The role of natural VWF/FVIII complex concentrates in contemporary haemophilia care: a guideline for the next decade.

Current treatment for haemophilia provides excellent efficacy and safety albeit with a number of unresolved issues. The development of inhibitors following treatment with factor VIII (FVIII) is the most challenging complication of haemophilia and bears the highest economic burden for a chronic disease. Moreover, prophylactic therapy for haemophilia requires repeated infusions of FVIII, frequently as often as two or three times weekly, which can impact greatly on patients' daily lives. As considerable scope remains for further advancements in the management of this condition, the primary focus of this paper relates to issues regarding current treatment and strategies in place to resolve the various issues. For countries approaching access to replacement therapy, it is important to know whether or not plasma-derived and recombinant products are associated with different risks of inhibitor development in previously untreated patients with severe haemophilia. The ongoing international SIPPET study is expected to provide an answer to this clinical dilemma. Methods under investigation to prolong the half-life of factor concentrates offer new hope to reduce the burden of prophylaxis for patients with haemophilia, with early results suggesting greater benefits with FIX.