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In 12 severe hemophiliacs with an antibody to factor VIII of the high responder type antibody activity was followed over a treatment free period of at least three months up to seven years, following 30 factor VIII treatments. After reaching the peak level the antibody titer declined exponentially with a median half disappearance time of 36 days within in a period of 2 - 7 months. There was a considerable variation of the half disappearance time among patients and even in the same patient. Particularly inter - esting were two patients who showed an unusually short half disappearance time of 5 and 9,5 days,respectively. On the other hand, in one patient the half disappearance time after three stimulations was between 67 and 98 days.  In five patients a biexponential disappearance curve was observed. In these patients after a first component of rapid decline (as described above) a second slower component was observed. The half disappearance time of this second component was between 92 - 480 days (median 200 days). In one patient eventually a plateau was reached. The transition of the first to the second component occured 2-7 months after stimulation, when the antibody level had fallen to 2 - 30 % of the peak level. Biexponential curves were observed only in patients with peak levels of more than 300 BU/ml. However, only a single rapid component was observed in one patient with peak levels of 470 BU/ml. Hemophilic factor VIII antibodies are heterogenous with regard to their behaviour in vivo. These differences have to be taken into account if therapeutic decisions have to be made.

The Natural History Of Hemophilic Factor VIII-Antibodies: Differences In The Half Disappearance Time Following Anamnestic Rise