title: Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP.
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.
authors.affiliation: 2nd Neurology, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Nobile-Orazio
authors.affiliation: Department of Neuroscience, A.O. Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Cocito
authors.affiliation: Department of Neuroscience, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Jann
authors.affiliation: Department of Neuroscience and Imaging, University "G. D'Annunzio", SS Annunziata Hospital, Chieti, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Uncini
authors.affiliation: Laboratory of Neurological Disorders, IRCCS Mario Negri Institute, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Messina
authors.affiliation: Department of Neuroscience, Mental Health and Sensory Organs, Rome University "Sapienza", Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Antonini
authors.affiliation: Department of Neurology, San Raffaele Scientific Institute, INSPE, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Fazio
authors.affiliation: 2nd Neurology, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gallia
authors.affiliation: Department of Neuroscience, Ophthalmology and Genetics, Genoa University, San Martino Hospital, Genoa, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Schenone
authors.affiliation: Department of Neurology and Psychiatry, Umberto I° Policlinico, Rome, Italy.
authors.forename: Ada
authors.initials: A
authors.lastname: Francia
authors.affiliation: Central and Peripheral Degenerative Neuropathy Unit, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pareyson
authors.affiliation: Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II° University, Naples, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Santoro
authors.affiliation: Department of Neurological and Movement Sciences, Verona University, Policlinico G.B. Rossi, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.affiliation: Department of Surgery and Translational Medicine, Milan Bicocca University, San Gerardo Hospital, Monza, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Cavaletti
authors.affiliation: Department of Medical and Surgical Sciences and Neurosciences, Siena University, Policlinico Le Scotte, Siena, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Giannini
authors.affiliation: Department of Neurology, Catholic University, Policlinico Gemelli, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sabatelli
authors.affiliation: Laboratory of Neurological Disorders, IRCCS Mario Negri Institute, Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008775:Methylprednisolone
keywords: NEUROIMMUNOLOGY; NEUROPATHY; STEROIDS