LOE switchers had a better clinical response to the second treatment. AE switchers responded equally well to both treatments, with a low risk of discontinuing the second drug as a result of AE. Drug survival of the switchers' second biological therapy was higher than of the first, but lower than that of non-switchers. No difference between various sequences of drugs were found. Danish post-marketing data thus support that RA patients may benefit from switching biological therapy.

stimulation of blood lymphocytes from Mycoplasrna pneurnoniae infected patients with pneumonia and with disorders of the central nervous system. Acta path. microbiol. scand. Sect. C, 88: 61-65, 1980. In 23 patients with Mycoplasma pneurnoniae (MP) infection ( I 3 with pneumonia and 10 with an acute febrile, non-bacterial disorder of the central nervous system (CNS)) and in 26 healthy control persons, thymidine incorporation of blood lymphocytes stimulated in vitro by killed MP was studied. The lymphocyte response to MP was significantly higher in the pneumonia patients than in the controls. In the patients with an acute disorder of the CNS, lymphocyte responses to MP tended to be low or normal in lack of pleocytosis in the spinal fluid, but were predominantly high when either pleocytosis or a pulmonary infiltrate was present. Lymphocyte responses to the mitogens PHA, PWM and Con-A were normal in all groups. The lack of increased responses to MP antigen in some of the neurological patients. despite a current MP infection, may reflect an antigen-specific depression or a lack of specific sensitization of their lymphocytes.

The in vitro transformation of lymphocytes stimulated by a Mycoplasma pneumoniae preparation was measured by the uptake of 14C-thymidine. The lymphocytes from five patients with M.pneumoniae pneumonia showed a high degree of responsiveness when they were compared to the lymphocytes taken from eleven healthy control subjects who lacked M.pneumoniae antibodies. Another four patients with an acute affection of the central nervous system and serological evidence of an actual or recent M.pneumoniae infection had a lymphocyte response within the same range as that of the controls. The transformation of lymphocytes was studied at intervals for seven months after the onset of the illness in one of the patients with pneumonia. These studies showed an increasing response to a small dose of mycoplasma antigen. Lymphocyte transformation induced by other microbial antigens was studied in three pneumonia patients during and after convalescence. The first responses were low and increased more steeply than the response to M.pneumoniae. The later responses to the mycoplasmal and to the other microbial antigens increased in parallel. The usefulness of incorporating other microbial antigens in the evaluation of the patient's immune response to a relevant antigen in this type of experiment is discussed.

Severe autoimmune haemolytic anaemia in a five year old boy was unaffected by treatment with prednisone and splenectomy, but subsided after combined immunosuppressive therapy and three plasma exchanges. Over five months, a total of 93 transfusions of concentrated erythrocytes was given (equal to 18.6 grams of iron or 1.1 g/kg BW). This resulted in severe iron overload with cardiac, hepatic, and pancreatic complications, together with growth-retardation. These complications disappeared after treatment with desferrioxamine and vitamin C, but despite a normal growth hormone response to glucagon the concentration of somatomedin in serum remained low. Treatment by plasma exchanges and immunosuppressive agents may therefore be of value in severe haemolytic anaemia refractory to corticosteroids and splenectomy. Iron chelating therapy should be considered if multiple transfusions result in iron overload.