Acquired haemophilia A in a patient with chronic hepatitis C virus infection receiving treatment with pegylated interferon plus ribarivin: role of rituximab

• Published in: Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria Vol. 37; no. 6; p. 494
• Main Authors: Fernández de Palencia Espinosa, M Á, Arocas Casañ, V, Garrido Corro, B, de la Rubia Nieto, A
• Format: Journal Article
• Language: English
• Published: Spain 01-11-2013
• Subjects: Antibodies, Monoclonal, Murine-Derived - adverse effects; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Factor VIII - analysis; Hematoma - chemically induced; Hemophilia A - complications; Hemophilia A - drug therapy; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Male; Middle Aged; Polyethylene Glycols; Prednisolone - adverse effects; Prednisolone - therapeutic use; Ribavirin - adverse effects; Ribavirin - therapeutic use; Rituximab
• EISSN: 0214-753X

Acquired haemophilia is an uncommon condition caused by the development of clotting factor inhibitors. To eliminate them, immunosuppressive therapy with corticosteroids and cytotoxic drugs is required.
We describe a case of rituximab use in acquired haemophilia refractory to conventional therapy in a 63 year old male patient with chronic hepatitis C virus infection who was receiving treatment with pegylated-interferon-a-2a plus ribavirin.
After 21 weeks of antiviral therapy, the patient was admitted to hospital with a large haematoma in the abdominal muscles. Factor VIII level was zero and inhibitor titer was 345 Bethesda units. Oral immunosuppressive therapy with methylprednisolone and cyclophosphamide was administered for 1 month, with limited improvement. Therefore, cyclophosphamide was replaced by a four once-weekly dose of intravenous rituximab. Two months later, factor VIII level was normal and inhibitor titer was undetectable.
Rituximab may be useful for the treatment of acquired haemophilia resistant to standard therapy.