Correspondence |


Robert A. Sandhaus, MD, PhD, FCCP; Sarah E. Everett, MEd, JD; Gerard Turino, MD; Bruce C. Trapnell, MD; Edwin K. Silverman, MD, PhD; James K. Stoller, MD, MS, FCCP
Author and Funding Information

Affiliations: Alpha-1 Foundation Miami, FL,  St. Luke's-Roosevelt Hospital New York, NY,  Cincinnati Children's Hospital Medical Center Cincinnati, OH,  Channing Laboratory Boston, MA,  Cleveland Clinic Cleveland, OH

Correspondence to: Robert A. Sandhaus, MD, PhD, FCCP, Alpha-1 Foundation, 2937 SW 27th Ave, Suite 305, Miami, FL 33133; e-mail: rasandhaus@alphaone.org

All authors are or have been members of the Alpha-1 Foundation Medical and Scientific Advisory Committee. Dr. Silverman is also a member of the Alpha-1 Foundation Board of Director. Dr. Sandhaus serves as the clinical director of the Alpha-1 Foundation. Dr. Sandhaus has presented talks relating to α-antitrypsin deficiency (AAT) deficiency at events sponsored by Talecris Biotherapeutics, CSL Behring, Baxter Healthcare, and Dey Pharmaceuticals, and has been a principal investigator for therapeutic clinical trials in AAT deficiency sponsored by Talecris Biotherapeutics, CSL Behring, and Kamada Pharmaceuticals. Ms. Everett has severe AAT deficiency, receives augmentation therapy, and has been a member of the voluntary leadership of the Alpha-1 Foundation for the past 12 years. Dr. Turino has no conflicts of interest to disclose. Dr. Trapnell has no conflicts of interest to disclose. Dr. Silverman received an honorarium for a talk on COPD genetics in 2006, grant support and consulting fees from GlaxoSmithKline for two studies of COPD genetics, an honorarium from Bayer Biologicals for a symposium at the 2005 European Respiratory Society Meeting, an honorarium for a talk at the Lund Symposium in 2007, and consulting fees from AstraZeneca. Dr. Stoller has served as a consultant to Talecris Biotherapeutics; has given lectures that have been supported by Talecris Biotherapeutics, Baxter Healthcare, Grifols, and CSL Behring; and has served as a member of a data monitoring and safety committee for Kamada Pharmaceuticals. In addition to individual disclosures, the authors wish to disclose the following potential conflicts of interest: the Alpha-1 Foundation relies entirely on donations for its operating budget. Included among the major donors to the Alpha-1 Foundation are all the companies that produce the augmentation therapy products mentioned in this commentary.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

Chest. 2009;135(4):1110. doi:10.1378/chest.08-2833
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To the Editor:

We appreciate the opportunity to respond to the comments of Dr. Reddy and Ms. Zaremba criticizing the perception of our “trumping” physician judgment.1 By way of clarity, we wish to emphasize that our intent is in no way to undermine physician judgment (which we believe we are also exercising in drafting this commentary), but to point out that the cornerstone of good judgment, namely evidence, is lacking with regard to the justification of augmentation therapy for individuals with PI*MZ α1-antitrypsin deficiency.

We lack clarity from reading Dr. Reddy's letter as to how our clinical commentary1 undermines patients' access to specialists any more than the current economic adversity may, but appreciate and agree that access to the best medical information and clinicians is essential for the optimal care of individuals with α1-antitrypsin deficiency. We suspect that in our current economic climate, patients' precious dollars should be spent first on a visit to a well-informed physician before prescribing for them a treatment the efficacy of which in the specific setting of PI*MZ α1-antitrypsin deficiency lacks support and could contribute significant expense to the frail health-care system funding in our country. We contend that, in summarizing existing knowledge and its important gaps, our position in the clinical commentary1 facilitates informed judgment, and we applaud the leadership of CHEST for its careful and critical review of the material.

Sandhaus R, Turino G, Stocks J, et al. α1-Antitrypsin augmentation therapy for PI MZ heterozygotes: a cautionary note. Chest. 2008;134:831-834. [PubMed] [CrossRef]




Sandhaus R, Turino G, Stocks J, et al. α1-Antitrypsin augmentation therapy for PI MZ heterozygotes: a cautionary note. Chest. 2008;134:831-834. [PubMed] [CrossRef]
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