Factor eight inhibitor bypass activity (FEIBA) in the management of bleeds in hemophilia patients with high-titer inhibitors

Figures & data

Table 1 Coagulation factor concentrates with proven efficacy in hemophilia patients with high-titer inhibitors

Factor concentrate	Advantage	Disadvantage	Comments
Porcine (p) FVIII	Measurable FVIII levels	Inhibitors often show cross-reactivity with pFVIII or the patients develop pFVIII after 5–10 days of treatment Risk of transmission of porcine viruses	Plasma derived pFVIII are presently not available A recombinant pFVIII concentrate is in clinical development
PPCs	Bypass the need for FVIII Relatively inexpensive	Inferior efficacy compared to aPCCs Potentially thrombogenic High frequency of infusion related adverse events	aPCCs have supplanted the use of PCCs
aPCCs	Long history of use Efficacy of 80–90% in clinical trials Long-half life compared to rFVIIa More effective than PCCs Cost advantage over rFVIIa	Unpredictable hemostatic response Potentially thrombogenic Trace amounts of FVIII leading to anamnesis of the inhibitor Possibility of transmission of human viruses No established laboratory assay to monitor efficacy and optimal dosing	The risk of thrombotic complications with standard doses is low Increase in inhibitor titer does not hamper efficacy
rFVIIa	Efficacy in 80–90% in clinical trials No anamnestic response No risk of transmission of human viruses	Unpredictable hemostatic response Potentially thrombogeneic No established laboratory assay to monitor efficacy and optimal dosing Short half-life making rFVIIa less convenient than aPCCs	The risk of thrombotic complications is low Whether the risk of thrombotic complications differ significantly between aPCCs and rFVIIa is an unresolved issue