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Research paper
Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP
  1. Eduardo Nobile-Orazio1,
  2. Dario Cocito2,
  3. Stefano Jann3,
  4. Antonino Uncini4,
  5. Paolo Messina5,
  6. Giovanni Antonini6,
  7. Raffaella Fazio7,
  8. Francesca Gallia1,
  9. Angelo Schenone8,
  10. Ada Francia9,
  11. Davide Pareyson10,
  12. Lucio Santoro11,
  13. Stefano Tamburin12,
  14. Guido Cavaletti13,
  15. Fabio Giannini14,
  16. Mario Sabatelli15,
  17. Ettore Beghi5
  18. for the IMC Trial Group
    1. 12nd Neurology, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Center, Milan, Italy
    2. 2Department of Neuroscience, A.O. Città della Salute e della Scienza di Torino, Turin, Italy
    3. 3Department of Neuroscience, Niguarda Ca’ Granda Hospital, Milan, Italy
    4. 4Department of Neuroscience and Imaging, University “G. D'Annunzio”, SS Annunziata Hospital, Chieti, Italy
    5. 5Laboratory of Neurological Disorders, IRCCS Mario Negri Institute, Milan, Italy
    6. 6Department of Neuroscience, Mental Health and Sensory Organs, Rome University “Sapienza”, Sant'Andrea Hospital, Rome, Italy
    7. 7Department of Neurology, San Raffaele Scientific Institute, INSPE, Milan, Italy
    8. 8Department of Neuroscience, Ophthalmology and Genetics, Genoa University, San Martino Hospital, Genoa, Italy
    9. 9Department of Neurology and Psychiatry, Umberto I° Policlinico, Rome, Italy
    10. 10Central and Peripheral Degenerative Neuropathy Unit, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
    11. 11Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II° University, Naples, Italy
    12. 12Department of Neurological and Movement Sciences, Verona University, Policlinico G.B. Rossi, Verona, Italy
    13. 13Department of Surgery and Translational Medicine, Milan Bicocca University, San Gerardo Hospital, Monza, Italy
    14. 14Department of Medical and Surgical Sciences and Neurosciences, Siena University, Policlinico Le Scotte, Siena, Italy
    15. 15Department of Neurology, Catholic University, Policlinico Gemelli, Rome, Italy
    1. Correspondence to Professor E Nobile-Orazio, 2nd Neurology, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan 20089, Italy; eduardo.nobile{at}unimi.it

    Abstract

    Background We reported that 6-month therapy with intravenous immunoglobulin (IVIg) was more frequently effective or tolerated than intravenous methylprednisolone (IVMP) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We now retrospectively compared the proportion of patients who eventually worsened after discontinuing therapy and the median time to clinical worsening.

    Methods By March 2013, data were available from 41 of the 45 patients completing the trial with a median follow-up after therapy discontinuation of 42 months (range 1–60). Three patients withdrew during the original study and one failed to respond to either of the therapies. No patient received a diagnosis alternative to CIDP during the follow-up.

    Results Twenty-eight of the 32 patients treated with IVIg (as primary or secondary therapy after failing to respond to IVMP) improved after therapy (87.5%) as compared with 13 of the 24 patients treated with IVMP as primary or secondary therapy (54.2%). After a median follow-up of 42 months (range 1–57), 24 out of 28 patients responsive to IVIg (85.7%) worsened after therapy discontinuation. The same occurred in 10 out of 13 patients (76.9%) responsive to IVMP (p=0.659) after a median follow-up of 43 months (range 7–60). Worsening occurred 1–24 months (median 4.5) after IVIg discontinuation and 1–31 months (median 14) after IVMP discontinuation (p=0.0126).

    Conclusions A similarly high proportion of patients treated with IVIg or IVMP eventually relapse after therapy discontinuation but the median time to relapse was significantly longer after IVMP than IVIg. This difference may help to balance the more frequent response to IVIg than to IVMP in patients with CIDP.

    • NEUROPATHY
    • NEUROIMMUNOLOGY
    • STEROIDS

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