high), and type of factor concentrate (recombinant vs. plasma-derived), only the type of prophylaxis regimen had a significant effect (P = 0.005). Logistic regression analysis was not performed for the risk of high responder inhibitors due to lack of events in patients given the new regimen. There were however highly significant differences between groups for the prophylaxis-related factors: age at start of prophylaxis and the number of EDs before the introduction of prophylaxis (Table 3). Whereas the new prophylaxis regimen was started after a median of 1 FVIII EDs at a median age of 10.7 months

find more compared to the historical control group were high dose prophylaxis was started later after a median of 30 FVIII on-demand EDs at a median age of 19 months (P < 0.006). Age at start of prophylaxis was available for 23 of the 30 subjects in the standard prophylaxis group and all 26 subjects given the new regimen. The median age at start of prophylaxis was 19 months (range 0.8–87) for those given standard prophylaxis and 10.7 months (range 0.5–24.5) for those given the new regimen. This difference is highly significant (P < 0.0006).

Standard prophylaxis had been introduced after a median of 30 EDs (range 1–infinity) whereas the new regimen was introduced after a median of 1 ED (range 0–14). This difference too is highly significant (P < 0.0001). Fourteen of the 30 subjects given standard prophylaxis and one of the 26 subjects given the new prophylaxis regimen developed an inhibitor. The difference between the groups was highly significant (P = 0.0003, OR 0.048, this website 95% CI: 0.001–0.372) (Table 4). Eight subjects given standard prophylaxis but none of those given the new regimen were high responders. The difference between groups was again significant (P = 0.005, OR for high response 0.00, 95% CI: 0.00–0.57) (Table 4). Inhibitors in the control group developed after a median of 11 EDs check details (range: 3–170 EDs) which is well in agreement with a recent international study [16]. The cumulative inhibitor incidence in the study group on the new prophylaxis regimen was reduced by 95% (OR 0.048) as compared

to the control group on a standard protocol (P = 0.0003, 95% CI: 0.001–0.372) (Fig. 2). As a post-hoc analysis, these results should be interpreted as hypothesis generating. Confirmation in a prospectively planned, historically controlled study would be warranted. It may be considered that the overall risk of developing an inhibitor reflects the level of danger signals perceived by the patient’s immune system. It is not, therefore, surprising that on-demand treatment which is, by definition, given in the presence of bleeding should cause inhibitor development more frequently than prophylaxis. The value of prophylactic factor replacement therapy in the prevention of severe joint bleeds and arthropathy is now well established [17], and is increasingly being adopted as the standard approach to treatment of haemophilia A.