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J Peripher Nerv Syst. 2018 Jun;23(2):78-87. doi: 10.1111/jns.12262. Epub 2018 Apr 19.

Individualized immunoglobulin therapy in chronic immune-mediated peripheral neuropathies.

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Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
Immunology Research and Development, CSL Behring, King of Prussia, PA, USA.
Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain.
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Department of Neurology, King's College Hospital, London, UK.


Despite the well-recognized importance of immunoglobulin therapy individualization during the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP), the pathway to best achieve optimization is unknown. There are many pharmacokinetic and immunobiologic variables that can potentially influence the appropriateness of any individual therapy. Although identification of specific autoantibodies and their targets has only been accomplished in a minority of patients with CIDP, already the diagnostic and treatment implications of specific autoantibody detection are being realized. Individual variability in IgG pharmacokinetic properties including IgG catabolic rates and distribution, as well as the IgG level necessary for disease control also require consideration during the optimization process. For optimization to be successful there must be a measure of treatment response that has a clinically meaningful interpretation. There are currently available well-defined and validated clinical assessment tools and outcome measures that are well suited for this purpose. While there remains much to learn on how best to manipulate immunopathology and immunoglobulin pharmacokinetics in the most favorable way, there currently exists an understanding of these principles to a degree sufficient to begin to develop rational and evidence-based treatment optimization strategies.


autoimmune neuromuscular diseases; chronic inflammatory demyelinating polyneuropathy; immune-mediated neuropathies; intravenous immunoglobulin; pharmacokinetics

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