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Suggest Treatment For Primary Immune Deficiency
Question: I need to try a new drug therapy - unfortunately I have PSA and other Autoimmune diseases, however this has occurred due to the fact that I have a dysfunctional immune system and I am I have a Primary immune Deficiency.
This means that any of the drugs that would help restrict or reduce my immune system, could actually kill me because my Immunuglogulan is already far too low.
My Doctors are at a loss and were not that willing to try TNF Inhibitors or Biologics for this reason, so is there a list of drugs for PSA as I need to look at each to send my Doctors other options.
I have already tried the below options and they either, did not were not suitable, because of dramatic side effects or lowering my immune system too far
I dont get flairs (its constant) and the Doctors have said my PSA is quite severe indeed
1/ Prednisone - works great but no longer allowed to take more than 5mg a day which is not enough
2/ Methroexate - lowered my immune system too far and did not work anyhow
3/ Planquinal - Had no effect
4/ Arava - Horrible side effects
5/ Sulfasalazine - didnt work
Even if what you on is a TNF or Biologic I would still like to know the options, not all are approved yet for my country but it may give me something that my Doctors can get me a trial of later.
Thanks in advance
This means that any of the drugs that would help restrict or reduce my immune system, could actually kill me because my Immunuglogulan is already far too low.
My Doctors are at a loss and were not that willing to try TNF Inhibitors or Biologics for this reason, so is there a list of drugs for PSA as I need to look at each to send my Doctors other options.
I have already tried the below options and they either, did not were not suitable, because of dramatic side effects or lowering my immune system too far
I dont get flairs (its constant) and the Doctors have said my PSA is quite severe indeed
1/ Prednisone - works great but no longer allowed to take more than 5mg a day which is not enough
2/ Methroexate - lowered my immune system too far and did not work anyhow
3/ Planquinal - Had no effect
4/ Arava - Horrible side effects
5/ Sulfasalazine - didnt work
Even if what you on is a TNF or Biologic I would still like to know the options, not all are approved yet for my country but it may give me something that my Doctors can get me a trial of later.
Thanks in advance
Brief Answer:
psoriatic arthritis
Detailed Answer:
Good evening.
Thank you for writing on health care magic.
I have gone through your history. Your case does look like very complicated. It is a very unusual combination of primary immune deficiency with another disease which needs immunosuppression.
What I do want to know here is:
1. How are the levels of IgA and IgM.
2. How frequency you are taking the infusion of ivig. What about the dosing
3. What are the levels of ivig before the infusion
Among the anti tnf inhibitors Remicade is known to have more side effects with infections than ENBREL. Although it is the first choice of drug, I will still be scared to use it in your case.
Do let me know these answers and I will try to guide u further. We will try to figure out the best option for u
Take care
Regards
Dr naval
psoriatic arthritis
Detailed Answer:
Good evening.
Thank you for writing on health care magic.
I have gone through your history. Your case does look like very complicated. It is a very unusual combination of primary immune deficiency with another disease which needs immunosuppression.
What I do want to know here is:
1. How are the levels of IgA and IgM.
2. How frequency you are taking the infusion of ivig. What about the dosing
3. What are the levels of ivig before the infusion
Among the anti tnf inhibitors Remicade is known to have more side effects with infections than ENBREL. Although it is the first choice of drug, I will still be scared to use it in your case.
Do let me know these answers and I will try to guide u further. We will try to figure out the best option for u
Take care
Regards
Dr naval
Above answer was peer-reviewed by :
Dr. Yogesh D
I am not sure if I ever had IGA or IGM checked, as most of my infections were mucous membraine areas I think they only ever tested IgG - certainly they were the only ones they tested with sub levels ie IgG1 ,2 ,3 and 4 etc
I take a monthly infusion of 30ml IVIG this is now being pushed up to 36ml - Intragram P - I am told this brand is higher in IgG types.
They plan to move me to Subcutaneous infusions soon as I seem to be worst at the end of the month and with Sub Cut I can infuse once a week
I only ever had trough level testing done once - I dont have it on me but from memory IgG1 was low and IgG3 was very very low _ i will try and find this information for you and send it on
I take a monthly infusion of 30ml IVIG this is now being pushed up to 36ml - Intragram P - I am told this brand is higher in IgG types.
They plan to move me to Subcutaneous infusions soon as I seem to be worst at the end of the month and with Sub Cut I can infuse once a week
I only ever had trough level testing done once - I dont have it on me but from memory IgG1 was low and IgG3 was very very low _ i will try and find this information for you and send it on
Brief Answer:
Psoriatic Arthritis
Detailed Answer:
Good evening XXXXXXX
Psoriatic arthritis has a very close relation to Primary Immunodeficiency syndromes especially with CVID. And the balance has to be thre so you dont get recurrent infections.
Considering your immunodeficiency, since you are getting recurrent symptoms at the end month, i would suggest you go for the same dose but at a shorter interval than switching to s.c. weekly( unless you are comfortable with it). You can take the 30 g dose at 3 weekly interval rather than monthly. It will help you out better.
For your arthritis, you need to discuss out the options of Enbrel, but all that can be done once your infection control is good.
Do let me know your further queries. Would be happy to help you out
Take Care
Regards
Dr Naval
Psoriatic Arthritis
Detailed Answer:
Good evening XXXXXXX
Psoriatic arthritis has a very close relation to Primary Immunodeficiency syndromes especially with CVID. And the balance has to be thre so you dont get recurrent infections.
Considering your immunodeficiency, since you are getting recurrent symptoms at the end month, i would suggest you go for the same dose but at a shorter interval than switching to s.c. weekly( unless you are comfortable with it). You can take the 30 g dose at 3 weekly interval rather than monthly. It will help you out better.
For your arthritis, you need to discuss out the options of Enbrel, but all that can be done once your infection control is good.
Do let me know your further queries. Would be happy to help you out
Take Care
Regards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Prasad
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