Brain, Vol. 119, No. 4, 1067-1077, 1996
© 1996 Guarantors of Brain
research-article |
Intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy
A double-blind, placebo-controlled, cross-over study
1University of Western Ontario London 2University of Calgary Calgary, Canada
Correspondence to:
Correspondence to: Dr A. F. Hahn, Department of Clinical Neurological Sciences, Victoria Hospital, 375 South Street, London, Ontario, Canada N6A 4G5
Thirty patients with definite or probable chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) of chronic progressive (16 patients) or relapsing (14 patients) course were randomly assigned to receive intravenous immuno-globulin (IvIg) 0.4 g per kg body weight or a placebo treatment on 5 consecutive days in a double-blind, cross-over trial. Neurological function was monitored by serial quantitative assessments [neurological disability score (NDS); clinical grade (CG) and grip strength (GS) measurements] and by electrophysiological studies before and after each treatment period. Twenty-five patients completed both treatment periods. A comparison of the observed changes in clinical outcome measures revealed statistically significant differences in favour of IvIg, with (mean±SD) improvements in NDS by 24.4±5.4 points (P < 0.002) in CG by 1±0.3 points (P < 0.001) in GS by + 6.3±1.7 kg (P < 0.005), whereas scores were unchanged or worse with placebo. A secondary two-group analysis of the first trial period included all 30 patients; 16 patients had been randomly assigned to Ivlg and 14 to placebo treatments. Again significant differences in favour of Ivlg were observed in all the clinical end-points: improvement in NDS was 35.6±25 points (P < 0.001), in CG it was 1.3±1.9 points (P < 0.002) and in GS +9.8±7.7 kg (P <0.001), whereas all scores worsened with placebo. Of the 30 patients, 19 (63%) improved with IvIg treatments; nine out of 16 patients (56%) with chronic progressive CIDP, and 10 out of 14 patients (71%) with relapsing CIDP (differences were not statistically significant). A placebo response was seen in five patients. Comparison of paired electrophysiological measurements before and 4 weeks after IvIg treatments revealed statistically significant). A placebo response was seen in five patients. Comparision of paired electrophysiological measurements before and 4 weeks after IvIg treatments revealed statistically significant improvements in the summed motor conduction velocities (
MCV; P<–0.0001) and in the summed compound muscle action potentials (CMAP) evoked with proximal stimulation (proximal CMAP, P<0.03) of median, ulnar, peroneal and tibial nerves. Eight of nine IvIg responders with chronic progressive CIDP improved gradually to normal function with a single 5 day course of IvIg; in five of these, small doses of prednisone were prescribed during follow-up. In 10 IvIg responders with relapsing CIDP, improvement lasted a median 6 weeks (range 3–22 weeks) and was reproducible with open label treatments. All 10 patients have been maintained and stabilized with IvIg pulse therapy of I g per kg body weight or less, given as a single infusion prior to the expected relapse. A beneficial response to IvIg was found to be most likely in patients with acute relapse or with disease of one year or less. Patients with predominantly sensory signs did not improve.
