Hemophilia in a Changing Treatment Landscape

Hematol Oncol Clin North Am. 2019 Jun;33(3):409-423. doi: 10.1016/j.hoc.2019.01.007. Epub 2019 Mar 29.

Abstract

The mainstay of hemophilia management has been the regular, prophylactic infusion of missing coagulation factors VIII/IX. This approach is limited by the need for frequent intravenous infusions, high cost, limited availability, and the development of inhibitory antibodies to factors VIII/IX. Numerous recent breakthroughs are addressing many of these limitations. These include the development of extended half-life factors that require less frequent infusions and the development of various novel agents that can be given subcutaneously and infrequently, including FVIII-mimetic antibody and downregulators of natural anticoagulants. Finally, gene therapy is set to offer patients a possibility for a cure.

Keywords: Concizumab; Emicizumab; Extended half-life factors; Fitusiran; Gene therapy; Hemophilia; Inhibitors.

Publication types

  • Review

MeSH terms

  • Antibodies, Bispecific / administration & dosage*
  • Antibodies, Bispecific / immunology
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antibodies, Monoclonal, Humanized / immunology
  • Blood Coagulation / drug effects
  • Blood Coagulation / genetics
  • Factor IX / administration & dosage*
  • Factor IX / immunology
  • Factor VIII / administration & dosage*
  • Factor VIII / immunology
  • Genetic Therapy / methods*
  • Hemophilia A / blood
  • Hemophilia A / genetics
  • Hemophilia A / therapy*
  • Hemostasis / drug effects
  • Hemostasis / genetics
  • Humans
  • Models, Biological

Substances

  • Antibodies, Bispecific
  • Antibodies, Monoclonal, Humanized
  • emicizumab
  • Factor VIII
  • Factor IX