Linda G. Shaffer, MD; Martin D. Phillips, MD
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Shaffer L., Phillips M.; Oral Immunosuppressive Therapy for Acquired Hemophilia. Ann Intern Med. 1998;128:325. doi: 10.7326/0003-4819-128-4-199802150-00035
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Published: Ann Intern Med. 1998;128(4):325.
We thank Dr. Green for his comments and the interesting new data he presents. In our series of patients, the objective was to achieve completely effective treatment for this serious condition, not to determine the minimal effective therapy. However, we are of a similar opinion about the treatment of low-titer autoantibodies to factor VIII. A pattern of response to therapy is emerging that may lead to a decrease in the intensity of therapy in a subset of patients with low inhibitor titers.
As noted in our article and by Dr. Green, patients who respond to steroid therapy alone generally have low inhibitor titers. In the new patients presented here, much like in the published experience, only one patient with a Bethesda titer greater than 5 had a remission with prednisone (patient 4); the other (patient 3) had relapse and required cyclophosphamide therapy. From the data discussed in our article and those presented by Dr. Green, we conclude that it may be reasonable to use prednisone alone to treat patients with Bethesda titers less than 5, but clinical observation should be close.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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