Haemophilia
& Treatment
How to treat Inhibitors
What can you do about them?
For someone with hereditary haemophilia who develops an inhibitor the first course of action would normally be to try to eliminate it.
The most common method to do this is called Immune Tolerance Induction (ITI).
ITI is the infusion of high doses of clotting factor on a regular basis and can involve 3 -4 infusions a week or even daily infusions. The purpose is to swamp the inhibitor, so that the body's immune system gets used to the clotting factor replacement and stops producing antibodies. This treatment can take some time (up to 2 years) and may not always be successful.
People often experience breakthrough bleeds during ITI, which take priority as any bleeding needs to be controlled as soon as possible. Breakthrough bleeds may be treated on demand or in some cases using prophylaxis, with a bypassing agent (click here for more information if you are a FEIBA patient).
ITI is successful in about 70% of cases. However the implication of failing ITI for a patient is that their inhibitor is likely to be permanent.
How are bleeding episodes treated?
More frequent and higher doses of clotting factor replacement therapy are often used to treat bleeds when low titre inhibitors are present. However, if the inhibitor is high responding and factor replacement therapy is insufficient, then a bypassing agent is usually required to control the bleeding.
People with high titre inhibitors are usually treated with bypassing agents, so called because they bypass the need for clotting factors.
Bypassing agents may also be used if breakthrough bleeds occur during ITI.
Your Haemophilia centre will advise you on how to treat bleeds. If you have any concerns that a bleed is not responding to the treatment, you should contact your Haemophilia Centre straight away for advice.
