The uptake of recombinant Factor VIII in the Netherlands

Abstract

Summary. In comparison with other biotechnology substitutions, the adoption of recombinant Factor VIII (rFVIII) has been relatively slow. We sent a postal questionnaire to all Dutch haemophilia patients and haemophilia-treating physicians, to determine which factors predict whether a patient uses plasma-derived FVIII (pdFVIII) or rFVIII and to investigate patientsÕ and doctors' opinions on both products. Fifty-six per cent of patients received rFVIII. This percentage varied widely between centres. Only one doctor would choose to use pdFVIII if he suffered from haemophilia A himself, and 74% would choose to use rFVIII. Younger patients, those not infected with the human immunodeficiency virus or hepatitis C, and those who did not have family members who used pdFVIII switched more often from pdFVIII to rFVIII. Patients who rated themselves as innovative, who had family members who used rFVIII, and those who were treated in a large haemophilia treatment centre were also more likely to have switched. For physicians and patients alike, the respondents generally did not see large differences between rFVIII and pdFVIII, except for the risk of infections and the knowledge of long-term effects (both larger for pdFVIII). Although haemophilia patients represent one of the most empowered patient groups, physicians appear to have been influential in choosing between pdFVIII and rFVIII.

Thirty years of hemophilia treatment in the Netherlands, 1972-2001

“…14 In 1995, recombinant factor VIII products were introduced in the Netherlands and have become increasingly used, 15 especially in previously untreated patients; along with the use of purified plasma-derived products, this minimizes the risk of transmission of HIV or HCV. 16 Today, the most important complication of clotting factor treatment is the development of neutralizing antibodies (inhibitors) against factor VIII or IX. 17 In the Netherlands, a series of 5 national postal surveys 18,19 have been performed from 1972 onward.…”