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J Neurol Neurosurg Psychiatry. 2015 Jul;86(7):729-34. doi: 10.1136/jnnp-2013-307515. Epub 2014 Sep 22.

Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP.

Author information

1
2nd Neurology, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Center, Milan, Italy.
2
Department of Neuroscience, A.O. Città della Salute e della Scienza di Torino, Turin, Italy.
3
Department of Neuroscience, Niguarda Ca' Granda Hospital, Milan, Italy.
4
Department of Neuroscience and Imaging, University "G. D'Annunzio", SS Annunziata Hospital, Chieti, Italy.
5
Laboratory of Neurological Disorders, IRCCS Mario Negri Institute, Milan, Italy.
6
Department of Neuroscience, Mental Health and Sensory Organs, Rome University "Sapienza", Sant'Andrea Hospital, Rome, Italy.
7
Department of Neurology, San Raffaele Scientific Institute, INSPE, Milan, Italy.
8
Department of Neuroscience, Ophthalmology and Genetics, Genoa University, San Martino Hospital, Genoa, Italy.
9
Department of Neurology and Psychiatry, Umberto I° Policlinico, Rome, Italy.
10
Central and Peripheral Degenerative Neuropathy Unit, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy.
11
Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II° University, Naples, Italy.
12
Department of Neurological and Movement Sciences, Verona University, Policlinico G.B. Rossi, Verona, Italy.
13
Department of Surgery and Translational Medicine, Milan Bicocca University, San Gerardo Hospital, Monza, Italy.
14
Department of Medical and Surgical Sciences and Neurosciences, Siena University, Policlinico Le Scotte, Siena, Italy.
15
Department of Neurology, Catholic University, Policlinico Gemelli, Rome, Italy.

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.

KEYWORDS:

NEUROIMMUNOLOGY; NEUROPATHY; STEROIDS

PMID:
25246645
DOI:
10.1136/jnnp-2013-307515
[Indexed for MEDLINE]

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