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Immune Tolerance

Immune Tolerance

While the treatments discussed in the preceding sections provide options for treating a bleed, they do not have the same positive, long-term outcomes as treatment with replacement factor (VIII or IX) in patients without inhibitors. These less-than-optimal treatments can also lead to secondary problems such as infections, bleeding into joints and organ damage.

Because of these complications, many healthcare providers believe that ridding of the body of inhibitors is the best option. This is done using a course of therapy known as "immune tolerance." There are different treatment regimens used for immune tolerance, but most require repeated exposures to clotting factor.

People who opt for immune tolerance therapy will need daily doses of factor over a period of weeks, or in some cases, years. Some people going through this therapy are also prescribed immune suppressive drugs, which can predispose one to infections. The risks and benefits of each treatment regimen and the adjunct medications used should be discussed in detail with your hematologist or primary healthcare provider. The goal of immune tolerance therapy is to eventually "teach" the body to tolerate the factor and to not mount an immune response so that normal replacement therapy can be used to prevent or control bleeding.

Overall, immune tolerance induction (ITI) can effectively remove an inhibitor in about 70% of patients with hemophilia A and in about 30% of individuals with hemophilia B. However, the process of eradicating an inhibitor can take anywhere from a few months to even years of therapy. In all cases, patients who develop an inhibitor should discuss their treatment options with a hematologist experienced in managing inhibitors.