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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1180509/full |
| _version_ | 1797840594593120256 |
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| author | Sigbjørn Berentsen Bruno Fattizzo Wilma Barcellini |
| author_facet | Sigbjørn Berentsen Bruno Fattizzo Wilma Barcellini |
| author_sort | Sigbjørn Berentsen |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-09T16:17:24Z |
| format | Article |
| id | doaj.art-c68af42595fa4d3e9c8edb0bd07b822e |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-09T16:17:24Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-c68af42595fa4d3e9c8edb0bd07b822e2023-04-24T04:24:13ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-04-011410.3389/fimmu.2023.11805091180509The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket?Sigbjørn Berentsen0Bruno Fattizzo1Wilma Barcellini2Department of Research and Innovation, Haugesund Hospital, Helse Fonna Hospital Trust, Haugesund, NorwayFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, and Department of Oncology and Hemato-Oncology, University of Milan, Milan, ItalyFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyAutoimmune 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.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1180509/fullclinical trialscomplement inhibitorscold agglutinin diseasecorticosteroidsimmune suppressionrituximab |
| spellingShingle | Sigbjørn Berentsen Bruno Fattizzo Wilma Barcellini The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? Frontiers in Immunology clinical trials complement inhibitors cold agglutinin disease corticosteroids immune suppression rituximab |
| 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 | clinical trials complement inhibitors cold agglutinin disease corticosteroids immune suppression rituximab |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1180509/full |
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