Intravenous immunoglobulin cessation trials in chronic inflammatory demyelinating polyneuropathy

Background

Chronic inflammatory demyelinating neuropathy (CIDP) is the most common autoimmune neuropathy. 70-80% improve with first-line treatment, including IVIg. But 16-55% of patients enter remission over time, no longer requiring maintenance treatment. The only way to determine remission versus well-treated, active disease is to cease treatment and observe for deterioration using MCID change in MRC-SS, I-RODS and grip strength.

Aims

We examined trust compliance with national guidance and the success rate of IVIg cessation trials in patients with stable CIDP.

Results

125 CIDP patients were on maintenance IVIg; 76 on stable treatment regimens and 45 clinically stable over 12 months. 9 patients had undergone recent treatment cessation trials between 2018-2021 demonstrating active disease, were re-established on IVIg and not rechallenged within the study period, leaving 36 eligible patients. 12/36 (33.3%) had a treatment cessation trial performed, with 8/12 (66.7%) remaining stable off treatment for ≥6 months. The median IVIg spend was £107,000 per person/year. Successful cessation in 8 patients equates to cost reduction of £850,000/year going forward. Optimal compliance with national guidance (66.7% stable off treatment in 36 eligible patients) could reduce IVIg spend by £1.7 million/year.