Elsevier

The Lancet

Volume 310, Issue 8044, 29 October 1977, Page 933
The Lancet

Letters to the Editor
MASSIVE FACTOR-VIII INFUSION IN HÆMOPHILIAC WITH FACTOR-VIII INHIBITOR, HIGH RESPONDER

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    Three approaches to this problem have been developed (Figure 1): induction of antigen-specific immune tolerance (ITI), immune suppression therapy (IST), and restoring hemostasis through alternative molecules or pathways to circumvent the antibody blockade (such as bypass therapies, bispecific antibodies that mimic the function of FVIII or suppression of anticoagulant pathways). Antigen-specific ITI protocols were first used in the 1970s and showed that frequent IV delivery of FVIII can eliminate inhibitors.2 Furthermore, ITI protocols not only eradicate ADA but also promote lasting tolerance, serving as an important proof of principle that antigen-specific tolerance to the therapeutic drugs can be achieved in replacement therapy for genetic diseases.

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