Hemophilia Perspectives: An Update on Risk Stratification, Eradication, and Management of Hemophilia Patients with Inhibitors

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Release Date: June 28, 2016
Expiration Date: June 28, 2017
Estimated Time to Complete Activity: 60
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Target Audience

This activity has been designed to meet the educational needs of hemophilia treatment center clinicians, advanced practice registered nurses, registered nurses, and other healthcare providers interested in the comprehensive care of congenital hemophilia patients with inhibitors.

Statement of Need/Program Overview

Inhibitor development represents the most severe adverse event of replacement therapy in hemophilia A patients in high-income countries. The management of hemophilia patients with inhibitors remains a challenge in spite of great strides in the understanding of risk factors involved in inhibitor development. Conflicting data need to be addressed by further studies, in particular with respect to factors potentially modifiable by clinical choices, including regimens of treatment and the highly debated role of different sources of FVIII products. Hemophilia A patients with high-titer inhibitors require therapies with bypassing agents to control bleedings or immune tolerance induction to attempt inhibitor eradication and restore FVIII therapy. This activity will provide learners with new information and current expert opinion on the risks associated with the development of inhibitors in patients with hemophilia A and B, as well as updates on the strategies employed to eradicate and manage these patients.

Educational Objectives
After participating in this activity, participants should be able to:
  • Review the genetic and non-genetic risk factors associated with the development of inhibitors in patients with hemophilia (PWH)
  • Utilize inhibitor prediction models and genotyping to identify and evaluate the risk of developing inhibitors in PWH
  • Discuss the development of inhibitors in non-severe PWH and their clinical implications
  • Discuss the controversies associated with the relative immunogenicity of different factor VIII concentrates
  • Review relevant clinical practice information derived from registries, international immune tolerance induction (ITI) guidelines, and clinical trial data from prospective studies investigating the efficacy and safety of ITI therapy in PWH with inhibitors
  • Discuss the role of predictive markers of successful ITI therapy in PWH with inhibitors
  • Implement appropriate eradication and management strategies, including ITI and bypassing therapy, to the care of PWH with inhibitors
  • Assess the economics of inhibitor eradication and treatment regimens
Presenting Faculty
Jaime Morales, MD
Associate Professor of Pediatrics
Louisiana State University
Director, Hemophilia Treatment Center and
Bleeding Disorders and Thrombosis Program
Children’s Hospital of New Orleans
New Orleans, Louisiana

Michael Tarantino, MD
Medical Director and President
Bleeding & Clotting Disorders Institute
Professor of Pediatrics and Medicine
University of Illinois College of Medicine-Peoria
Peoria, Illinois

Patricia Amerson, RN, MSN, CPNP
University of Texas Health Science Center at San Antonio
Pediatric Nurse Practitioner
South Texas Hemophilia Treatment Center
San Antonio, Texas

Physician Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education
Credit Designation
This educational activity for 1.0 contact hours is provided by Postgraduate Institute for Medicine and is designated for 0.5 contact hours of pharmacotherapy credit for Advanced Practice Registered Nurses.

Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Method of Participation
During the period of June 28, 2016 through June 28, 2017, participants must:
  • Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form
A statement of credit will be issued automatically upon successfully completing the post-activity survey with a score of 75% or better and submitting the activity evaluation.

Fee Information
There is no fee for this educational activity.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by PIM for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter Reported Financial Relationship
Jaime Morales, MD

Consulting Fees: Pfizer, Octapharma, Baxalta, CSL Behring, Biogen

Fees for Non-CME/CE Services: Novo Nordisk, Baxalta, CSL Behring
 Michael Tarantino, MD

Consulting Fees: Novo Nordisk, Baxalta, Grifols, Amgen, Pfizer, Biogen, HRSA, CDC

Fees for Non-CME/CE Services: Novo Nordisk, Grifols, Amgen, Biogen

Contracted research: Grifols
Patricia Amerson, RN, MSN, CPNP

Consulting Fees: Novo Nordisk

Fees for Non-CME/CE Services: Novo Nordisk
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Name of Planner or Manager Reported Financial Relationship
PIM Clinical Reviewers: Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker-Mitchek, RN, BSN; Jan Schultz, RN, MSN, CHCP

Have no real or apparent conflicts of interest to report.

Educational Concepts in Medicine: Patrick J. Crowley, MBA, President/CEO; Jodi Andrews, Vice President, Operations; Zeena Nackerdien, PhD, Medical Writer; Kathy Marshall, MBA, Program Manager
Have no real or apparent conflicts of interest to report.


Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Commercial Support
This activity is supported by an educational grant from Novo Nordisk Inc