title: Intravenous immunoglobulin response in treatment-naïve chronic inflammatory demyelinating polyradiculoneuropathy.
abstract: OBJECTIVE
  There is no consensus on which treatment should be used preferentially in individual patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Patients unlikely to respond to intravenous immunoglobulin (IVIg) could be prescribed corticosteroids first to avoid high cost and a delayed treatment response. We investigated which factors determined a response to IVIg.
  
  
  METHODS
  Treatment-naïve patients with CIDP initially treated with at least one full course of IVIg (2 g/kg) at one of two neuromuscular disease centres were included. Patients fulfilled the European Federation of Neurological Societies/Peripheral Nerve Society clinical criteria for CIDP. Significant improvement following IVIg was defined as an improvement (≥ 1 grade) on the modified Rankin scale. Difference in weakness between arms and legs was defined as ≥ 2 grades on the Medical Research Council scale between ankle dorsiflexion and wrist extension. Clinical predictors with a p value <0.15 in univariate analysis were analysed in multivariate logistic regression.
  
  
  RESULTS
  Of a total of 281 patients, 214 patients (76%) improved. In univariate analysis, the presence of pain, other autoimmune disease, difference in weakness between arms and legs, and a myelin-associated glycoprotein negative IgM monoclonal gammopathy of undetermined significance were associated with no response to IVIg. In multivariate analysis no pain (p=0.018) and no difference in weakness between arms and legs (p=0.048) were independently associated with IVIg response. Of IVIg non-responders, 66% improved with plasma exchange and 58% with corticosteroids.
  
  
  CONCLUSIONS
  IVIg is a very effective first-line treatment. Patients with CIDP presenting with pain or a difference in weakness between arms and legs are less likely to respond to IVIg.
authors.affiliation: Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Department of Neurology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.
authors.forename: Krista
authors.initials: K
authors.lastname: Kuitwaard
authors.affiliation: Department of Neurology, London Health Sciences Center, London, Ontario, Canada.
authors.forename: Angelika F
authors.initials: AF
authors.lastname: Hahn
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marinus
authors.initials: M
authors.lastname: Vermeulen
authors.affiliation: Department of Neurology, London Health Sciences Center, London, Ontario, Canada.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Venance
authors.affiliation: Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: van Doorn
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D018908:Muscle Weakness / Q000209:etiology; D010146:Pain / Q000209:etiology; D010951:Plasma Exchange; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous
keywords: CLINICAL NEUROLOGY; GUILLAIN-BARRE SYNDROME; NEUROIMMUNOLOGY; NEUROMUSCULAR; NEUROPATHY