IVIg ‘superior’ to corticosteroids for long-term CIDP treatment
MedWire News: Intravenous immunoglobulin (IVIg) may be better than corticosteroid treatment with methylprednisolone for patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), suggest study findings.
Despite long-term use of IVIg being less frequently discontinued because of inefficacy, adverse events, or intolerance, patients given methylprednisolone experienced longer-term remission than those given IVIg.
Eduardo Nobile-Orazio (University of Milan, Italy) and colleagues compared the efficacy and tolerability of IVIg (0.5 g/kg per day for 4 days) versus intravenous methylprednisolone (0.5 g per day for 4 days) given every month for 6 months to 45 patients with active or stationary CIDP.
Following discontinuation of treatment, patients were followed up for 6 months to assess for relapse. Treatment discontinuation owing to inefficacy or intolerance was the primary outcome of the study.
A significantly greater proportion of patients treated with IVIg completed the 6-month study period compared those treated with methylprednisolone, at 88% versus 48%. This finding remained significant after adjusting for age, gender, disease duration, comorbidity, modified Ranking scale, overall neuropathy limitations scale (ONLS) scores at enrollment, and previous treatment with IVIg and corticosteroids (odds ratio [OR]=7.7).
Of the 11 patients who discontinued methylprednisolone, five did so because of progressive worsening after treatment, three because of failure to improve after therapy, one because of gastritis development, and two without giving any reason. Conversely, two patients discontinued IVIg because of progressive worsening after therapy, and one because of absence of improvement.
During the 6 months after therapy discontinuation, none of the 10 patients who had improved with methylprednisolone worsened and required further therapy compared with eight of the 21 patients who responded to IVIg. At 12 months, 48% and 54% of patients treated with methylprednisolone and IVIg showed improvement and remained stable without therapy.
Significant improvements were seen at 6 months for both groups in the modified Rankin scale, Rotterdam nine-task handicap scale, and Short-Form 36 scores. Indeed, the proportion of patients without limitation in the ONLS and modified Ranking scale scores at the end of 6 months was similar in the IVIg and methylprednisolone group (29 vs 24%).
The proportion of patients with adverse events was not significantly different between patients who received methylprednisolone compared with IVIg (67 vs 46%).
"Future studies should assess whether the longer-term efficacy of intravenous methylprednisolone compared with IVIg has an effect on the chronic course of CIDP," conclude the researchers in The Lancet.
By Ingrid Grasmo