Warm autoimmune hemolytic anemia

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Last updated on 2024-07-23:4 regimens on this page
4 variants on this page
=Guidelines=
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
==British Society for Haematology==
*2017: Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia EuroPMC
*2016: The diagnosis and management of primary autoimmune haemolytic anaemia EuroPMC
=All lines of therapy=
==Prednisolone monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Birgens et al. 2013 (AIHA-KA04062-gms)	2005-03 to 2012-06 	Phase 3 (C)	Prednisolone & Rituximab	Seems to have shorter RFS
====Immunosuppressive therapy====
*Prednisolone (Millipred) 1.5 mg/kg/day PO on days 1 to 14, then 0.75 mg/kg/day PO on days 15 to 21 (week 3), then 0.5 mg/kg/day PO on days 22 to 28 (week 4), then a gradual reduction over the next 4 to 8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level
12-week course
===References===
#AIHA-KA04062-gms: Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. link to original article EuroPMC NCT01134432
==Prednisone monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Michel et al. 2016 (RAIHA)	2011-2015 	Phase 3 (C)	Prednisone & Rituximab	Seems to have lower ORR
====Immunosuppressive therapy====
*Prednisone (Sterapred) 1 mg/kg PO once per day on days 1 to 14, then tapered "according to a pre-defined recommended reduction scheme"
One course
===References===
#RAIHA: Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. link to original article dosing details in abstract have been reviewed by our editors EuroPMC NCT01181154
==Prednisolone & Rituximab==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Birgens et al. 2013 (AIHA-KA04062-gms)	2005-03 to 2012-06 	Phase 3 (E-esc)	Prednisolone	Seems to have longer RFS (secondary endpoint)
====Immunosuppressive therapy====
*Prednisolone (Millipred) 1.5 mg/kg/day PO on days 1 to 14, then 0.75 mg/kg/day PO on days 15 to 21 (week 3), then 0.5 mg/kg/day PO on days 22 to 28 (week 4), then a gradual reduction over the next 4 to 8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level
*Rituximab (Rituxan) 375 mg/m2 IV once per day on days 1, 8, 15, 22
====Supportive therapy====
*Folic acid (Folate) 5 mg PO once per day
12-week course
===References===
#AIHA-KA04062-gms: Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. link to original article EuroPMC NCT01134432
==Prednisone & Rituximab==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Michel et al. 2016 (RAIHA)	2011-2015 	Phase 3 (E-esc)	Prednisone	Seems to have higher ORR (primary endpoint)
====Immunosuppressive therapy====
*Prednisone (Sterapred) 1 mg/kg PO once per day on days 1 to 14, then tapered "according to a pre-defined recommended reduction scheme"
*Rituximab (Rituxan) 1000 mg IV once per day on days 1 & 15
One course
===References===
#RAIHA: Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. link to original article dosing details in abstract have been reviewed by our editors EuroPMC NCT01181154
Category:Warm autoimmune hemolytic anemia regimens
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Category:Autoimmune hematologic conditions
Category:Hemolytic process