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

[Church, Joseph]

Thank you all for your very helpful responses.  Joe Church

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Terri Tarrant
Sent: Thursday, March 08, 2012 3:53 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Patient with Selective Antibody deficiency and autoimmune disorder

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<mailto: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<http://JChurch@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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