BORIS Theses

BORIS Theses
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Immunoadsorption for the treatment of acquired hemophilia: new observational data, systematic review and meta-analysis

Esteves Pereira, Michael (2021). Immunoadsorption for the treatment of acquired hemophilia: new observational data, systematic review and meta-analysis. (Thesis). Universität Bern, Bern

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The treatment of patients with acquired hemophilia is challenging due to life-threatening hemorrhages, delayed response, and adverse effects to immunosuppressive agents. Even though immunoadsorption (IA) rapidly removes autoantibodies against factor VIII, this intervention's effectiveness is still a matter of debate. We aimed to study important outcomes of IA as adjunctive treatment in patients with acquired hemophilia. We performed comprehensive literature searches in MEDLINE and EMBASE databases. Clinical and laboratory data of all patients treated in our institution were additionally included. Literature searching yielded 498 records, of which eleven studies describing 116 patients were finally included. The number of patients varied from 1 to 65, and patients' ages ranged between 14 and 89. Treatment criteria in most patients were (a) failed response to immunosuppressive treatment alone, and/or (b) uncontrollable bleeding episodes, and/or (c) high inhibitor titer. Methodological quality was moderate. The number of IA sessions varied from 1 to 24. Within our institution, 12 patients have been treated since 2002; median age was 76 years (range 34, 86); median titer of factor VIII inhibitor was 20 Bethesda units (range 3, 214). Pooled estimates, modeling a random-effect binominal distribution incorporating the Freeman-Tukey double arcsine transformation, were 86% in case of factor VIII recovery (95% confidence interval 76% to 94%), 95% for reduction of factor VIII inhibitor (83%, 100%), and 7% in case of death (0%, 18%). Our data suggest that IA might be a beneficial adjunctive treatment in patients with high-risk acquired hemophilia, but future studies shall confirm this observation.

Item Type: Thesis
Dissertation Type: Single
Date of Defense: 14 April 2021
Subjects: 600 Technology > 610 Medicine & health
Institute / Center: 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
Depositing User: Hammer Igor
Date Deposited: 03 Jan 2022 16:43
Last Modified: 20 Jan 2022 04:13

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