Thromb Haemost 1996; 76(02): 200-204
DOI: 10.1055/s-0038-1650554
Original Article
Schattauer GmbH Stuttgart

Immunological Aspects of Recombinant Factor Vila (rFVIIa) in Clinical Use

Else Marie Nicolaisen
Novo Nordisk A/S, Gentofte, Denmark
,
Lisbeth Lyng Hansen
Novo Nordisk A/S, Gentofte, Denmark
,
Fritz Poulsen
Novo Nordisk A/S, Gentofte, Denmark
,
Steven Glazer
Novo Nordisk A/S, Gentofte, Denmark
,
Ulla Hedner
Novo Nordisk A/S, Gentofte, Denmark
› Author Affiliations
Further Information

Publication History

Received 01 February 1996

Accepted after revision 26 April 1996

Publication Date:
10 July 2018 (online)

Summary

Patients, receiving rFVIIa for treatment of bleeding disorders, have been followed for specific antibody formation. No antibodies against FVII were demonstrated in 170 patients, with hemophilia, or with acquired inhibitors to clotting factors. Of 6 FVII-deficient patients, one overdosed patient developed antibodies to human FVII. There was no indication of de novo formation of antibodies to potential contaminating foreign protein, which could be correlated to the rFVIIa treatment. Except for the FVII-deficient population, which may represent a risk group, rFVIIa appears to be immunologically safe for use in patient groups with bleeding disorders, including hemophilia A and B patients.

 
  • References

  • 1 Hedner U, Kisiel W. Use of human factor Vila in the treatment of two hemophilia A patients with high-titer inhibitors. J Clin Invest 1983; 71: 1836-41
  • 2 Hedner U, Glazer S, Pingel K, Alberts KA, Blombäck M, Shulman S, Johnsson H. Successful use of recombinant factor Vila in patient with severe haemophilia A during synovectomy. Lancet 1988; 2: 1193 (letter)
  • 3 Hedner U. Factor Vila in the treatment of haemophilia. Blood Coagul Fibrinolysis 1990; 1: 307-317
  • 4 Hedner U, Glazer S. Management of Hemophilia patients with inhibitors. Hematology/Oncology Clinics of North America 1992; 6: 1035-1046
  • 5 Hedner U, Glazer S, Falch J. Recombinant activated factor VII in the treatment of bleeding episodes in patients with inherited and acquired bleeding disorders. Transfus Med Rev 1993; 7: 78-83
  • 6 Macik GB, Hohneker J, Roberts HR, Griffen AM. Use of recombinant activated factor VII for treatment of a retropharyngeal hemorrhage in a hemophilic patient with a high titer inhibitor. Am J Hematol 1989; 32: 232-234
  • 7 Majumdar G, Savidge GF. Recombinant factor Vila for intracranial haemorrhage in a Jehovah’s witness with severe haemophilia A and factor VIII inhibitors. Blood Coagul Fibrinolysis 1993; 4: 1031-1033
  • 8 Majumdar G, Phillips JK, Lavallee H, Savidge GF. Acquired haemophilia in association with type III von Willebrand’s disease: successful treatment with high purity von Willebrand’s factor and recombinant factor Vila. Blood Coagul Fibrinolysis 1993; 4: 1035-1037
  • 9 O’Marcaigh AS, Schmaltz BJ, Shaughnessy WJ, Gilchrist GS. Successful Hemostasis during a major orthopedic operation by using recombinant activated factor VII in a patient with severe hemophilia A and a potent inhibitor. Mayo Clin Proc 1994; 69: 641-644
  • 10 Schmidt ML, Gamerman S, Smith HE, Scott JP, Di Michele DM. Recombinant Activated Factor VII (rFVIIa) Therapy for Intracranial Hemorrhage in Hemophilia A Patients with Inhibitors. Am J Hematol 1994; 47: 36-40
  • 11 Stubbs JR, Uzel CS, Baker SL, Martino RL. Peripartum use of recombinant factor Vila in inherited factor VII deficiency. Transfusion 1994; 34: S121 (abstr)
  • 12 Di Michele D. Patients treated on a compassionate use basis - case stories. Hemophilia B. In: 2nd Symposium on New Aspects of Hemophilia Treatment Hedner U, Roberts HR. eds Medicom: 1991: 130-132
  • 13 Bergman F, Hoyer PF, Barthels M. Rescue treatment with recombinant factor Vila (rFVIIa) in a hemophilia B patient with inhibitor. Annals of Hematology 1995; 70 (Suppl. 01) A37 (abstr)
  • 14 Wildgoose P, Nemerson Y, Hansen LL, Nielsen FE, Glazer G, Hedner U. Measurement of basal levels of factor Vila in Hemophilia A and B patients. Blood 1992; 80: 25-28
  • 15 Macik BG, Lindley CM, Lusher J, Sawyer WT, Bloom AL, Harrison JF, Baird-Cox K, Birch K, Glazer S, Roberts HR. Safety and initial clinical efficacy of three dose levels of recombinant activated factor VII (rFVIIa): Results of a phase I study. Blood Coagul Fibrinolysis 1993; 4: 521-527
  • 16 Lusher JM. rFVIIa Results of a double-blind dose finding study. Transfusion 1994; 34: 728 (abstr)
  • 17 Glazer S. Recombinant activated factor VII - Safety and efficacy. Transfusion 1994; 34: 728 (abstr)
  • 18 Ukkonen P, Korpela J, Suni J, Hedman K. Inactivation of Human Immunodeficiency Virus in Serum Specimens as a Safety Measure for Diagnostic Immunoassays. Eur J Clin Microbiol Infect Dis 1988; 7: 518-523
  • 19 Bech RM, Nicolaisen EM, Andersen PM, Glazer S, Hedner U. Recombinant FVIIa for the treatment of congenital factor VII deficient patients. Thromb Haemost 1995; 73: 983 (abstr)
  • 20 Fort JA. An infant with FVII deficiency. In: 2nd Symposium on New Aspects of Hemophilia Treatment Hedner U, Roberts HR. eds Medicom: 1991: 142-143
  • 21 Richards SM, Olson TA, McPherson JM. Antibody Response in Patients With Gaucher Disease After Repeated Infusion With Macrophage-Targeted Glucocerebrosidase. Blood 1993; 82: 1402-1409
  • 22 Roberts HR, Hoffman M. Hemophilia and Related Conditions-Inherited Deficiencies of Prothrombin (Factor II), Factor V, and Factors VII to XII. In: Williams Hematology, Fifth Edition Beutler E, Lichtman MA, Coller BS, Kipps TJ. eds New York: MacGraw-Hill; 1995: 1431
  • 23 Delmer A, Horellou M-H, Andreu G, Lecompte T, Rossi F, Kazatchkine MD, Samana M, Zittoun R. Life-Threatening Intracranial Bleeding Associated with the presence of an antifactor VII autoantibody. Blood 1989; 74: 229-232
  • 24 Campbell E, Sanal S, Mattson J, Walker L, Estry S, Mueller L, Schwartz M, Hampton S. Factor VII Inhibitor. Am J Med 1980; 68: 962-964
  • 25 Raucourt E, Dumont MD, Tourani JM, Hubsch JP, Riquet M, Fisher AM. Acquired factor VII deficiency associated with pleural liposarcoma. Blood Coagul Fibrinolysis 1994; 5: 833-836
  • 26 Weisdorf D, Hasegawa D, Fair DS. Acquired factor VII deficiency associated with aplastic anaemia: correction with bone marrow. Br J Haematol 1989; 71: 409-413
  • 27 Thim L, Bjøm S, Christensen M, Nicolaisen EM, Lund-Hansen T, Pedersen A, Hedner U. Amino acid sequence and post-translational modifications of human factor Vila from plasma and transfected baby hamster kidney cells. Biochemistry 1988; 27: 7785-7793
  • 28 Thompson RJ, Jackson AP, Langlois N. Circulating antibodies to mouse immunoglobulins in normal subjects-inci dence , species specificity, and effects on two-site assay for creatine kinase-MB isoenzyme. Clin Chem 1986; 32: 476-481
  • 29 Bray GL, Kazemi M, Liu S-L, Courier S, Buckwalter C, White III G, Gom-perts ED. and the Recombinate® Study Group. Results of foreign protein antibody (AB) ELISAs in a cohort of recombinant FVIII (r-FVIII) treated patients. Blood 1994; 84: 65a (Suppl. 01) (abstr)