Magalie Rabin1, Gurkam Mutlu2, Tanya Stojkovic3, Thierry Maisonobe4, Timothée Lenglet5, Emmanuel Fournier6, Pierre Bouche1, Jean-Marc Léger7, Karine Viala5. 1. Département de Neurophysiologie Clinique, Groupe Hospitalier Pitié-Salpêtrière Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France. 2. Groupe Hospitalier Pitié-Salpêtrière Paris, Service d'urgence cérébrovasculaire Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France. 3. Département de Neurophysiologie Clinique, Groupe Hospitalier Pitié-Salpêtrière Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France Groupe Hospitalier Pitié-Salpêtrière Paris, Centre de Référence des Pathologies Neuromusculaires Paris Est, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France. 4. Département de Neurophysiologie Clinique, Groupe Hospitalier Pitié-Salpêtrière Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France Centre diagnostique et thérapeutique des neuropathies périphériques, Département de Neurophysiologie et Service de Neurologie 1, Groupe Hospitalier Pitié-Salpêtriére Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France Département de Neuropathologie R Escourolle, Groupe Hospitalier Pitié-Salpêtrière Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France. 5. Département de Neurophysiologie Clinique, Groupe Hospitalier Pitié-Salpêtrière Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France Centre diagnostique et thérapeutique des neuropathies périphériques, Département de Neurophysiologie et Service de Neurologie 1, Groupe Hospitalier Pitié-Salpêtriére Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France. 6. Département de Neurophysiologie Clinique, Groupe Hospitalier Pitié-Salpêtrière Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France Groupe Hospitalier Pitié-Salpêtrière Paris, Centre de Référence des Pathologies Neuromusculaires Paris Est, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France Centre diagnostique et thérapeutique des neuropathies périphériques, Département de Neurophysiologie et Service de Neurologie 1, Groupe Hospitalier Pitié-Salpêtriére Paris, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France. 7. Groupe Hospitalier Pitié-Salpêtrière Paris, Centre de Référence des Pathologies Neuromusculaires Paris Est, Université Pierre et Marie Curie-Paris VI, AP-HP, Paris, France.
Abstract
BACKGROUND: About 40% of responders to treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) remain treatment dependent and have a relapse if treatment is interrupted. OBJECTIVE: To look for factors associated with treatment dependence or successful withdrawal in CIDP patients. METHODS: We retrospectively studied 70 responder CIDP patients comprising 34 patients who remained treatment dependent (treatment-dependent group) and 36 patients whose treatment could be discontinued (treatment withdrawal group). Clinical, biological, electrophysiological and therapeutic features were compared between these groups. RESULTS: A multifocal deficit was more frequent in the treatment-dependent group (35%) than in the treatment withdrawal group (8%) (p<0.01). The most frequent effective treatment was intravenous immunoglobulin (IVIG) for the treatment-dependent group (79%). In this group, more patients were resistant to corticosteroids in first-line therapy (93%) than in the treatment withdrawal group (40%) (p=0.002). The delay to effective treatment was significantly shorter for the treatment withdrawal group than for the treatment-dependent group (mean 11.1 vs 31.2 months; p<0.01). The rate of successful withdrawal was lower with IVIG (29%) than with corticosteroids (83%) (p<0.001). CONCLUSIONS: When compared with the treatment withdrawal group, the treatment-dependent group was more frequently responsive to IVIG, more frequently resistant to corticosteroids in first-line treatment, had a longer delay to effective treatment and was more likely to present a multifocal deficit. The rate of successful withdrawal seems to be higher with corticosteroids, but a prospective study with a long-term follow-up is needed to confirm these features. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: About 40% of responders to treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) remain treatment dependent and have a relapse if treatment is interrupted. OBJECTIVE: To look for factors associated with treatment dependence or successful withdrawal in CIDPpatients. METHODS: We retrospectively studied 70 responder CIDPpatients comprising 34 patients who remained treatment dependent (treatment-dependent group) and 36 patients whose treatment could be discontinued (treatment withdrawal group). Clinical, biological, electrophysiological and therapeutic features were compared between these groups. RESULTS: A multifocal deficit was more frequent in the treatment-dependent group (35%) than in the treatment withdrawal group (8%) (p<0.01). The most frequent effective treatment was intravenous immunoglobulin (IVIG) for the treatment-dependent group (79%). In this group, more patients were resistant to corticosteroids in first-line therapy (93%) than in the treatment withdrawal group (40%) (p=0.002). The delay to effective treatment was significantly shorter for the treatment withdrawal group than for the treatment-dependent group (mean 11.1 vs 31.2 months; p<0.01). The rate of successful withdrawal was lower with IVIG (29%) than with corticosteroids (83%) (p<0.001). CONCLUSIONS: When compared with the treatment withdrawal group, the treatment-dependent group was more frequently responsive to IVIG, more frequently resistant to corticosteroids in first-line treatment, had a longer delay to effective treatment and was more likely to present a multifocal deficit. The rate of successful withdrawal seems to be higher with corticosteroids, but a prospective study with a long-term follow-up is needed to confirm these features. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Anne Louise Oaklander; Michael Pt Lunn; Richard Ac Hughes; Ivo N van Schaik; Chris Frost; Colin H Chalk Journal: Cochrane Database Syst Rev Date: 2017-01-13
Authors: Richard K Burt; Paul Tappenden; Roumen Balabanov; Xiaoqiang Han; Kathleen Quigley; John A Snowden; Basil Sharrack Journal: Front Neurol Date: 2021-03-22 Impact factor: 4.003
Authors: G G A van Lieverloo; S Peric; P E Doneddu; F Gallia; A Nikolic; L Wieske; C Verhamme; I N van Schaik; E Nobile-Orazio; I Basta; F Eftimov Journal: J Neurol Date: 2018-07-02 Impact factor: 4.849