Intensity of factor VIII treatment and inhibitor development in children with severe hemophilia A: the RODIN study

Blood. 2013 May 16;121(20):4046-55. doi: 10.1182/blood-2012-09-457036. Epub 2013 Apr 3.


The objective of this study was to examine the association of the intensity of treatment, ranging from high-dose intensive factor VIII (FVIII) treatment to prophylactic treatment, with the inhibitor incidence among previously untreated patients with severe hemophilia A. This cohort study aimed to include consecutive patients with a FVIII activity < 0.01 IU/mL, born between 2000 and 2010, and observed during their first 75 FVIII exposure days. Intensive FVIII treatment of hemorrhages or surgery at the start of treatment was associated with an increased inhibitor risk (adjusted hazard ratio [aHR], 2.0; 95% confidence interval [CI], 1.3-3.0). High-dose FVIII treatment was associated with a higher inhibitor risk than low-dose FVIII treatment (aHR, 2.3; 95% CI, 1.0-4.8). Prophylaxis was only associated with a decreased overall inhibitor incidence after 20 exposure days of FVIII. The association with prophylaxis was more pronounced in patients with low-risk F8 genotypes than in patients with high-risk F8 genotypes (aHR, 0.61, 95% CI, 0.19-2.0 and aHR, 0.85, 95% CI, 0.51-1.4, respectively). In conclusion, our findings suggest that in previously untreated patients with severe hemophilia A, high-dosed intensive FVIII treatment increases inhibitor risk and prophylactic FVIII treatment decreases inhibitor risk, especially in patients with low-risk F8 mutations.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blood Coagulation Factor Inhibitors / blood
  • Blood Coagulation Factor Inhibitors / metabolism*
  • Chemoprevention / adverse effects
  • Child
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Factor VIII / administration & dosage*
  • Factor VIII / antagonists & inhibitors*
  • Hemophilia A / blood
  • Hemophilia A / drug therapy*
  • Hemophilia A / epidemiology*
  • Hemophilia A / metabolism
  • Hemorrhage / blood
  • Hemorrhage / epidemiology
  • Hemorrhage / metabolism
  • Hemorrhage / prevention & control*
  • Humans
  • Risk Factors
  • Severity of Illness Index
  • Young Adult


  • Blood Coagulation Factor Inhibitors
  • Factor VIII