Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1994 Nov;57(Suppl):38–42. doi: 10.1136/jnnp.57.suppl.38

Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy.

P A van Doorn 1
PMCID: PMC1016723  PMID: 7964851

Abstract

Intravenous immunoglobulin (IVIg) treatment is shown to be effective in a selected group of patients with a chronic inflammatory demyelinating polyneuropathy (CIDP). The proportion of patients that improve after IVIg treatment varies between studies. Because 40% of a group of IVIg treated CIDP patients needed intermittent IVIg infusions to maintain their improved clinical condition, it is expected that IVIg is effective, at least in this subgroup of patients. However, the proportion of patients that improve after IVIg is highly dependent on the selection of patients. Patients with signs and symptoms of an active disease and clear involvement of both arms and legs appear to have the highest chance of improvement after IVIg treatment, but additional or prospective studies are needed to verify these criteria. Results obtained from small numbers of patients treated in open studies suggest that CIDP patients with a monoclonal gammopathy may also improve after IVIg treatment. Further studies are required to evaluate the prognostic factors for improvement after IVIg treatment in CIDP patients and to compare the efficacy and safety of IVIg with other long-term treatment regimes. New studies should also focus on the mechanism of IVIg treatment in patients with CIDP.

Full text

PDF
38

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asbury A. K., Cornblath D. R. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27 (Suppl):S21–S24. doi: 10.1002/ana.410270707. [DOI] [PubMed] [Google Scholar]
  2. Azulay J. P., Pouget J., Pellissier J. F., Blin O., Serratrice G. Polyradiculonévrites chroniques: 25 cas. Rev Neurol (Paris) 1992;148(12):752–761. [PubMed] [Google Scholar]
  3. Bromberg M. B., Feldman E. L., Albers J. W. Chronic inflammatory demyelinating polyradiculoneuropathy: comparison of patients with and without an associated monoclonal gammopathy. Neurology. 1992 Jun;42(6):1157–1163. doi: 10.1212/wnl.42.6.1157. [DOI] [PubMed] [Google Scholar]
  4. Cornblath D. R., Chaudhry V., Griffin J. W. Treatment of chronic inflammatory demyelinating polyneuropathy with intravenous immunoglobulin. Ann Neurol. 1991 Jul;30(1):104–106. doi: 10.1002/ana.410300119. [DOI] [PubMed] [Google Scholar]
  5. Cornblath D. R., Chaudhry V., Griffin J. W. Treatment of chronic inflammatory demyelinating polyneuropathy with intravenous immunoglobulin. Ann Neurol. 1991 Jul;30(1):104–106. doi: 10.1002/ana.410300119. [DOI] [PubMed] [Google Scholar]
  6. Currò Dossi B., Tezzon F. High-dose intravenous gammaglobulin for chronic inflammatory demyelinating polyneuropathy. Ital J Neurol Sci. 1987 Aug;8(4):321–326. doi: 10.1007/BF02335733. [DOI] [PubMed] [Google Scholar]
  7. Dwyer J. M. Manipulating the immune system with immune globulin. N Engl J Med. 1992 Jan 9;326(2):107–116. doi: 10.1056/NEJM199201093260206. [DOI] [PubMed] [Google Scholar]
  8. Dyck P. J., Daube J., O'Brien P., Pineda A., Low P. A., Windebank A. J., Swanson C. Plasma exchange in chronic inflammatory demyelinating polyradiculoneuropathy. N Engl J Med. 1986 Feb 20;314(8):461–465. doi: 10.1056/NEJM198602203140801. [DOI] [PubMed] [Google Scholar]
  9. Dyck P. J. Intravenous immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy and in neuropathy associated with IgM monoclonal gammopathy of unknown significance. Neurology. 1990 Feb;40(2):327–328. doi: 10.1212/wnl.40.2.327. [DOI] [PubMed] [Google Scholar]
  10. Dyck P. J., Lais A. C., Ohta M., Bastron J. A., Okazaki H., Groover R. V. Chronic inflammatory polyradiculoneuropathy. Mayo Clin Proc. 1975 Nov;50(11):621–637. [PubMed] [Google Scholar]
  11. Dyck P. J., O'Brien P. C., Oviatt K. F., Dinapoli R. P., Daube J. R., Bartleson J. D., Mokri B., Swift T., Low P. A., Windebank A. J. Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment. Ann Neurol. 1982 Feb;11(2):136–141. doi: 10.1002/ana.410110205. [DOI] [PubMed] [Google Scholar]
  12. Dyck P. J., O'Brien P. C., Oviatt K. F., Dinapoli R. P., Daube J. R., Bartleson J. D., Mokri B., Swift T., Low P. A., Windebank A. J. Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment. Ann Neurol. 1982 Feb;11(2):136–141. doi: 10.1002/ana.410110205. [DOI] [PubMed] [Google Scholar]
  13. Faed J. M., Day B., Pollock M., Taylor P. K., Nukada H., Hammond-Tooke G. D. High-dose intravenous human immunoglobulin in chronic inflammatory demyelinating polyneuropathy. Neurology. 1989 Mar;39(3):422–425. doi: 10.1212/wnl.39.3.422. [DOI] [PubMed] [Google Scholar]
