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The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket?
Autoimmune hemolytic anemia (AIHA) is defined by increased erythrocyte turnover mediated by autoimmune mechanisms. While corticosteroids remain first-line therapy in most cases of warm-antibody AIHA, cold agglutinin disease is treated by targeting the underlying clonal B-cell proliferation or the cl...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10165002/ https://www.ncbi.nlm.nih.gov/pubmed/37168855 http://dx.doi.org/10.3389/fimmu.2023.1180509 |
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author | Berentsen, Sigbjørn Fattizzo, Bruno Barcellini, Wilma |
author_facet | Berentsen, Sigbjørn Fattizzo, Bruno Barcellini, Wilma |
author_sort | Berentsen, Sigbjørn |
collection | PubMed |
description | Autoimmune hemolytic anemia (AIHA) is defined by increased erythrocyte turnover mediated by autoimmune mechanisms. While corticosteroids remain first-line therapy in most cases of warm-antibody AIHA, cold agglutinin disease is treated by targeting the underlying clonal B-cell proliferation or the classical complement activation pathway. Several new established or investigational drugs and treatment regimens have appeared during the last 1-2 decades, resulting in an improvement of therapy options but also raising challenges on how to select the best treatment in individual patients. In severe warm-antibody AIHA, there is evidence for the upfront addition of rituximab to prednisolone in the first line. Novel agents targeting B-cells, extravascular hemolysis, or removing IgG will offer further options in the acute and relapsed/refractory settings. In cold agglutinin disease, the development of complement inhibitors and B-cell targeting agents makes it possible to individualize therapy, based on the disease profile and patient characteristics. For most AIHAs, the optimal treatment remains to be found, and there is still a need for more evidence-based therapies. Therefore, prospective clinical trials should be encouraged. |
format | Online Article Text |
id | pubmed-10165002 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-101650022023-05-09 The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? Berentsen, Sigbjørn Fattizzo, Bruno Barcellini, Wilma Front Immunol Immunology Autoimmune hemolytic anemia (AIHA) is defined by increased erythrocyte turnover mediated by autoimmune mechanisms. While corticosteroids remain first-line therapy in most cases of warm-antibody AIHA, cold agglutinin disease is treated by targeting the underlying clonal B-cell proliferation or the classical complement activation pathway. Several new established or investigational drugs and treatment regimens have appeared during the last 1-2 decades, resulting in an improvement of therapy options but also raising challenges on how to select the best treatment in individual patients. In severe warm-antibody AIHA, there is evidence for the upfront addition of rituximab to prednisolone in the first line. Novel agents targeting B-cells, extravascular hemolysis, or removing IgG will offer further options in the acute and relapsed/refractory settings. In cold agglutinin disease, the development of complement inhibitors and B-cell targeting agents makes it possible to individualize therapy, based on the disease profile and patient characteristics. For most AIHAs, the optimal treatment remains to be found, and there is still a need for more evidence-based therapies. Therefore, prospective clinical trials should be encouraged. Frontiers Media S.A. 2023-04-24 /pmc/articles/PMC10165002/ /pubmed/37168855 http://dx.doi.org/10.3389/fimmu.2023.1180509 Text en Copyright © 2023 Berentsen, Fattizzo and Barcellini https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Berentsen, Sigbjørn Fattizzo, Bruno Barcellini, Wilma The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
title | The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
title_full | The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
title_fullStr | The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
title_full_unstemmed | The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
title_short | The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
title_sort | choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10165002/ https://www.ncbi.nlm.nih.gov/pubmed/37168855 http://dx.doi.org/10.3389/fimmu.2023.1180509 |
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