title: Immunoadsorption in patients with chronic inflammatory demyelinating polyradiculoneuropathy with unsatisfactory response to first-line treatment.
abstract: OBJECTIVE
  First-line treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are corticosteroids, intravenous immunoglobulin, and plasma exchange. In a significant number of patients, first-line therapy fails, and long-term maintenance treatment still remains a therapeutic challenge. Immunoadsorption (IA) may be an alternative to classical plasma exchange in the therapy of immune-mediated neurologic diseases. The aim of this investigation was to evaluate efficacy and safety of IA in patients with CIDP with unsatisfactory response to first-line treatment options.
  
  
  METHODS
  CIDP patients received adjunct IA treatment using tryptophan-immune adsorbers. The inflammatory neuropathy cause and treatment disability (INCAT) score was used to grade disability and monitor treatment effects.
  
  
  RESULTS
  In total, 14 CIDP patients were analyzed. Ten patients were treated in hospital. After one IA treatment series, the INCAT score decreased significantly in all 10 patients. Four of these 14 patients were treated in outpatient clinics using long-term maintenance IA with 1-2 treatments per week. In these 4 patients, effects of long-term maintenance IA resulted in an improvement of overall disability. In all patients, IA was safe, well tolerated, and no severe adverse effects occurred.
  
  
  CONCLUSIONS
  IA could be an effective and safe option for CIDP patients with unsatisfactory response to first-line treatment options and for long-term maintenance treatment.
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany. norbert.galldiks@uk-koeln.de
authors.forename: Norbert
authors.initials: N
authors.lastname: Galldiks
authors.forename: Lothar
authors.initials: L
authors.lastname: Burghaus
authors.forename: Christian
authors.initials: C
authors.lastname: Dohmen
authors.forename: Sven
authors.initials: S
authors.lastname: Teschner
authors.forename: Manfred
authors.initials: M
authors.lastname: Pollok
authors.forename: Josef
authors.initials: J
authors.lastname: Leebmann
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Frischmuth
authors.forename: Peter
authors.initials: P
authors.lastname: Hollinger
authors.forename: Nahed
authors.initials: N
authors.lastname: Nazli
authors.forename: Cordula
authors.initials: C
authors.lastname: Fassbender
authors.forename: Reinhard
authors.initials: R
authors.lastname: Klingel
authors.forename: Thomas
authors.initials: T
authors.lastname: Benzing
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.forename: Walter F
authors.initials: WF
authors.lastname: Haupt
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014364:Tryptophan / Q000378:metabolism*
chemical_list: D014364:Tryptophan