Inhibitors can take a toll on your physical and emotional well-being, and it can also be very expensive. There are different ways of managing inhibitors. While some individuals prefer treating with emicizumab (Hemlibra®), despite having an inhibitor, others may want to take a more proactive approach. Immune tolerance therapy (ITI) provides an option to remove the inhibitor.
Immune tolerance induction
Currently, the only treatment option to stop your body from creating inhibitors is immune tolerance induction, or ITI. The goal of ITI is to “teach” the body to accept the clotting factor. Another way to think about ITI is that it helps the body not see the factor as a threat. When ITI is successful, the body “remembers” that the factor treatment is not a foreign object and belongs there, and so it stops creating the inhibitor to eliminate the factor.
ITI is done by giving individuals with an inhibitor more frequent infusions and/or higher doses of clotting factor over a given time period. It can take weeks or months, and in some cases years, until the body gets used to the factor. There are many different protocols for ITI that the provider might use, which means that not all individuals will have the same treatment plan. For many individuals, especially young children, a port (a surgically inserted device to help give clotting factor through a vein) may be needed if it is difficult to find a vein to infuse. Ports can make an individual more likely to develop an infection, so, it is important to talk to the health care provider before one is inserted. It is also important to discuss how ITI will be given. Writing down any questions and bringing them to the appointment will be helpful.