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Specialists Treat Primary Immunodeficiency Diseases More Aggressively Than Other Clinicians: Presented at AAAAI

By Bryan DeBusk

SAN DIEGO, CA -- February 26, 2007 -- A survey of academy members suggests that specialists in primary immunodeficiency diseases (PID) prescribe more aggressive therapies than their nonexpert colleagues, according to findings presented here at the 2007 American Academy of Asthma, Allergy, and Immunology (AAAAI) annual meeting.

"The objectives of this survey were to identify clinical practice as applied to primary immunodeficiency disease patients, especially where there is little existing clinical evidence, to identify expert practices, and identify questions to fuel future clinical research in PID," said Jordan Orange, MD, PhD, assistant professor of paediatrics, division of allergy and immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.

In a presentation on February 24^th, Dr. Orange related the results of a web-based survey of AAAAI members on behalf of the AAAAI-PID committee and the Immune Deficiency Foundation. Of 3,000 members invited to participate in the survey, 408 responded.

While 80% of respondents reported treating patients with PID, the majority reported that PID patients comprised less than 10% of their practices. The committee labelled physicians as PID experts if more than 10% of their patients had a PID. Both nonexperts and experts reported seeing about 100 patients per week, and nonexperts tended to see patients in solo practice while experts tended to operate in a hospital outpatient setting.

The survey responses indicated a number of differences in the way experts and nonexperts treat patients with PID. Dr. Orange noted that while 87% of physicians with PID patients prescribe intravenous (IV) immunoglobulin (IG) therapy to prevent infection, experts are 6 times more likely to prescribe this therapy for their PID patients than nonexperts.

Both experts and nonexperts prescribed IVIG for all patients with X-linked agammaglobulinemia (XLA), but prescription patterns for other diseases were less consistent. Experts were more likely to prescribe IVIG for patients with ataxia telangiectasia, hyper-IgM syndrome, severe combined immunodeficiency, Wiskott-Aldrich syndrome, and X-linked lymphoproliferation.

Additionally, 63% of experts said they aim for trough IgG levels > 600mg/dL while nonexperts were more likely to aim for lower levels. No difference in the therapy schedule was reported between experts and nonexperts, and 87.1% of respondents said they prescribe IVIG every 4 weeks while 10.6% prescribe every 3 weeks.

Prophylactic antibiotics are prescribed by 55% of respondents for at least some patients, and there was a trend toward experts using them more frequently, while some respondents prescribe them in addition to IVIG.

Reflecting on the importance of the survey results, Dr. Orange said, "I think it is important to have rigorous standards upon which the use of IVIG is based for PID -- Hopefully these data can be used to fuel pertinent questions."


[Presentation title: Specialist Physician Perspectives on Primary Immunodeficiency Diseases: A 2006 Survey of the AAAAI Membership. Abstract 279]

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