How does Hemlibra work?

Hemlibra creates a bridge

Hemlibra doesn’t try to replace factor VIII. Instead, Hemlibra creates a bridge between factor IXa and factor X, that you do have in your blood.

By creating this bridge Hemlibra allows the rest of the clotting factors to continue working together to form a clot.

Because Hemlibra is not the same as factor VIII replacement therapy, inhibitors to factor VIII shouldn’t stick to Hemlibra to stop it from working.

what if i have a bleed

Find out more about Hemlibra and the clotting cascade

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The science part

After the initial four loading doses of 3.0 mg/kg once a week, you will take Hemlibra once every week, once every 2 weeks, or once every 4 weeks, depending on the schedule you and your haemophilia team have decided on.

Hemlibra levels remain stable between doses. This means that you do not need to take additional doses of Hemlibra or factor VIII replacement therapy to cover activities such as playing sport.

Bypassing agents

Bypassing agents are treatments for haemophilia A with inhibitors to factor VIII. They help blood to clot when factor VIII replacement therapy does not work any more. They are used to treat bleeds in people with inhibitors, whereas Hemlibra can only be used for regular treatment.

You may have already taken bypassing agents.
These are called:

Activated prothrombin complex concentrate (aPCC, Feiba)
Recombinant activated factor VII (rFVIIa, NovoSeven)

The level of bypassing agent therapy falls following administration, meaning repeat doses may be required to manage bleeds.

This example shows the peaks and troughs in recombinant factor VIIa therapy with repeat doses (such as NovoSeven).

Bypassing agent levels after IV administration

(adapted from Stenmo C, Fernandez-Bello I, Ezban M, et al. Blood. 2014;124:2824)

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