based regimens required approximately twice as long. Immunoglobulin administration did not improve outcome. Second-line therapy was successful in approximately 60% of cases that failed first- line therapy. Outcome was not affected by the choice of first-line therapy. The likelihood of achieving stable remission was not affected by underlying etiology but was influenced by the presenting inhibitor titer and FVIII level. (Blood. 2012;120(1):47-55)

Datos de la publicación

ISSN/ISSNe:
0006-4971, 1528-0020

BLOOD  AMER SOC HEMATOLOGY

Tipo:
Article
Páginas:
47-55
PubMed:
22517903

Citas Recibidas en Web of Science: 246

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