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

[John Ziegler]

One would expect impaired Pneumovax responses in patients on MTX and etanercept (eg http://www.ncbi.nlm.nih.gov/pubmed/18502006) is a result of the therapy - it would be interesting to know the response to 10- or 13-valent Pc conjugate vaccines and perhaps such patients should receive cotrimoxazole prophylaxis. I suppose IgAD in case 2 is more significant as a predisposing factor for the RA than a consequence of anything.


From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Hare, Nathaniel D
Sent: Monday, 23 May 2011 11:00 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Anti-TNF in pt with selective antibody deficiency

Colleagues,

To follow up on Joe Church's question, I basically have the same question about using IVIG in patients either on a TNF-inhibitor or in whom one will possibly be started.  In both patients, I am wondering if I need to add IVIG.  Like Joe, I am wondering if I am being too cautious.

Patient 1
30 yo male with psoriatic arthritis
Treated with methotrexate
Rheumatology wants to add etanercept
Specific Antibody Deficiency (response to 5/23 pneumococcal serotypes after Pneumovax vaccination, tested while on methotrexate)
Tested b/c of history of recurrent pneumonia that predated the methotrexate therapy


Patient 2
47 yo female with symmetric polyarticular inflammation B27 positive CCP positive, treated with methotrexate and etanercept
Selective IgA deficiency, IgG4 subclass deficiency (for what it's worth) and specific antibody deficiency (response to 2/23 pneumococcal serotypes after Pneumovax vaccination, tested while on methotrexate and etanercept)
Tested b/c history of chronic sinusitis, CT documented.


Thanks,

Nathan Hare


Nathaniel D. Hare MD
Allergy & Immunology
CMC - Dartmouth Hitchcock Keene
Keene, NH  03431

ph  (603) 354-5496
fax (603) 354-5498
________________________________
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Friday, May 20, 2011 9:11 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Anti-TNF in pt with selective antibody deficiency

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



---------------------------------------------------------------------
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,
is for the sole use of the intended recipient(s) and may contain confidential
or legally privileged information. Any unauthorized review, use, disclosure
or distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of this original message.
---------------------------------------------------------------------
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20110529/6cdecd75/attachment.html>