There will be a great need for well-designed, prospective, multi-centred studies that look closely at outcomes, quality of life and cost. Of course with any new product there

must remain an ongoing scrutiny to look for any potential safety issues with these agents. Long-acting factor concentrates represent a major advance in the management of haemophilia. And yet these molecules are likely to be only stepping stones, given the future potential of manufactured products with even longer half-lives, of these products being partnered with therapies such as tissue factor pathway inhibitors (TFPI), and of subcutaneous or even oral delivery of such products. In addition to this, gene therapy is PARP inhibitor becoming a closer reality. As such, the next 10–20 years are likely to bring a plethora of activity in the area of prophylaxis in haemophilia and hopefully will further improve the lives of people with haemophilia. I am grateful to the following people who reviewed this paper and

provided some helpful feedback: Len Valentino and Bruce Ewenstein (Baxter); Prasad Mathew (Bayer); Glenn Pierce (Biogen); Debbie Bensen-Kennedy and Henry Mead (CSL Behring); and Karin Knobe and Stephanie Seremetis SB525334 solubility dmso (Novo Nordisk). M. Carcao has received honoraria/speaker fees and grant support from Bayer, Baxter, Biogen, CSL Behring, Novo Nordisk, Octapharma and Pfizer. He has also participated in industry sponsored research studies on long acting factor concentrates from Bayer, Biogen and Novo Nordisk. “
“Summary.  Haemostasis management in people with haemophilia can present a range of challenges to physicians. Specific challenges that may be encountered PAK5 relate to regimens for immune tolerance induction, use of central venous access devices, optimizing care of paediatric patients with inhibitors

and improving outcomes in acquired haemophilia. There are also challenges related to performing surgery, and the establishment of specialist centres is valuable with regard to this. These challenges are considered in the light of available data, and with perspectives gained from the experience of experts treating patients around the world. Sharing this knowledge may help to improve patient management. “
“The objective of this study was to teach a small group of Chinese physiatrists and physiotherapists to: (i) become trainers and leaders in haemophilia physiotherapy (PT) care in China and (ii) to acquire rapid proficiency in using the reliable and validated Hemophilia Joint Health Score (HJHS) for evaluating musculoskeletal health in boys with haemophilia. Two experienced Canadian physiotherapists and co-developers of the HJHS moderated a 4-day PT training workshop with six Chinese participants. Emphasis was placed on instruction and practice in administering the HJHS. Practical sessions with haemophilia patients were interchanged with theory (power point presentations) and interactive question and answer periods.