Is there any place for replacement therapy of hemophilia A in children in present and future?

Abstract

In recent years, we have seen a revolution in the treatment of patients with hemophilia A. The emergence of new methods of non-factor and the development of gene therapy raise a natural question for doctors: what are the prospects for the classical treatment of hemophilia A using factor concentrates? This is especially true for patients with hemophilia A and inhibitors (HAI), for whom, until now, the only option to reduce the frequency of hemorrhagic manifestations has been the use of bypassing agents that do not allow complete control of bleeding. Improving the results of treatment of patients with HAI was possible only with complete eradication of inhibitors. The most effective and safe method to get rid of inhibitors is immune tolerance induction therapy (ITI). With the advent of emicizumab and the truly fantastic results of its use in patients with HAI, doctors are increasingly faced with the question of the need for ITI. This issue is especially acute in children with HAI.This review provides basic information about modern advances in the treatment of hemophilia A, and also determines the place of substitution therapy drugs in the present and future.