[CIS-PAGID] Anti-TNF in pt with selective antibody deficiency

[Terri Tarrant]

The CVID patients I have treated with concomitant inflammatory arthritis who
are already on IVIG have not done well with anti-TNF.  Much more frequent
sinusitis and bronchial infections when on those particular biologics.
Along the same venue our functional asplenic sickle cell patients with RA
have done poorly on anti-TNF, one of which was in the MICU for a
considerable amount of time with pneumococcal sepsis.  Consequently, we have
taken the approach of rituximab in these patients who are more susceptible
to encapsulated organisms (RA protocol of 1g IV weeks 0 and 2), and all have
not had increased infections.  In your patient, my bias would be to start
IVIG, but ideally to avoid anti-TNFs if possible.

Terri Tarrant
UNC Rheumatology, Allergy, Immunology

On Fri, May 20, 2011 at 9:11 PM, Church, Joseph <JChurch at chla.usc.edu>wrote:


>  Colleagues:

>

>

>

> I am following a 12yo girl who has rheumatoid arthritis per our

> Rheumatology service.  They are recommending anti-TNF therapy.

>

>

>

> However, she also has IgA deficiency and selective antibody deficiency (+

> response to 2 of 23 pneumococcal serotypes tested after Pneumovax

> immunization.  These were evaluated because of recurrent sinusitis.

>

>

>

> My bias would be to put her on IVIG or SCID while she is receiving

> anti-TNF.  Am I being overly cautious?

>

>

>

> Thank you for your time.

>

>

>

> Joe Church

>

> Children’s Hospital Los Angeles

>

>

>

>

>

>

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