In older patients, the difference would be 59 h, ranging from 51 to 110 h (Fig. 1). To look at these data in a different way, in patients on a prophylactic regimen of 30 IU kg−1 on alternate days, the trough FVIII level in the average 1–6 year-old would be 1.7 IU dL−1. In those with the longest half-lives, the trough would be 4.7 IU dL−1, whereas those with the shortest half-life
would spend 17.5 h per week with FVIII less than 1 IU dL−1 . This suggests that standard prophylactic regimens may not be appropriate for all patients and that knowledge of half-life, in addition to observation of the bleeding pattern, may help tailor prophylaxis to individual patients. Similar calculations for recovery show that this parameter has a proportionally much smaller effect than half-life . The frequency of infusions, whilst keeping the total dose of coagulation factor constant, has GS-1101 clinical trial a large effect on trough levels in patients treated with prophylaxis for both FVIII and IX [5,7–9,13]. If the effect of the half-life
selleck screening library and the frequency of dosing are combined, then widely variable amounts of FVIII would be required to maintain the trough FVIII above a predetermined level. Data presented in Table 1 are adapted from a previous publication  and summarize the amount of FVIII required in an average adult to maintain a trough FVIII between 1 and 1.5 IU dL−1 depending on half-life and dose frequency. In these simulations, the dose of FVIII required to selleckchem maintain a trough level between 1 and 1.5 IU dL−1 in the average adult varied 30-fold when comparing daily with every third day dosing. The effect of half-life is the largest if every third day regimens are used with
a 37-fold difference in the amount of FVIII required when comparing the shortest and longest half-lives. This is in contrast to a 12-fold and fivefold difference when alternate day or daily dosing is used. The effect of half-life is, therefore, exaggerated by less frequent dosing and knowledge of a patient’s FVIII half-life will potentially have a significant impact on the prescription of prophylactic regimens, especially in adult patients. In contrast to changing the frequency of dosing, increasing the dose kg−1 of FVIII for each prophylactic infusion has a smaller effect on the trough level. For example, if a certain dose results in a trough of 1 IU dL−1 at 48 h, then doubling the dose would result in a trough of 2 IU dL−1. To date, there is no corresponding simulation study on FIX, due to lack of data on the variance of PK (in particular on pdFIX) in a representative population of patients. In addition, FIX is characterized by marked ‘two-compartment PK’, with a rapid initial and a slow terminal half-life [10,36].