[PAGID] XLA and Spondyoarthritis

[tarra002 at gmail.com]

I am a Rheumatologist and AI boarded also. In my CVI cohort with autoimmunity, we use immunosuppression frequently, but I tend to use anti-TNFs the least since I do see increased infections.  That being said, the best data for efficacy in AS are the anti-TNFs.  I'd start with Humira or Enbrel as a single agent and avoid MTX combination therapy for now due to the rare pulmonary toxicity risks that could confound the clinical picture in an XLA pt with recurrent sinopulmonary infections.  I'd avoid Remicade due to the long half life so that if your pt gets infected you can hold the drug more quickly and effectively.

Teresa Tarrant, MD
UNC Rheumatology and Allergy Immunology
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: Howard Lederman <hlederm1 at jhmi.edu>
Date: Mon, 3 May 2010 16:45:52 
To: pagid at list.clinimmsoc.org<pagid at list.clinimmsoc.org>
Subject: Re: [PAGID] XLA and Spondyoarthritis

I have a number of Ab deficient pts who are on TNF inhibitors, mtx and other  immunosuppressive drugs.  Most are CVID pts with inflammatory bowel disease.

I think that there is a small increased risk for infection with the TNF inhibitors, as several  have had pneumonias while on the TNF inhibitor whereas they did not have pneumonias prior to that tx.  Most have had no problems at all.

Overall, I think that the improvement in auto-immune disease has been well worth the risk.  Pts just need to know about the risks and the need to come in for evaluation of fevers, cough, etc.

Howard M. Lederman, M.D., Ph.D.
Professor of Pediatrics, Medicine and Pathology
Division of Pediatric Allergy and Immunology
Johns Hopkins Hospital - CMSC 1102
600 N. Wolfe Street
Baltimore, MD 21287-3923
Phone: 410-955-5883
Fax: 410-955-0229
Email: Hlederm1 at jhmi.edu<mailto:Hlederm1 at jhem.jhmi.edu>

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From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Monday, May 03, 2010 4:05 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] XLA and Spondyoarthritis

Colleagues:

I have a 10yo with XLA and HLA-B27+ juvenile ankylosing spondylitis.  He is very adherent to his weekly SCIG infusions.

Our Rheumatologists tell me they would start anti-TNF+/- methotrexate if he did not have XLA.

At how much greater risk for infection is he from this suggested treatment versus a patient without a primary immune deficiency?

Thank you for your help.

Joe Church

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