Taghizade, NigarBabayeva, RoyalaKara, AltanKarakus, Ibrahim SerhatCatak, Mehmet CihangirBulutoglu, AlperHaskologlu, Zehra Sule2024-02-232024-02-2320230091-67491097-6825https://doi.org/10.1016/j.jaci.2023.08.004https://hdl.handle.net/20.500.12452/12087Background: LPS-responsive beige-like anchor (LRBA) deficiency (LRBA-/-) and cytotoxic T-lymphocyte-associated antigen-4 (CTLA4) insufficiency (CTLA41/-) are mechanistically overlapped diseases presenting with recurrent infections and autoimmunity. The effectiveness of different treatment regimens remains unknown. Objective: Our aim was to determine the comparative efficacy and long-term outcome of therapy with immunosuppressants, CTLA4-immunoglobulin (abatacept), and hematopoietic stem cell transplantation (HSCT) in a single-country multicenter cohort of 98 patients with a 5-year median follow-up.Methods: The 98 patients (63 LRBA-/- and 35 CTLA41/-) were followed and evaluated at baseline and every 6 months for clinical manifestations and response to the respective therapies.Results: The LRBA-/- patients exhibited a more severe disease course than did the CTLA41/- patients, requiring more immunosuppressants, abatacept, and HSCT to control their symptoms. Among the 58 patients who received abatacept as either a primary or rescue therapy, sustained complete control was achieved in 46 (79.3%) without severe side effects. In contrast, most patients who received immunosuppressants as primary therapy (n = 61) showed either partial or no disease control (72.1%), necessitating additional immunosuppressants, abatacept, or transplantation. Patients with partial or no response to abatacept (n = 12) had longer disease activity before abatacept therapy, with higher organ involvement and poorer disease outcomes than those with a complete response. HSCT was performed in 14 LRBA-/- patients; 9 patients (64.2%)showed complete remission , 3 (21.3%) continued to receive immunosuppressants after transplantation. HSCT , abatacept therapy gave rise to similar probabilities of survival. Conclusions: Abatacept is superior to immunosuppressants in controlling disease manifestations over the long term, especially when started early, and it may provide a safe and effective therapeutic alternative to transplantation. (J Allergy Clin Immunol 2023;152:1634-45.)eninfo:eu-repo/semantics/closedAccessInborn Errors Of ImmunityLps-Responsive Beige-Like AnchorCytotoxic T-Lymphocyte-Associated Antigen-4Immune Dysre-GulationNatural HistoryAbataceptHematopoietic Stem Cell TransplantationArticle152616341645375957592-s2.0-85172936642Q1WOS:00113367210000110.1016/j.jaci.2023.08.004