Redefining hemophilia management: treatment goals, nonfactor replacement therapies, and the role of fitusiran

Hemophilia is a rare, but debilitating congenital bleeding disorder. Current therapeutic guidelines, last updated in 2020, recommend recombinant clotting factor concentrates as the standard replacement therapy, with emicizumab offered as an alternative nonfactor standard of care. Since the publication of those guidelines, approvals of new gene-based and nonfactor therapies have reshaped the therapeutic landscape. This supplement describes the safety and efficacy of those therapies approved after the 2020 guidelines were published. It also presents managed care considerations describing how opportunities for resource optimization, therapeutic efficiency, and alternative administration approaches may advance progress toward aspirational treatment goals. A main focus is on fitusiran, the most recently approved nonfactor therapy, which introduced a novel mechanism of action and dosing strategy to the hemophilia therapeutic landscape in addition to its broad patient applicability. As this and other therapeutic advancements redefine the standard of care for patients with hemophilia, managed care and policy frameworks must adapt to ensure timely access and affordability. Likewise, updates to clinical guidelines and care pathways are essential to capture the rapidly evolving therapeutic landscape.