chronic demyelinating polyneuropathy; CIDP; double-blind trial; conduction block; immunoglobulin intravenous
Received November 10, 1995. Revised January 26, 1996. Accepted March 20, 1995.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Iijima, M. Tomita, S. Morozumi, Y. Kawagashira, T. Nakamura, H. Koike, M. Katsuno, N. Hattori, F. Tanaka, M. Yamamoto, et al. Single nucleotide polymorphism of TAG-1 influences IVIg responsiveness of Japanese patients with CIDP Neurology, October 27, 2009; 73(17): 1348 - 1352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I.S.J. Merkies, V. Bril, M. C. Dalakas, C. Deng, P. Donofrio, K. Hanna, H-P Hartung, R. A.C. Hughes, N. Latov, P. A. van Doorn, et al. Health-related quality-of-life improvements in CIDP with immune globulin IV 10%: The ICE Study Neurology, April 14, 2009; 72(15): 1337 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Tackenberg, I. Jelcic, A. Baerenwaldt, W. H. Oertel, N. Sommer, F. Nimmerjahn, and J. D. Lunemann Impaired inhibitory Fc{gamma} receptor IIB expression on B cells in chronic inflammatory demyelinating polyneuropathy PNAS, March 24, 2009; 106(12): 4788 - 4792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Muley, P. Kelkar, and G. J. Parry Treatment of Chronic Inflammatory Demyelinating Polyneuropathy With Pulsed Oral Steroids Arch Neurol, November 1, 2008; 65(11): 1460 - 1464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. H. Van Asseldonk, L. H. Van den Berg, G. H. Wieneke, J. H. J. Wokke, and H. Franssen Criteria for conduction block based on computer simulation studies of nerve conduction with human data obtained in the forearm segment of the median nerve. Brain, September 1, 2006; 129(Pt 9): 2447 - 2460. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Odaka, M Tatsumoto, K Susuki, K Hirata, and N Yuki Intractable chronic inflammatory demyelinating polyneuropathy treated successfully with ciclosporin J. Neurol. Neurosurg. Psychiatry, August 1, 2005; 76(8): 1115 - 1120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Iijima, M. Yamamoto, M. Hirayama, F. Tanaka, M. Katsuno, K. Mori, H. Koike, N. Hattori, K. Arimura, M. Nakagawa, et al. Clinical and electrophysiologic correlates of IVIg responsiveness in CIDP Neurology, April 26, 2005; 64(8): 1471 - 1475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Koller, B. C. Kieseier, S. Jander, and H.-P. Hartung Chronic Inflammatory Demyelinating Polyneuropathy N. Engl. J. Med., March 31, 2005; 352(13): 1343 - 1356. [Full Text] [PDF]
|
|
|
|
|
|
H. G. Roed, A. Langkilde, F. Sellebjerg, M. Lauritzen, P. Bang, A. Morup, and J. L. Frederiksen A double-blind, randomized trial of IV immunoglobulin treatment in acute optic neuritis Neurology, March 8, 2005; 64(5): 804 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Lopate, A. Pestronk, and M. Al-Lozi Treatment of Chronic Inflammatory Demyelinating Polyneuropathy With High-Dose Intermittent Intravenous Methylprednisolone Arch Neurol, February 1, 2005; 62(2): 249 - 254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Dalakas Intravenous Immunoglobulin in Autoimmune Neuromuscular Diseases JAMA, May 19, 2004; 291(19): 2367 - 2375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P V Mohan, W Tarnow-Mordi, B Stenson, P Brocklehurst, K Haque, V Cavendish, and A Cust Can polyclonal intravenous immunoglobulin limit cytokine mediated cerebral damage and chronic lung disease in preterm infants? Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2004; 89(1): F5 - F8. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Ropper Current treatments for CIDP Neurology, April 22, 2003; 60(90083): S16 - 22. [Abstract] [Full Text]
|
|
|
|
|
|
H. W. Sander and E. T. Hedley-Whyte Case 6-2003 - A Nine-Year-Old Girl with Progressive Weakness and Areflexia N. Engl. J. Med., February 20, 2003; 348(8): 735 - 743. [Full Text] [PDF]
|
|
|
|
|
|
D. W. Zochodne, R. Auer, and M. J. Fritzler Longstanding ataxic demyelinating polyneuronopathy with a novel autoantibody Neurology, January 14, 2003; 60(1): 127 - 129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Koski Therapy of CIDP and related immune-mediated neuropathies Neurology, December 24, 2002; 59(90126): S22 - 27. [Abstract] [Full Text]
|
|
|
|
|
|
T. H. Brannagan III Intravenous gammaglobulin (IVIg) for treatment of CIDP and related immune-mediated neuropathies Neurology, December 24, 2002; 59(90126): S33 - 40. [Abstract] [Full Text]
