Why Prescribe Highly Purified Factor VIII and IX Concentrates?

Abstract

The aftermath of the HIV catastrophe and hepatitis virus transmission to hemophiliacs has been characterized by continuous efforts to improve the purity of factor VIII and factor IX concentrates, increasing sophistication of the virucidal methods used, and the introduction of recombinant factor VIII. The cost of hemophilia care is substantial and there is a large price difference between products depending on their purity; generally, the purer the concentrate, the higher the price. The use of expensive highly purified concentrates may be questioned if these products are not superior in terms of safety, efficacy or convenience. The properties of concentrates used in hemophilia care are discussed in this review, as are their safety and side effects. The available data do not clearly reveal any clinical difference between factor VIII concentrates, although the highly purified products may be of theoretical benefit. With regard to factor IX, purified products do not seem to carry any risk of the well-known thromboembolic complications which occur in certain situations after treatment with prothrombin complex concentrates.

No effect of a new second‐generation B‐domain‐deleted recombinant product on lymphocyte transformation in vitro: a study of plasma‐derived and recombinant products

“…Biochemical properties of factor IX concentrates (Berntorp, 1996). significantly less immunomodulatory (P < 0 .…”

“…All Mab-purified CFCs inhibited Table I. Biochemical properties of factor VIII concentrates (Berntorp, 1996 Monoclate-P and Hemofil M (P ¼ 0 . 01).…”

“…Findings in several studies have suggested that CFCs affect immunocompetent cells both in vitro and in vivo, but it is still a matter of debate whether these effects are correlated to product purity (Evans et al, 1991;Nilsson et al, 1992;Watson & Ludlam, 1992;Batchelor et al, 1992;Funk et al, 1993;Berntorp, 1994Berntorp, ,1996. This issue might be important not only for the development of inhibitors, but also for replacement therapy in haemophiliacs with associated immune defects such as HIV.…”

“…Tables I and II show the characteristics of r-VIII SQ and the other recombinant CFCs as well as the plasma-purified concentrates tested. The purity of the CFCs was defined as previously described (Berntorp, 1996).…”

Factor VII and Activated- Factor-VII Content of Prothrombin Complex Concentrates

“…Three-factor PCC are now gradually being replaced by high-purity FIX concentrates, which are obviously less thrombogenic [15][16][17][18][19].…”