However, the extent to which this goal can be accomplished for patients with haemophilia

remains to be seen. Although the approval process for biosimilars is expected to be less than that for a new biologic, it is still considerably more extensive than that of a generic drug, and therefore the extent of savings over the reference product is yet to be determined. A range of other factors are also expected to affect the economic success of biosimilars, including clinician and patient attitudes about switching to Romidepsin an unbranded product and safety issues that may emerge with biosimilars (mainly immunogenicity) as they enter the market. Other issues to consider include formulary and insurance coverage for biosimilars and possible price reductions by the reference product manufacturer that may be implemented to dissuade switching to biosimilar versions. Due to the limited number of patients, rare bleeding disorders (RBDs) have drawn less attention from the industry than haemophilia or von Willebrand disease. In all RBDs (fibrinogen, FII, FV, FV+VIII, FX, combined vitamin

K-dependent factors, FXI and FXIII deficiencies), fresh frozen plasma (FFP) is a possibility when no concentrates are available but FFP bring unnecessary factors and proteins, carry the risk of infections, allergic reactions and fluid overload (in the event of volume overload diuretics are sometimes used). Cryoprecipitates Nivolumab research buy are used for fibrinogen disorders and sometimes for FXIII deficiencies. A low cost minipooled solvent-detergent filtered cryoprecipitate FVIII has been developed that is also used for fibrinogen and FXIII deficiencies in countries with limited resources [19]. However, if there is no cost limitation, the best solution for a specific deficiency MCE is to bring the missing factor, so we will focus primarily on available concentrates. A list of products is regularly updated by the WFH [20]. A common problem for the RBDs is the difficulty to register new products when authorities require inclusion of many patients to show their

efficacy and safety, particularly when paediatric data are also required. Studies can be performed in countries where these disorders are more prevalent (especially in countries where consanguineous marriages are frequent) but often the same countries do not have the appropriate logistics. Because most RBDs are recessive disorders special attention has to be paid to affected women who suffer particularly (menorrhagia, ovarian haemorrhage, failures of pregnancy, post-partum haemorrhage). We will briefly consider all these deficiencies separately because each one has its particular feature and treatment. Fibrinogen disorders include quantitative (afibrinogenemia and hypofibrinogenemia) and qualitative disorders. Several plasma concentrates are now available [21].