Inhibitor recurrence after immune tolerance induction: a multicenter retrospective cohort study

Inhibitor recurrence after immune tolerance induction: a multicenter retrospective cohort study

Antun A (2015), Hemostasis and Thrombosis (Link to Abstract)


Immune tolerance induction (ITI) is successful in about 70% of cases in patients with Hemophilia A who develops inhibitors, but little is known about the rate and predictors of recurrence. This is a retrospective, multicenter (12 US center) cohort study of patients with Hemophilia A (levels 1% or less) after successful ITI. Sixty-four patients were included with a median follow up of 3.4 years. Probability of recurrence was 12.8% at 1 year, 26% at 3 years, and; 32% at 5 years.  Amongst them, 10 restarted ITI and 10 used bypassing agents.  Predictors of recurrence were: use of concurrent immune therapy during ITI (4/5 recurred), and recovery less than 85% (3 fold increase in risk). Lack of adherence to post ITI prophylaxis was not predictive of recurrence.


* There is a high rate of recurrence after successful ITI. Immune therapy and incomplete recovery are predictive of recurrence, but lack of adherence is not.