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Research paper
Intravenous immunoglobulin response in treatment-naïve chronic inflammatory demyelinating polyradiculoneuropathy
  1. Krista Kuitwaard1,2,
  2. Angelika F Hahn3,
  3. Marinus Vermeulen4,
  4. Shannon L Venance3,
  5. Pieter A van Doorn1
  1. 1Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  2. 2Department of Neurology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
  3. 3Department of Neurology, London Health Sciences Center, London, Ontario, Canada
  4. 4Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Pieter A van Doorn, Erasmus MC, University Medical Center Rotterdam, Department of Neurology, Room Ba-450, ‘s Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; p.a.vandoorn{at}erasmusmc.nl

Abstract

Objective There is no consensus on which treatment should be used preferentially in individual patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Patients unlikely to respond to intravenous immunoglobulin (IVIg) could be prescribed corticosteroids first to avoid high cost and a delayed treatment response. We investigated which factors determined a response to IVIg.

Methods Treatment-naïve patients with CIDP initially treated with at least one full course of IVIg (2 g/kg) at one of two neuromuscular disease centres were included. Patients fulfilled the European Federation of Neurological Societies/Peripheral Nerve Society clinical criteria for CIDP. Significant improvement following IVIg was defined as an improvement (≥1 grade) on the modified Rankin scale. Difference in weakness between arms and legs was defined as ≥2 grades on the Medical Research Council scale between ankle dorsiflexion and wrist extension. Clinical predictors with a p value <0.15 in univariate analysis were analysed in multivariate logistic regression.

Results Of a total of 281 patients, 214 patients (76%) improved. In univariate analysis, the presence of pain, other autoimmune disease, difference in weakness between arms and legs, and a myelin-associated glycoprotein negative IgM monoclonal gammopathy of undetermined significance were associated with no response to IVIg. In multivariate analysis no pain (p=0.018) and no difference in weakness between arms and legs (p=0.048) were independently associated with IVIg response. Of IVIg non-responders, 66% improved with plasma exchange and 58% with corticosteroids.

Conclusions IVIg is a very effective first-line treatment. Patients with CIDP presenting with pain or a difference in weakness between arms and legs are less likely to respond to IVIg.

  • CLINICAL NEUROLOGY
  • NEUROIMMUNOLOGY
  • NEUROMUSCULAR
  • NEUROPATHY
  • GUILLAIN-BARRE SYNDROME

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