Acute hemarthroses: the benefits of early versus late treatment with recombinant activated factor VII.

In hemophiliacs without inhibitors, response to treatment for joint and soft tissue bleeding is much more effective when factor VIII is given early. The same is true in hemophiliacs with inhibitors treated with recombinant activated factor VII (rFVIIa; NovoSeven) for peripheral muscular hemorrhages. In the present report, we analyzed the responses to rFVIIa given to treat acute hemarthroses. We compared the amount of rFVIIa used in the treatment of acute hemarthroses in persons with hemophilia A and B with inhibitors and those with acquired hemophilia in the compassionate use, dose-finding, and United States (US) home treatment studies. We also compared the response rates in each of these studies. As in previous analyses for intramuscular hemorrhages, the average number of doses given for acute joint bleeding was significantly less when treatment was instituted early (as in the US home treatment study). Response rates were also much greater in the US home treatment study than in the dose-finding or compassionate use databases. It is clear that early treatment of acute hemarthroses with rFVIIa results in a greater rate of success, with fewer doses of product being required. Home treatment with rFVIIa results in greater convenience, cost savings and reduced morbidity.