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Inhibitor Development in Hemophilia: Practical Considerations

Release Date: June 23, 2008

Expiration Date: June 23, 2009

Estimated time to complete this Activity: 1 hour

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Overview

The development of inhibitors, alloantibodies directed against coagulation factor VIII (FVIII) or FIX, is the most clinically significant and devastating complication of hemophilia. These antibodies bind to functional domains on the FVIII molecule and neutralize its function. Affecting up to 30% of individuals with severe hemophilia A and 3% to 13% of those with hemophilia B and mild or moderate hemophilia A, this complication is an important cause of morbidity in the hemophilia population. An understanding of the biology of inhibitor formation is critical to optimally manage these patients. Treatment options include (1) eradication of the inhibitor through a process known as immune tolerance induction (ITI) with or without the use of immunosuppressive drugs and biological agents, (2) the treatment of bleeding with agents that bypass the inhibitor to promote blood clotting, and (3) preventative strategies in which bypassing agents are used as prophylaxis to prevent bleeding.

Target Audience

Inhibitor Development in Hemophilia: Practical Considerations is intended for residents and fellows in the field of pediatric hematology/oncology; however, practicing physicians and other health care professionals involved in the care and treatment of children with hematologic disorders also will benefit from this activity.

Educational Objectives

After completing this continuing medical education (CME) activity, participants should be able to:

• Describe the epidemiology of and risk factors for developing inhibitors
• Identify the signs and symptoms of inhibitor development and how to diagnose and classify the inhibitor
• Evaluate what treatment options are available to manage patients with inhibitors, including ITI, the treatment of bleeding with agents that bypass the inhibitor, and strategies to prevent bleeding

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of The FCG Institute for Continuing Education and IME, LLC. The FCG Institute for Continuing Education is accredited by the ACCME to provide CME for physicians.

Credit Designation Statement

The FCG Institute for Continuing Education designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

How to Get Credit

To receive CME credit, you must read the newsletter, complete the evaluation and credit request form, and pass with a score of 70% or higher on the posttest. Then print your certificate online. That's it — no need to wait for the certificate to be mailed to you!

Faculty Disclosure

It is the policy of The FCG Institute for Continuing Education that all faculty participating in CME activities are expected to disclose to the program audience (1) any real or apparent conflict(s) of interest related to the content of their presentation and (2) discussion of unlabeled or unapproved uses of drugs or medical devices. Faculty disclosure statements can be found with their biographical sketches.

Dr. Valentino has disclosed that he has received grant/research support from Baxter International Inc., Bayer HealthCare AG, CSL Behring, Novo Nordisk Inc., and Wyeth. He has served on advisory boards for Baxter International Inc., CSL Behring, Novo Nordisk Inc., and Wyeth and has been on speakers bureaus for Novo Nordisk Inc. and Wyeth. Dr. Valentino is on the Board of Directors of the CSL Behring Foundation.

Conflict of Interest Resolution

When individuals in a position to control or influence the development of the content have reported Financial Relationships with one or more commercial interests, The FCG Institute for Continuing Education utilizes a process to identify and resolve potential conflicts to ensure that the content presented is free of commercial bias. The content of this presentation was vetted through The Institute’s process of peer review and content validation and modified as required to meet this standard.

Notice About Investigational or Off-Label Use

This educational activity may include discussion of drugs or devices or uses of drugs and devices that have not been approved by the FDA or have been approved by the FDA for specific uses only. It is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice. The FCG Institute for Continuing Education is committed to the free exchange of medical education. Inclusion of any product or device discussion, including discussion of investigational or off-label uses, does not imply endorsement by The Institute of the uses, products, or techniques presented.

Disclaimer

This CME activity is designed for use by health care professionals for educational purposes only. The information and opinions expressed by the faculty are their own and do not necessarily reflect those of The FCG Institute for Continuing Education. The Institute neither defines a standard of care, nor intends to dictate an exclusive course of management but presents, through the educational activities it sponsors, recognized methods and techniques of clinical practice that physicians and other health care providers can consider incorporating into their practices. Participants should use their own clinical judgment before applying information, whether provided here or by others, for any professional use.

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Sponsored by: The FCG Institute for Continuing Education

The FCG Institute for Continuing Education
gratefully acknowledges an educational grant from
Novo Nordisk Inc. in support of this Web Site