Regimens of factor VIII administration--continuous infusion vs. bolus.

The Malmö protocol for immune tolerance induction uses intermittent injections of factor VIII/IX together with intravenous IgG and cyclophosphamide. In order to increase the production of antigen-antibody complexes, and also to improve cost-efficacy, we applied continuous infusion instead of intermittent injection in 5 high-responders (3 hemophilia A and 2 hemophilia B). All treatment attempts failed. However, we conclude that continuous infusion may play a role in immune tolerance induction, and the treatment failures in our study could probably be explained by the fact that the patients were partially selected to be resistant cases.