[CIS PIDD] [cis-pidd] CVID + "Lupus"

[Church, Joseph]

Thank you all for the very timely responses.  They are much appreciated.

Joe Church

-----Original Message-----
From: Riedl, Marc [mailto:MRiedl at mednet.ucla.edu] 
Sent: Friday, December 07, 2012 6:02 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] CVID + "Lupus"

Joe -

Agree with others that our rheumatologists have generally tried plaquenil or methotrexate first in our CVID population.   We've not had much experience with Cellcept in these patients.

I've no experience with Benlysta though it's an interesting idea - as a BLyS inhibitor is more targeted and data suggests less B-cell depletion than rituximab (which we've generally had few reservations about using in CVI patients on IVIG if indicated).

Marc Riedl, M.D., M.S.
Associate Professor of Medicine
Section Head, Clinical Immunology and Allergy UCLA - David Geffen School of Medicine
10833 Le Conte Ave, 37-131 CHS
Los Angeles, CA  90095-1680
Tel 310.206.4345  Fax 310.267.0090




From: <Church>, Joseph <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>>
Reply-To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Date: Thursday, December 6, 2012 6:47 PM
To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Subject: [cis-pidd] CVID + "Lupus"

Colleagues:

I follow a 40yo woman with fairly typical CVID.  Her rheumatologist diagnosed 'lupus' or 'non-specific connective tissue disease.'

Her chronic joint symptoms, primarily arthralgias, responded dramatically to 30 mg of prednisone per day.  As she tapered the steroid all symptoms returned.

Her rheumatologist indicated he is considering starting her on Benlysta, methotrexate or Cellcept.

Is there a "lesser evil" among these drugs for a patient with CVID?

JC

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