Clinical and economic comparison of an individualised immunoglobulin protocol vs. standard dosing for chronic inflammatory demyelinating polyneuropathy

AbstractBackgroundThe clinical and economic implications of an individualised intravenous immunoglobulin (IVIg) protocol for chronic inflammatory demyelinating polyneuropathy (CIDP) are unknown. Comparison with standard dosing regimens has not been performed.MethodsWe retrospectively studied 47 IVIg-treated subjects with CIDP over 4  years with an individualised, outcome-measured, dose-modifying protocol. We evaluated responder and remission rates, clinical improvement levels and dose requirements. We compared clinical benefits and costs with those reported with standard dosing at 1 g/kg every 3 weeks.ResultsThe IVIg-responder rate was 83% and the 4-year remission rate was 25.6%. Mean IVIg dose requirements were 22.06  g/week (SD:15.29) in patients on ongoing therapy. Dose range was wide (5.83–80 g/week). Mean infusion frequency was every 4.34 weeks (SD:1.70) and infusion duration of 2.79 days (SD:1.15). Mean Overall Neuropathy Limitation Scale improvement was 2.54 (SD:1.89) and mean MRC sum score improveme nt of 12.23 (SD:7.17) in IVIg-responders. Mean modified-INCAT (Inflammatory Neuropathy Cause and Treatment) score improvement was similar (p = 0.47) and mean MRC sum score improvement greater (p 
Source: Journal of Neurology - Category: Neurology Source Type: research

Related Links:

Patients with nodal/paranodal antibodies represent a specific subgroup of inflammatory peripheral neuropathies, whose clinical presentation with a prolonged subacute phase, additional symptoms such as ataxia and tremor, and poor treatment response to IV immunoglobulin (IVIG) often differs from classic Guillain-Barré syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP).1
Source: Neurology Neuroimmunology and Neuroinflammation - Category: Neurology Authors: Tags: Guillain-Barre syndrome, Chronic inflammatory demyelinating polyneuropathy Clinical/Scientific Notes Source Type: research
AbstractImmune-mediated neuropathies include some specific types such as acute and chronic inflammatory demyelinating polyneuropathy (AIDP and CIDP). Previous studies have demonstrated abnormal cellular or humoral immune responses in these conditions. Although aberrant regulation of several cytokines have been reported in AIDP and CIDP, the significance of interleukin 19 (IL-19) in these conditions have not been elucidated yet. In the current study, we assessed serum levels of IL-19 in 12 CIDP patients (female/male ratio, 4/8), 9 AIDP patients (female/male ratio, 3/6), and 27 normal subjects (female/male ratio. 8/19) using...
Source: Journal of Molecular Neuroscience - Category: Neuroscience Source Type: research
Myasthenia gravis (MG) is a prototypical autoantibody mediated disease. The autoantibodies in MG target structures within the neuromuscular junction (NMJ), thus affecting neuromuscular transmission. The major disease subtypes of autoimmune MG are defined by their antigenic target. The most common target of pathogenic autoantibodies in MG is the nicotinic acetylcholine receptor (AChR), followed by muscle-specific kinase (MuSK) and lipoprotein receptor-related protein 4 (LRP4). MG patients present with similar symptoms independent of the underlying subtype of disease, while the immunopathology is remarkably distinct. Here we...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion Contactin-1 IgG has a distinct sensory predominant presentation commonly associated with neuropathic pain, with demyelinating changes on electrophysiologic studies. A paraneoplastic cause should be considered. Testing of contactin-1 IgG among cases with similar presentations may guide immunotherapy selection, especially second-line immunotherapy consideration.
Source: Neurology Neuroimmunology and Neuroinflammation - Category: Neurology Authors: Tags: Autoimmune diseases, Peripheral neuropathy, Chronic inflammatory demyelinating polyneuropathy, Neuropathic pain Article Source Type: research
Diabetic neuropathy has a major impact on morbidity and mortality. However, the diagnosis and management of diabetic neuropathy is South ‐East Asia is limited. Clear guidance is required to diagnose and manage patients with diabetic and other neuropathies. AbstractBurning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10...
Source: Journal of Diabetes Investigation - Category: Endocrinology Authors: Tags: Review Article Source Type: research
This study adds evidence to the possible role of physical activity in improving symptom severity, disability and QoL in patients with CIDP. None of the other environmental factors investigated appeared to have an impact on the severity and health perception of CIDP.
Source: Journal of Neurology - Category: Neurology Source Type: research
AbstractChronic inflammatory demyelinating polyneuropathy (CIDP) is classically defined as polyneuropathy with symmetric involvement of the proximal and distal portions of the limbs. In addition to this “typical CIDP”, the currently prevailing diagnostic criteria proposed by the European Federation of Neurological Societies and Peripheral Nerve Society (EFNS/PNS) define “atypical CIDP” as encompassing the multifocal acquired demyelinating sensory and motor (MADSAM), distal acquired demyelin ating symmetric (DADS), pure sensory, pure motor, and focal subtypes. Although macrophage-induced demyelinatio...
Source: Neurology and Therapy - Category: Neurology Source Type: research
AbstractChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune ‐mediated polyneuropathy characterized by relapsing or steadily progressive clinical course. A major feature of the syndrome is that it encompasses several pathogeneses, and it is actually assumed that both cellular and humoral immunity can be involved with superiority depending on the particular subtype. Although cellular immunity typified by macrophage‐derived demyelination can play an essential role in classical CIDP, other pathogeneses that involve humoral immunity, such as autoantibodies targeting node of Ranvier protein...
Source: Clinical and Experimental Neuroimmunology - Category: Neurology Authors: Tags: REVIEW ARTICLE Source Type: research
AbstractAcute and chronic inflammatory demyelinating polyneuropathy (AIDP and CIDP) are two types of immune-mediated neuropathies in which abnormal cellular or humoral immune responses have been observed. Although dysregulation of several cytokines has been detected in these disorders, expression of interleukin 38 (IL-38) has not yet been assessed in AIDP and CIDP. In the current study, we evaluated serum concentrations of this member of the IL-1 family of cytokines in 24 patients with CIDP, 13 patients with AIDP and 27 healthy subjects. We detected higher levels of IL-38 in CIDP patients compared with controls. When asses...
Source: Journal of Molecular Neuroscience - Category: Neuroscience Source Type: research
Patients with CIDP have impairments, including muscle weakness, that could be consequences of demyelination, conduction block, and eventually axonal loss and denervation, leading to muscle atrophy. Consequently, motor unit (MU) activation of the muscle may be impaired contributing to weakness; but this has not been explored in CIDP.
Source: Journal of the Neurological Sciences - Category: Neurology Authors: Source Type: research
More News: Brain | CIDP | Neurology | Study