{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T10:47:39Z","timestamp":1778150859109,"version":"3.51.4"},"reference-count":49,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T00:00:00Z","timestamp":1711238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Prophylaxis has become standard of care for all persons with haemophilia (PWH) with a severe phenotype. However, \u2018standard prophylaxis\u2019 with either factor or non\u2010factor therapies (currently only emicizumab available) is prohibitively expensive for much of the world. We sought to address the question of \u2018How much prophylaxis is enough?\u2019 and \u2018Can it be individualized?\u2019 and specifically \u2018Can emicizumab be individualized?\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed the literature on prophylaxis in haemophilia since its inception in the 1950s to the present, the development of more and less intense factor prophylaxis regimens and their outcomes and additionally the published outcomes of prophylaxis with low dose emicizumab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>What these experiences collectively show is that low dose emicizumab does result in significant benefits to patients whilst being much less expensive than a \u201cone size fits all\u201d emicizumab prophylaxis approach. We also took note that some non\u2010factor therapies still in development are individualized given that high doses of these can potentially put patients at risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prophylaxis is now clearly accepted as standard of care for PWH with a severe phenotype but now in a very short time a large assortment of different treatment options for prophylaxis have become\/are becoming available and the haemophilia community will need to determine how to best use these recognizing that no \u2018one treatment fits all\u2019.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hae.14964","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T04:33:33Z","timestamp":1711341213000},"page":"86-94","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["How much prophylaxis is enough in haemophilia?"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5350-1763","authenticated-orcid":false,"given":"Manuel","family":"Carcao","sequence":"first","affiliation":[{"name":"Division of Haematology\/Oncology; Department of Paediatrics Hospital for Sick Children University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena","family":"Selvaratnam","sequence":"additional","affiliation":[{"name":"Hematology Department Ampang Hospital  Ampang Selangor Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6261-9157","authenticated-orcid":false,"given":"Jan","family":"Blatny","sequence":"additional","affiliation":[{"name":"Hospital Bory, Bratislava Slovakia and Masaryk University  Brno Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.14046"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2008.01946.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.13862"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-021-00278-x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.14531"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2021.100852"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S363028"},{"issue":"9","key":"e_1_2_6_9_1","article-title":"Clotting factor concentrates given to prevent bleeding and bleeding\u2010related complications in people with hemophilia A or B","author":"Iorio A","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16704"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-018-0908-9"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14242"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2011.02682.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.5482\/HAMO-15-12-0033"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.13327"},{"key":"e_1_2_6_16_1","first-page":"111","article-title":"Our experience in Sweden with prophylaxis on haemophilia","volume":"34","author":"Nilsson IM","year":"1970","journal-title":"Bibl Haematol"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08139.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2012.02909.x"},{"key":"e_1_2_6_19_1","unstructured":"YangR Chinese guidelines on the treatment of hemophilia (version2020). 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