|
|
|
|
|
|
I. S.J. Merkies, P. I.M. Schmitz, F. G.A. van der Meche, J. P.A. Samijn, and P. A. van Doorn Quality of life complements traditional outcome measures in immune-mediated polyneuropathies Neurology, July 9, 2002; 59(1): 84 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Sharma, J. Cross, D. R. Ayyar, A. Martinez-Arizala, and W. G. Bradley Diabetic Demyelinating Polyneuropathy Responsive to Intravenous Immunoglobulin Therapy Arch Neurol, May 1, 2002; 59(5): 751 - 757. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Gorson, A. H. Ropper, D. H. Weinberg, and R. Weinstein Efficacy of Intravenous Immunoglobulin in Patients With IgG Monoclonal Gammopathy and Polyneuropathy Arch Neurol, May 1, 2002; 59(5): 766 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C M Wiles, P Brown, H Chapel, R Guerrini, R A C Hughes, T D Martin, P McCrone, J Newsom-Davis, J Palace, J H Rees, et al. Intravenous immunoglobulin in neurological disease: a specialist review J. Neurol. Neurosurg. Psychiatry, April 1, 2002; 72(4): 440 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Mori, N. Hattori, M. Sugiura, H. Koike, K. Misu, M. Ichimura, M. Hirayama, and G. Sobue Chronic inflammatory demyelinating polyneuropathy presenting with features of GBS Neurology, March 26, 2002; 58(6): 979 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Benatar and J. R. Mendell Randomized controlled trial of IVIg in untreated chronic inflammatory demyelinating polyradiculoneuropathy Neurology, September 11, 2001; 57(5): 938 - 938. [Full Text] [PDF]
|
|
|
|
|
|
M. D. Kazatchkine and S. V. Kaveri Immunomodulation of Autoimmune and Inflammatory Diseases with Intravenous Immune Globulin N. Engl. J. Med., September 6, 2001; 345(10): 747 - 755. [Full Text] [PDF]
|
|
|
|
|
|
J.R. Mendell, R.J. Barohn, M.L. Freimer, J.T. Kissel, W. King, H.N. Nagaraja, R. Rice, W.W. Campbell, P.D. Donofrio, C.E. Jackson, et al. Randomized controlled trial of IVIg in untreated chronic inflammatory demyelinating polyradiculoneuropathy Neurology, February 27, 2001; 56(4): 445 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. S. J. Merkies, P. I. M. Schmitz, F. G. A. van der Meche, and P. A. van Doorn Psychometric evaluation of a new sensory scale in immune-mediated polyneuropathies Neurology, February 22, 2000; 54(4): 943 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Stangel, F. Boegner, C. H Klatt, C. Hofmeister, and S. Seyfert Placebo controlled pilot trial to study the remyelinating potential of intravenous immunoglobulins in multiple sclerosis J. Neurol. Neurosurg. Psychiatry, January 1, 2000; 68(1): 89 - 92. [Abstract] [Full Text]
|
|
|
|
 |
|
 A J Larner and S F Farmer Recent advances: Neurology BMJ, August 7, 1999; 319(7206): 362 - 366. [Full Text]
|
|
|
|
|
|
P. S. Sorensen Intravenous Immunoglobulin Treatment in Neurologic Disorders: Yes Arch Neurol, August 1, 1999; 56(8): 1025 - 1027. [Full Text] [PDF]
|
|
|
|
|
|
D. Leppert, P. Hughes, S. Huber, B. Erne, C. Grygar, G. Said, K. M. Miller, A. J. Steck, A. Probst, and P. Fuhr Matrix metalloproteinase upregulation in chronic inflammatory demyelinating polyneuropathy and nonsystemic vasculitic neuropathy Neurology, July 1, 1999; 53(1): 62 - 62. [Abstract] [Full Text]
|
|
|
|
|
|
M. Stangel, K. V. Toyka, and R. Gold Mechanisms of High-Dose Intravenous Immunoglobulins in Demyelinating Diseases Arch Neurol, June 1, 1999; 56(6): 661 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. North NEW PERSPECTIVES IN PEDIATRIC NEUROMUSCULAR DISORDERS Hotel Intercontinental Sydney, Sydney, Australia, August 28, 1998 J Child Neurol, January 1, 1999; 14(1): 26 - 57. [PDF]
|
|
|
|
|
|
D. S. M. Molenaar, M. Vermeulen, M. de Visser, and R. de Haan Impact of neurologic signs and symptoms on functional status in peripheral neuropathies Neurology, January 1, 1999; 52(1): 151 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. S Francis, M. S Freedman, and J. P Antel Failure of intravenous immunoglobulin to arrest progression of multiple sclerosis: a clinical and MRI based study Multiple Sclerosis, December 1, 1997; 3(6): 370 - 376. [Abstract] [PDF]
|
|
|
|
|
|
R.A.C. Hughes, C.M. Gabriel, N.A. Gregson, and K.J. Smith Treatment of inflammatory neuropathy Multiple Sclerosis, April 1, 1997; 3(2): 88 - 92. [Abstract] [PDF]
|
|