Wolfgang Miesbach: A Paradigm Shift in the Management of Acquired Haemophilia A
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn:
”A Paradigm Shift in the Management of Acquired Haemophilia A.
At the 70th Annual Meeting of the GTH in Bonn, Andreas Tiede delivered a landmark lecture – presenting the current state of the art and the decisive contributions of the GTH Working Group on Acquired Haemophilia.
AHA is a rare but life-threatening autoimmune disorder caused by neutralising antibodies against factor VIII. It hits older, frail patients hard – 30–50% have an underlying condition (malignancy, autoimmune disease, pregnancy). Fatal bleeding (3–9%) and fatal infection from immunosuppression (up to 16%) remain sobering realities.
3 treatment goals:
- Stop acute bleeding using rFVIIa, aPCC, or porcine recombinant FVIII
- Prevent bleeding with emicizumab prophylaxis
- Eliminate the inhibitor through immunosuppressive therapy (IST)
GTH-AHA-EMI (Tiede et al., Lancet Haematol 2023): Rapid-loading emicizumab without IST for 12 weeks resulted in 70% of patients had zero new bleeds.
Survival benefit confirmed (Schimansky et al., Blood Adv 2025): Infection-related mortality 4% vs. 16% with immediate IST – a striking difference in a frail population.
Looking ahead: Anti-CD19 CAR-T cell therapy achieved complete remission in a heavily pre-treated IST-resistant patient (Schultze-Florey et al., Leukemia 2025) – innovation is accelerating.
Take-home: Use emicizumab upfront in AHA. A bispecific antibody born in congenital haemophilia is now reshaping the entire AHA landscape.”
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