Is there a connection between RTX and lung infections ?

[Geoff]

Great to get feed back from Dr Jayne who wants me straight into Clinic for a check up and CT scan. His response was that i had a persistent chest infection and wouldnt comment within the framework of an email as to any connection with my 2 year RTX IV. I will however take the opportunity at Clinic to discuss, altho Dr J is away on holiday.
For myself, I am sleeping better and feeling as tho i have good energy levels. Still persistent cough and sore chest, still onwards and upwards!

[DEE]

Hope you get all the right answers from your clinic visit. I've just slept for 24hrs straight don't know why but feel better than when I went to sleep x

[MaxD]

Hi Alysia,

Here is the paper describing the results of the RAVE study:

http://www.immunetolerance.org/sites...NEJM_Stone.pdf

It's very clearly written, and the study included most of the preeminent vasculitis centers in the US. By the way, it was on the basis of this study that the FDA approved Rituxan for GPA in 2011. I haven't looked at ongoing studies, but it sure would be nice to see results of longer-term investigations. One problem may be that there are relatively few GPA patients, and while some of our symptoms are common to all of us, many are not, we're spread out age-wise, etc. So by the time our population is carved up according to different criteria, each category has small sample size that it's hard to draw conclusions with high degree of statistical confidence.

WOW, Thank you so much Max for the info and the thinking
can you tell more about the RAVE study ?

[Alysia]

Thanks Max comforting info.
Geoff, I hope you will continue to feel better you are so blessed to have your doc. please let us know what he will say.

[Alysia]

I just saw this one on the vasculitis group:
Late Infections Seen With Rituxan in Vasculitis
2 important points in it:
1. The serious infections were more common among patients with these subnormal IgG levels.
2. None of the patients have died, and there were no opportunistic infections suggesting loss of T-cell function.

[kelly anne]

I thought this was common knowledge and the reason I was prescribed Bactrim for the 6-month life of the rituxan...to avoid lung infection.

[annekat]

A lot of us take Bactrim for that reason, to prevent a certain opportunistic lung infection while on any immunosuppressant. That part is common knowledge. The discussion about lung infections after RTX seems to be a little different.... since I'm not on RTX and never have been, haven't looked into it that deeply, but it seems to be a more unexpected development, different infections, maybe, or coming about for different reasons? This thread has been going for awhile and maybe looking at the beginning of it will shed some light on what is being said other than just what we take Bactrim for. In any case, I feel good taking Bactrim for whatever it might prevent or control.

[me2]

Bactrim was in use for us long before Rituxan was invented. The initial reason was to prevent Staph infection which is unique in its ability to cause WG relapse. The bactrim is prophalactic for Staph infection.
Well, it WAS. I think the reasoning might now be expanded with the use of Rituxan and the risks it poses for infection- although I don't know that.

[annekat]

I have always read on here that Bactrim is prophylactic for pneumocystiis carnii, as described in this article:
Pneumocystis carnii Pneumonia: A Clinical Review - American Family Physician, and that that's why it is primarily used for us. That doesn't mean that it could not also be used as prophylactic for staph or other things. Maybe, as you say, Kirk, it was used for us to prevent staph early on, before the advent of AIDS, when that particular form of pneumonia could have become more recognized as something to use Bactrim as a prophylactic for. Although it would already be known about in relation to immunosuppressed patients, I'd think, before AIDs. I sort of skimmed the article. I'll try looking up Bactrim for staph next. And of course, if it helps with whatever people might get after using RTX, or anything else, great.

[annekat]

The type of pneumonia mentioned above has always been referred to as PCP, and now the more common name for it, and considered more correct, is P. jirovecii pneumonia, but it is still going by the same abbreviation, PCP. I'm sure this is the one most often mentioned on here for why we use Bactrim.

Have found a lot on using Bactrim to treat different forms of staphylococcus aureus, including MRSA, but not so much on prophylactic use for that, although I think there was some.... no more time to investigate this right now.