Continuous infusion of recombinant factor VIIa in patients with haemophilia and inhibitors - Experience in the Netherlands and Belgium.

Background: Initial clinical experience with recombinant factor VIIa (rVIIa ) for treatment of haemophilia patients with inhibitors against factor VIII or IX has been obtained by administration of rVIIa by repeated intravenous bolus injections. However, continuous infusion of rVIIa may be a more appr opriate administration method if prolonged treatment is indicated. Methods: We have surveyed and analysed the initial experience with continuo us infusion of rVIIa in the Netherlands and Belgium. Results: Five hospitals treated 7 haemophilia patients with inhibitors on 9 different occasions (4 bleedings, 5 surgical interventions) by continuous infusion of rVIIa over a total of 59 days. Haemostatic coverage was conside red effective in 8 out of 9 cases and partially effective in 1 case. Contin uous infusion of rVIIa was aimed at rVIIa target plasma levels of 10 U/ml a nd a decrease in prothrombin time (PT) of 3 s compared to control levels. T his was obtained by an initial bolus injection of 90 mu g/kg prior to conti nuous infusion of rVIIa at doses between 30-6 mu g/kg/h (mean 17.5 mu g/kg/ h). A conventional one-stage factor VII coagulation assay, often used in co mbination with a PT, was satisfactory in monitoring rVIIa treatment. The ad ditional clinical value of anti-fibrinolytic and anti-thrombophlebitic trea tment was unclear. Conclusion: In our experience, rVIIa appeared to be efficacious and safe wh en administered by continuous infusion. Continuous infusion of rVIIa is mor e convenient than bolus injections of rVIIa, easy to monitor and provides a cost reduction of > 50%, These advantages make continuous infusion an attr active administration method for prolonged treatment with rVIIa. (C) 1998 E lsevier Science B.V. All rights reserved.