How we choose factor VIII to treat hemophilia

Pier Mannuccio Mannucci, Maria Elisa Mancuso and Elena Santagostino

Article Figures & Data


  • Figure 1

    Cumulative incidence of FVIII inhibitors in previously untreated or minimally treated patients with hemophilia A exposed only to single plasma-derived FVIII products (left panel open bars) or recombinant products (right panel closed bars). The data from these studies were the broad basis of the systematic reviews.28,33,34 The names in the horizontal axis are those of the first authors of the corresponding articles, which are cited in the aforementioned systematic reviews.


  • Table 1

    Incidence of FVIII inhibitor (both high and low titer) by age category in patients with severe hemophilia A in the United Kingdom between 1990 and 2009

    Age category, yIncidence, % (per 1000 patient-years)
    > 6010.5
    • Data are from Hay et al.40

  • Table 2

    De novo inhibitors occurring in previously treated patients with hemophilia A who switched from plasma-derived to recombinant FVIII during prospective licensure studies

    Recombinant productNo. of patientsNo. of de novo inhibitors
    Recombinate (full-length)43690
    Kogenate (full-length)44861
    Kogenate-FS (full-length)45730
    Refacto (B-domainless)461131
    Advate (full-length)471081
    Refacto (B-domainless)482043
  • Table 3

    De novo inhibitors occurring in previously treated patients who switched FVIII product in the frame of the Canadian surveillance system

    Giles et al49Rubinger et al50
    339 inhibitor-free patients185 inhibitor-free patients
    All switched from plasma-derived to a recombinant FVIII productAll switched from a recombinant FVIII to another second-generation recombinant FVIII
    Central testing every 12 moCentral testing every 12 mo
    2 y of follow-up2 y of follow-up
    Inhibitor incidence: 14.7 per 1000 person-yearsNo de novo inhibitor