Table 2: Overview of eradication therapy

Treatment options Dosing Side effects Monitoring and prevention of side effects
Corticosteroids 0.5-1 mg prednisolon/kg BW p.o. once daily until clear increase in FVIII:C, thereafter tapering the dose rapidly. Oedemas, hypertension, Cushing symptoms, atrophy of skin and muscles, osteoporosis, electrolytic changes, diabetes mellitus, mental disturbances. Measure blood glucose. Prophylactic treatment with calcium, D-vitamin and proton pump inhibitor is recommended. Sulfamethoxazol-trimethoprim 400/80 mg 1 tbl. daily should be considered during combination therapy and 3 months after.
Cyclophosphamide 1.5-2 mg/kg BW p.o. once daily at maximum 3-4 months, alternatively 10 mg/kg BW i.v. on 2 consecutive days, followed by 1.5-2 mg/kg BW p.o. for 8 days. Leukopenia, thrombocytopenia, anemia, nausea, vomiting, alopecia, exanthema. Cyclophosphamide should not be given to fertile women or young men since it may cause infertility. Blood count is checked 3 times the first week if i.v. doses are given, otherwise once a week the first month, thereafter once a month.
Rituximab Rituximab 375 mg/m2 intravenously one dose.
HIV and hepatitis B virus screening should be performed prior to start.		 Asthenia, pain in bowel, back, chest, muscles or joints, lymphadenopathy, thrombocytopenia, neutropenia, anemia, hypertension, bradycardia, tachycardia, arrhythmia, postural hypotension, neurological symptoms, diarrhea, activation of herpes simplex or herpes zoster, respiratory symptoms, hyperglycemia.

Close surveillance of blood pressure, pulse and vital signs during infusion. Measure blood count, glucose and electrolytes.

Prophylactic treatment with acyclovir is recommended. Sulfamethoxazol- trimethoprim 400/80 mg 1 tbl. daily should be considered.
Azathioprine 2 mg/kg BW once daily for 6 weeks. Thereafter the dose is tapered slowly depending on the antibody titre and the factor level. Leukopenia, thrombocytopenia, less often anemia, nausea, vomiting, alopecia, exanthema, liver dysfunction, susceptibility to infections. Measure blood count and liver enzymes weekly initially, thereafter once a month.
Cyclosporin 5 mg/kg BW a day divided in two doses; if renal insufficiency is present the dose has to be reduced. Renal dysfunction, liver dysfunction, tiredness, headache, abdominal pain, hypertension, nausea, vomiting, hyperlipidemia, electrolyte changes, muscle cramp. Measure creatinine, liver enzymes, electrolytes, blood level of ciclosporin.