Martin Stangel1, Ralf Gold2, David Pittrow3, Ulrich Baumann4, Michael Borte5, Maria Fasshauer5, Manfred Hensel6, Dörte Huscher7, Marcel Reiser8, Claudia Sommer9. 1. Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hanover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. 2. Department for Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany. 3. Institute for Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany. 4. Paediatric Pulmonology, Allergy and Neonatology, Hanover Medical School, Hanover, Germany. 5. Paediatric Rheumatology, Immunology and Infectiology, Hospital St. Georg, Leipzig, Germany. 6. Mannheimer Onkologie Praxis, Mannheim, Germany. 7. Epidemiology, German Rheumatism Research Centre, Berlin, Germany and; Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany. 8. PIOH - Praxis Internistische Onkologie, Hämatologie, Köln, Germany. 9. Department of Neurology, University Hospital Würzburg, Germany.
Abstract
OBJECTIVES: The management of patients with multifocal motor neuropathy (MMN) under everyday clinical conditions has been insufficiently studied. We therefore collected comprehensive observational data on patients with MMN who received intravenous (IV) or subcutaneous (SC) immunoglobulins (IGs) as maintenance therapy. METHODS: This was a prospective, noninterventional study (registry) in neurological centres (hospitals and offices) throughout Germany. RESULTS: As of 1 December 2015, 80 patients with MMN were included (mean age 55.4 ± 9.8 years, 67% males, mean disease duration 10.7 ± 10.2 years). The affected limb regions were predominantly distal muscle groups of the upper extremities. On the inflammatory neuropathy cause and treatment (INCAT) scale, 94% of the patients had some disability in the arms and 61% in the legs. At inclusion, 98.8% received IVIG and 1.3% SCIG. Substantial variation was observed between IVIG treatment intervals (every 0.7 to 17.3 weeks) and dosage (0.2-2.1 g/kg body weight received during a single administration; mean monthly dosage, 0.9 g/kg body weight). However, the mean monthly dosage was steady over time. At 1-year follow up, improvement was seen in muscle strength, INCAT and quality of life (QoL) scores (SF-36 questionnaire). CONCLUSIONS: The management of patients with MMN in everyday clinical practice demonstrates a wide range of absolute dosages and treatment intervals of IG, supporting the recommended practice of determining treatment dose on an individual patient basis. The improvements in muscle strength and reduction in disability, accompanied by increased QoL, strengthen the case for use of IG as a maintenance treatment for MMN.
OBJECTIVES: The management of patients with multifocal motor neuropathy (MMN) under everyday clinical conditions has been insufficiently studied. We therefore collected comprehensive observational data on patients with MMN who received intravenous (IV) or subcutaneous (SC) immunoglobulins (IGs) as maintenance therapy. METHODS: This was a prospective, noninterventional study (registry) in neurological centres (hospitals and offices) throughout Germany. RESULTS: As of 1 December 2015, 80 patients with MMN were included (mean age 55.4 ± 9.8 years, 67% males, mean disease duration 10.7 ± 10.2 years). The affected limb regions were predominantly distal muscle groups of the upper extremities. On the inflammatory neuropathy cause and treatment (INCAT) scale, 94% of the patients had some disability in the arms and 61% in the legs. At inclusion, 98.8% received IVIG and 1.3% SCIG. Substantial variation was observed between IVIG treatment intervals (every 0.7 to 17.3 weeks) and dosage (0.2-2.1 g/kg body weight received during a single administration; mean monthly dosage, 0.9 g/kg body weight). However, the mean monthly dosage was steady over time. At 1-year follow up, improvement was seen in muscle strength, INCAT and quality of life (QoL) scores (SF-36 questionnaire). CONCLUSIONS: The management of patients with MMN in everyday clinical practice demonstrates a wide range of absolute dosages and treatment intervals of IG, supporting the recommended practice of determining treatment dose on an individual patient basis. The improvements in muscle strength and reduction in disability, accompanied by increased QoL, strengthen the case for use of IG as a maintenance treatment for MMN.
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