Cédric Hermans, Catherine LambertPublished in the journal : May 2020Category : Hémostase
COVID-19, especially in its severe form, is associated with a coagulopathy responsible for an increased incidence of venous and arterial thrombosis, pulmonary embolism, and pulmonary microthrombosis. Biologically, it results in increased D-dimer levels, which is of diagnostic and prognostic relevance. Depending on its severity, the COVID-19 infection requires a treatment with low-molecular-weight heparin (LMWH) at preventive or semi-therapeutic doses. In case of proven or strongly suspected thrombosis, anticoagulation with LMWH at therapeutic doses is recommended.
The current treatment of hemophilia relies on intravenous administration, repeated several times a week, of clotting factor VIII (FVIII) or factor IX (FIX) concentrates, either derived from plasma or produced by biotechnology. This preventive treatment is burdensome, expensive, and only allows for transient and partial corrections of the clotting factor deficiencies. Moreover, it is associated with the risk of developing neutralizing antibodies, termed inhibitors.
The FVIII and IX concentrates with a longer half-life, such as a bispecific monoclonal antibody mimicking the action of FVIII, as well as various strategies modifying the physiological regulation of coagulation, whilst being administered subcutaneously, represent new treatment options, either already validated or being evaluated. The first results of gene therapy studies also look very promising.
These developments offer patients with hemophilia new perspectives of treatment, if not cure, which this article proposes to review.