  14. Hughes R., Sanders E., Hall S., Atkinson P., Colchester A., Payan P. Subacute idiopathic demyelinating polyradiculoneuropathy. Arch Neurol. 1992 Jun;49(6):612–616. doi: 10.1001/archneur.1992.00530300044009. [DOI] [PubMed] [Google Scholar]
  15. Hurez V., Kaveri S. V., Kazatchkine M. D. Normal polyspecific immunoglobulin G (IVIg) in the treatment of autoimmune diseases. J Autoimmun. 1993 Dec;6(6):675–681. doi: 10.1006/jaut.1993.1056. [DOI] [PubMed] [Google Scholar]
  16. Lundkvist I., van Doorn P. A., Vermeulen M., Brand A. Spontaneous recovery from the Guillain-Barré syndrome is associated with anti-idiotypic antibodies recognizing a cross-reactive idiotype on anti-neuroblastoma cell line antibodies. Clin Immunol Immunopathol. 1993 Jun;67(3 Pt 1):192–198. doi: 10.1006/clin.1993.1064. [DOI] [PubMed] [Google Scholar]
  17. Lundkvist I., van Doorn P. A., Vermeulen M., van Lint M., van Rood J. J., Brand A. Regulation of autoantibodies in inflammatory demyelinating polyneuropathy: spontaneous and therapeutic. Immunol Rev. 1989 Aug;110:105–117. doi: 10.1111/j.1600-065x.1989.tb00029.x. [DOI] [PubMed] [Google Scholar]
  18. Newburger J. W., Takahashi M., Beiser A. S., Burns J. C., Bastian J., Chung K. J., Colan S. D., Duffy C. E., Fulton D. R., Glode M. P. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med. 1991 Jun 6;324(23):1633–1639. doi: 10.1056/NEJM199106063242305. [DOI] [PubMed] [Google Scholar]
  19. Reinhart W. H., Berchtold P. E. Effect of high-dose intravenous immunoglobulin therapy on blood rheology. Lancet. 1992 Mar 14;339(8794):662–664. doi: 10.1016/0140-6736(92)90806-e. [DOI] [PubMed] [Google Scholar]
  20. Simmons Z., Albers J. W., Bromberg M. B., Feldman E. L. Presentation and initial clinical course in patients with chronic inflammatory demyelinating polyradiculoneuropathy: comparison of patients without and with monoclonal gammopathy. Neurology. 1993 Nov;43(11):2202–2209. doi: 10.1212/wnl.43.11.2202. [DOI] [PubMed] [Google Scholar]
  21. Suarez G. A., Kelly J. J., Jr Polyneuropathy associated with monoclonal gammopathy of undetermined significance: further evidence that IgM-MGUS neuropathies are different than IgG-MGUS. Neurology. 1993 Jul;43(7):1304–1308. doi: 10.1212/wnl.43.7.1304. [DOI] [PubMed] [Google Scholar]
  22. Thornton C. A., Griggs R. C. Plasma exchange and intravenous immunoglobulin treatment of neuromuscular disease. Ann Neurol. 1994 Mar;35(3):260–268. doi: 10.1002/ana.410350304. [DOI] [PubMed] [Google Scholar]
  23. Vermeulen M., van Doorn P. A., Brand A., Strengers P. F., Jennekens F. G., Busch H. F. Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy: a double blind, placebo controlled study. J Neurol Neurosurg Psychiatry. 1993 Jan;56(1):36–39. doi: 10.1136/jnnp.56.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Vermeulen M., van der Meché F. G., Speelman J. D., Weber A., Busch H. F. Plasma and gamma-globulin infusion in chronic inflammatory polyneuropathy. J Neurol Sci. 1985 Oct;70(3):317–326. doi: 10.1016/0022-510x(85)90173-x. [DOI] [PubMed] [Google Scholar]
  25. Woodruff R. K., Grigg A. P., Firkin F. C., Smith I. L. Fatal thrombotic events during treatment of autoimmune thrombocytopenia with intravenous immunoglobulin in elderly patients. Lancet. 1986 Jul 26;2(8500):217–218. doi: 10.1016/s0140-6736(86)92511-0. [DOI] [PubMed] [Google Scholar]
  26. van Doorn P. A., Brand A., Strengers P. F., Meulstee J., Vermeulen M. High-dose intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy: a double-blind, placebo-controlled, crossover study. Neurology. 1990 Feb;40(2):209–212. doi: 10.1212/wnl.40.2.209. [DOI] [PubMed] [Google Scholar]
  27. van Doorn P. A., Brand A., Vermeulen M. Anti-neuroblastoma cell line antibodies in inflammatory demyelinating polyneuropathy: inhibition in vitro and in vivo by IV immunoglobulin. Neurology. 1988 Oct;38(10):1592–1595. doi: 10.1212/wnl.38.10.1592. [DOI] [PubMed] [Google Scholar]
  28. van Doorn P. A., Rossi F., Brand A., van Lint M., Vermeulen M., Kazatchkine M. D. On the mechanism of high-dose intravenous immunoglobulin treatment of patients with chronic inflammatory demyelinating polyneuropathy. J Neuroimmunol. 1990 Sep-Oct;29(1-3):57–64. doi: 10.1016/0165-5728(90)90147-f. [DOI] [PubMed] [Google Scholar]
  29. van Doorn P. A., Vermeulen M., Brand A., Mulder P. G., Busch H. F. Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy. Clinical and laboratory characteristics associated with improvement. Arch Neurol. 1991 Feb;48(2):217–220. doi: 10.1001/archneur.1991.00530140113024. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES