Wolfgang Miesbach: Rebalancing Agents in Haemophilia Are Not “Set and Forget” – Key Insights from WFH 2026
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared posts on LinkedIn, highlighting key insights from the World Federation of Hemophilia (WFH) 2026 Congress։
”Rebalancing agents are not ‘set and forget’
Excellent presentation today by Alok Srivastava at the Sanofi industry symposium during WFH Congress Kuala Lumpur on rebalancing agents in haemophilia – showing how different targets (TFPI leads to concizumab / marstacimab; AT leads to fitusiran), loading doses and maintenance intervals (QD / QW / Q2M) demand truly individualised dosing strategies.
- Traditional assays (PT / aPTT) largely unaffected
- PK/PD (where available) help to fine‑tune dose / frequency to maintain target range
- Global assays (TGA / TEG / ROTEM) could be useful in selected settings (e.g. peri‑operative management)
- All dosing decisions embedded in shared decision‑making, patient goals, comorbidities, thrombosis risk
A timely reminder that optimising dose and monitoring is now central to safe and effective haemostatic rebalancing.”
”In the rebalancing era, proactive, protocol‑driven management of any breakthrough bleed has become a fourth pillar of haemophilia care – alongside prophylaxis, monitoring and shared decision‑making.
Interesting summary of treatment recommendations for breakthrough bleeds under rebalancing agents, presented by Alok Srivastava at the Sanofi industry symposium during the WFH Congress in Kuala Lumpur.
- Patient population: haemophilia A/B, ± inhibitors
- Product choice: FVIII/FIX (standard or EHL), aPCC, rFVIIa
- Principle: use the lowest effective dose
- Interval before repeat dosing: typically 24 h vs 5–7 d, depending on product
- Antifibrinolytics: allowed, used with caution or avoided with certain agents.”
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