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Abstract Details

IVIG Refractory CIDP: Clinical Characteristics, Antibodies, and Response to Alternative Treatment
Neuromuscular and Clinical Neurophysiology (EMG)
S56 - Neuromuscular Therapeutics (4:18 PM-4:30 PM)
005

IVIG is frequently the first line of treatment for CIDP patients. However, some patients do no respond well to IVIG and require alternative therapy. 

To review the subtypes, antibodies, alternative treatment and outcome in patients with IVIG refractory CIDP. 

Retrospective chart review of all CIDP patients seen at OHSU neuromuscular clinic between 2018-2019.

Of the 40 patients studied, 24 (60%) responded to standard IVIG treatment, 15 (38%) did not respond to IVIG treatment, and one lost to follow-up. In the IVIG refractory CIDP group, all but 1 patient did not respond to alternative therapy. Successful alternative therapy was as follow: Steroid (3 IV solumedrol, 1 po prednisone), Plasma exchange (4), IV cyclophosphamide (3), IV Rituximab (3), azathioprine (1), mycophenolate, (1). In IVIG responsive patients 20 had classical CIDP, 2 had distal CIDP (non MAG), and 4 had MADSAM. Whereas in the IVIG refractory group, 8 had classic CIDP, 7 had distal CIDP (non MAG) (p=0.01), 2 had MADSAM. 5 of the IVIG refractory CIDP patients had neurofascin antibodies. After adjusting for age at onset in a logistic regression model, individuals with distal CIDP were 9 times more likely to be refractory to IVIG compared to those without distal CIDP (OR=9.2, 95%CI: 1.5, 56.4, p=0.016). 

Most IVIG refractory CIDP patients respond to alternative therapies (Steroid, PLEX, cyclophosphamide or rituximab). Distal CIDP (non MAG) are more likely not to respond to IVIG but they do respond to alternative therapy. Neurofascin antibodies are found in a minority of IVIG refractory CIDP patients.

Authors/Disclosures
Jamila Godil
PRESENTER
No disclosure on file
Nizar Chahin, MD No disclosure on file
Thomas E. Ragole, MD (University of Colorado Department of Neurology) The institution of Dr. Ragole has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. The institution of Dr. Ragole has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Ragole has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. The institution of Dr. Ragole has received research support from Alexion Pharmaceuticals.
Amy C. Visser, MD No disclosure on file
Matthew J. Barrett, MD (Virginia Commonwealth University) Dr. Barrett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Springer Healthcare LLC. The institution of Dr. Barrett has received research support from Kyowa Kirin. The institution of Dr. Barrett has received research support from NIH.
Orly Moshe-Lilie, MD (Boston VA Healthcare System) No disclosure on file
Chafic Y. Karam, MD (University of Pennsylvania) Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alnylam. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ionis. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Karam has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuroderm.