Raphael B. Stricker, MD
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Stricker RB. Interferon-α Treatment and Formation of Factor VIII Antibodies. Ann Intern Med. 1997;126:829. doi: 10.7326/0003-4819-126-10-199705150-00023
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Published: Ann Intern Med. 1997;126(10):829.
TO THE EDITOR:
Mauser-Bunschoten and colleagues  describe an apparent lack of association between formation of factor VIII inhibitors and long-term interferon-α therapy in patients with hemophilia A and chronic hepatitis C. The study addresses two reports of acquired factor VIII inhibitors in “dissimilar” patients with and without hemophilia who received long-term interferon-α treatment [2, 3]. Although the current findings are reassuring, they also raise intriguing questions about the pathogenesis of factor VIII antibodies and interferon-α-induced autoimmunity.
Factor VIII inhibitors may arise as alloantibodies in patients with severe hemophilia A (factor VIII level < 1%) or as autoantibodies in persons without hemophilia . Immunosuppressive therapy is generally ineffective against alloantibody inhibitors but may work against autoantibody inhibitors . This observation suggests that different immunologic mechanisms may be involved in the pathogenesis of the two inhibitor subtypes . Furthermore, alloantibodies and autoantibodies against factor VIII are associated with different patterns of bleeding . In this regard, the previous “dissimilar” cases of interferon-α-associated factor VIII inhibitors have a strong common feature: Both cases involved bleeding patterns typical of autoantibody inhibitors. In particular, one of the patients had mild hemophilia , with a baseline factor VIII level of 8%; this patient seems to have developed an autoantibody rather than an alloantibody inhibitor against factor VIII after long-term interferon-α therapy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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