Clinical picture and treatment of 2212 patients with common variable immunodeficiency
Makaleler > Tam Makale · 2014
Yazarlar: Benjamin GATHMANN, Nizar MAHLAOUI, Laurence GERARD, Eric OKSENHENDLER, Klaus WARNATZ, Ilka SCHULZE, Gerhard KINDLE, Taco W. KUIJPERS, Rachel T. VAN BEEM, David Guzman, Sarita Workman, Pere SOLER-PALACIN, Javier DE GRACIA, Torsten WITTE, Reinhold E. SCHMIDT, Jiri LITZMAN, Eva HLAVACKOVA, Vojtech THON, Michael BORTE, Stephan BORTE, Dinakantha Kumararatne, Conleth FEIGHERY, Hilary LONGHURST, Matthew HELBERT, Anna SZAFLARSKA, Anna SEDIVA, Bernd H. BELOHRADSKY, Alison Jones, Ulrich BAUMANN, Isabelle MEYTS, Necil KÜTÜKÇÜLER, Per WAGSTROM, Nermeen Mouftah GALAL, Joachim ROESLER, Evangelia Farmaki, Natalia ZINOVIEVA, Peter CIZNAR, Efimia Papadopoulou-Alataki, Kirsten BIENEMANN, Sirje VELBRI, Zoya PANAHLOO, Bodo GRIMBACHER
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, SCI Expanded İndekslerine Giren Dergi, Uluslararası, 2014, cilt 134, ss 116-
DOI: 10.1016/j.jaci.2013.12.1077
Özet
Background: Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative disorders. Objective: This study analyzes the clinical presentation, association between clinical features, and differences and effects of immunoglobulin treatment in Europe. Methods: Data on 2212 patients with CVID from 28 medical centers contributing to the European Society for Immunodeficiencies Database were analyzed retrospectively. Results: Early disease onset (< 10 years) was very frequent in our cohort (33.7%), especially in male subjects (39.8%). Male subjects with early-onset CVID were more prone to pneumonia and less prone to other complications suggesting a distinct disease entity. The diagnostic delay of CVID ranges between 4 and 5 years in many countries and is particularly high in subjects with early-onset CVID. Enteropathy, autoimmunity, granulomas, and splenomegaly formed a set of interrelated features, whereas bronchiectasis was not associated with any other clinical feature. Patient survival in this cohort was associated with age at onset and age at diagnosis only. There were different treatment strategies in Europe, with considerable differences in immunoglobulin dosing, ranging from 130 up to 750 mg/kg/mo. Patients with very low trough levels of less than 4 g/L had poor clinical outcomes, whereas higher trough levels were associated with a reduced frequency of serious bacterial infections. Conclusion: Patients with CVID are being managed differently throughout Europe, affecting various outcome measures. Clinically, CVID is a truly variable antibody deficiency syndrome.