[CIS-PAGID] Patient with Selective Antibody deficiency and autoimmune disorder

[Terri Tarrant]

Since I am a rheumatologist as well, most of my immunodeficiency cohort has
autoimmunity and has been tried on a potpourri of biologics.  Our best
success stories in CVID with autoimmunity has been using Rituximab, where
appropriate, and we have had no increased infections. I prefer this over
TNFs, but insurance companies typically balk and insist on a TNF failure
first for some diseases like RA. Orencia has been the most difficult for us
since we've seen a terrible Ramsay Hunt in one of our patients with CVID.
For selective antibody deficiency on appropriate IgG replacement, I agree
with the group that anti-TNF would be fine.
Terri Tarrant, MD
Assistant Professor of Medicine
Thurston Arthritis Research Center
Lineberger Cancer Center Member
CB # 7280, 3300 Manning Dr.
Chapel Hill, NC 27599
(919) 843-4727
http://tarc.med.unc.edu/tarrant_welcome.php


On Wed, Mar 7, 2012 at 11:23 PM, Cunningham-Rundles, Charlotte <
charlotte.cunningham-rundles at mssm.edu> wrote:


>  Hi Joe,

>

> I think she is covered. We have used TNF inhibitors for a  very immune

> deficient subjects on good Ig doses and had not had an issue so far.

>

>

>

> On 3/7/12 6:00 PM, "Church, Joseph" <JChurch at chla.usc.edu> wrote:

>

>  Colleagues:

>

> I have followed a 40yo woman with selective antibody deficiency for

> several months.  Despite excellent IgG levels on Hizentra (>2000mg/dL) she

> continues to have recurrent, but non-serious URIs.

>

> Her rheumatologist sees her for an undefined inflammatory process, perhaps

> RA or evolving SLE.  He wishes to treat the patient with a TNF blocker or

> Imuran, but is concerned about the potential for increased risk for serious

> infections because of the patient's antibody deficiency.

>

> My sense is that the patient's antibody deficiency is well covered by the

> Hizentra and that the risk for infection is perhaps marginally increased

> over the usual risks with these agents.

>

> I would very much appreciate your thoughts on this issue.

>

> Joe Church

> Children's Hospital Los Angeles

>

>

>

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