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CIDP prognosis in patients with IVIG treatment-related fluctuations.
Cook, Melissa; Pasnoor, Mamatha; Ajroud-Driss, Senda; Brannagan, Thomas H; Dimachkie, Mazen M; Allen, Jeffrey A.
Afiliación
  • Cook M; Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
  • Pasnoor M; Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA.
  • Ajroud-Driss S; Department of Neurology, Northwestern University, Chicago, Illinois, USA.
  • Brannagan TH; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Dimachkie MM; Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA.
  • Allen JA; Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
Muscle Nerve ; 67(1): 69-73, 2023 01.
Article en En | MEDLINE | ID: mdl-36330716
INTRODUCTION/AIMS: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated peripheral nerve disorder with variable prognosis and long-term dependence on immunotherapy. Frequent assessment of grip strength can be a useful tool to identify intravenous immunoglobulin (IVIG) treatment-related fluctuations (TRFs) and optimize IVIG treatment in real-time, but the long-term implications of TRFs are unknown. We aimed to explore the impact that real-time TRFs had on long-term CIDP prognosis, strength impairment, and disability. METHODS: This retrospective observational cohort study analyzed standard of care clinical and treatment outcomes in patients who participated in a published prospective study of intra-IVIG-cycle grip strength quantification. Patients were analyzed based upon the presence or absence of TRFs, as determined in the initial prospective study. RESULTS: Data were available for 23 CIDP patients with a mean follow-up period of 44.7 mo. There were no differences in baseline or follow-up strength, disability, or IVIG usage in patients with a low number of fluctuations compared to those with a high number of fluctuations. In both groups, drug-free remission was achieved in about one-third of patients. DISCUSSION: TRFs are important to identify in order to optimize treatment in real time, but poorly predict long-term disease activity status. The presence of minor TRFs are unlikely to result in substantial accumulation of disability over time. Periodic IVIG optimization trials using objective outcomes are encouraged in all CIDP patients receiving chronic IVIG treatment as a means to identify the lowest effective IVIG dose and frequency.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inmunoglobulinas Intravenosas / Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Muscle Nerve Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inmunoglobulinas Intravenosas / Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Muscle Nerve Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos