Inhibitor eradication with rituximab in haemophilia: where do we stand?

Br J Haematol. 2014 Jun;165(5):600-8. doi: 10.1111/bjh.12829. Epub 2014 Mar 15.

Abstract

Rituximab is a humanized chimeric anti-CD20 monoclonal antibody initially developed for the treatment of some haematological malignancies. Thanks to its ability to rapidly and specifically deplete B cells, it has also been used in a variety of autoimmune disorders, haematological or not. In this context, during the last decade several small case series have documented successful inhibitor eradication with rituximab, alone or in combination with other immunosuppressive agents, in patients with acquired haemophilia A refractory to standard therapy. In addition, a number of investigators have recently used this agent in patients with congenital haemophilia A or B and alloantibodies refractory to first-line treatment. This article critically reviews the current knowledge on the use of rituximab in acquired haemophilia or congenital haemophilia complicated by alloantibodies, also providing treatment algorithms for the management of these conditions.

Keywords: acquired haemophilia; alloantibodies; autoantibodies; congenital haemophilia; inhibitors; rituximab.

Publication types

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

MeSH terms

  • Antibodies, Monoclonal, Murine-Derived / therapeutic use*
  • Drug Therapy, Combination
  • Factor IX / antagonists & inhibitors
  • Factor IX / immunology
  • Factor IX / therapeutic use
  • Factor VIII / antagonists & inhibitors
  • Factor VIII / immunology
  • Factor VIII / therapeutic use
  • Female
  • Hemophilia A / drug therapy*
  • Hemophilia A / immunology
  • Hemophilia B / drug therapy
  • Hemophilia B / immunology
  • Humans
  • Immunologic Factors / therapeutic use*
  • Isoantibodies / immunology
  • Male
  • Rituximab

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Immunologic Factors
  • Isoantibodies
  • Rituximab
  • Factor VIII
  • Factor IX