Long‐term high dose factor VIII treatment of 3 haemophiliacs with factor VIII inhibitor

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Abstract
Three patients with hemophilia A and inhibitor against factor VIII were developing progressive hemophiliac arthropathy due to the non-feasibility of prophylactic treatment. In order to suppress inhibitor formation, long-term treatment with high-dose factor VIII (100 U/kg body weight twice daily) was initiated. Prothrombin complex concentate was given only for bleeding episodes. Though all 3 patients were high responders, they presented different treatment courses. Two became low responders after 4 and 11 mo. treatment, respectively. One patient had no demonstrable inhibitor after start of treatment. In all 3 patients, prophylactic treatment was established, in 1 case still with increased doses compared to non-inhibitor patients. The high-dose factor VIII treatment makes it possible to provide prophylactic treatment for the high-responder inhibitor patients. The extremely high costs represent a serious obstacle to this treatment.