Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP

Eduardo Nobile-Orazio, Dario Cocito, Stefano Jann, Antonino Uncini, Paolo Messina, Giovanni Antonini, Raffaella Fazio, Francesca Gallia, Angelo Schenone, Ada Francia, Davide Pareyson, Lucio Santoro, Stefano Tamburin, Guido Cavaletti, Fabio Giannini, Mario Sabatelli, Ettore Beghi, Ilaria Paolasso, Luisa De Toni Franceschini, Francesca NotturnoAlessandro Clemenzi, Francesca Bianchi, Elisabetta Fiorina, Simona Pontecorvo, Giuseppe Piscosquito, Fiore Manganelli, Maria Luigia Praitano, Marialuisa Piatti, Antonio Torzini, Marco Luigetti, Roberta Macchia

Research output: Contribution to journalArticle

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Abstract

Background: We reported that 6-month therapy with intravenous immunoglobulin (IVIg) was more frequently effective or tolerated than intravenous methylprednisolone (IVMP) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We now retrospectively compared the proportion of patients who eventually worsened after discontinuing therapy and the median time to clinical worsening. Methods: By March 2013, data were available from 41 of the 45 patients completing the trial with a median follow-up after therapy discontinuation of 42 months (range 1-60). Three patients withdrew during the original study and one failed to respond to either of the therapies. No patient received a diagnosis alternative to CIDP during the follow-up. Results: Twenty-eight of the 32 patients treated with IVIg (as primary or secondary therapy after failing to respond to IVMP) improved after therapy (87.5%) as compared with 13 of the 24 patients treated with IVMP as primary or secondary therapy (54.2%). After a median follow-up of 42 months (range 1-57), 24 out of 28 patients responsive to IVIg (85.7%) worsened after therapy discontinuation. The same occurred in 10 out of 13 patients (76.9%) responsive to IVMP (p=0.659) after a median follow-up of 43 months (range 7-60). Worsening occurred 1-24 months (median 4.5) after IVIg discontinuation and 1-31 months (median 14) after IVMP discontinuation (p=0.0126). Conclusions: A similarly high proportion of patients treated with IVIg or IVMP eventually relapse after therapy discontinuation but the median time to relapse was significantly longer after IVMP than IVIg. This difference may help to balance the more frequent response to IVIg than to IVMP in patients with CIDP.

Original languageEnglish
Pages (from-to)729-734
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume86
Issue number7
DOIs
Publication statusPublished - Jul 1 2015

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Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Intravenous Immunoglobulins
Methylprednisolone
Recurrence
Therapeutics
Relapse
Therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery
  • Arts and Humanities (miscellaneous)
  • Medicine(all)

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Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP. / Nobile-Orazio, Eduardo; Cocito, Dario; Jann, Stefano; Uncini, Antonino; Messina, Paolo; Antonini, Giovanni; Fazio, Raffaella; Gallia, Francesca; Schenone, Angelo; Francia, Ada; Pareyson, Davide; Santoro, Lucio; Tamburin, Stefano; Cavaletti, Guido; Giannini, Fabio; Sabatelli, Mario; Beghi, Ettore; Paolasso, Ilaria; De Toni Franceschini, Luisa; Notturno, Francesca; Clemenzi, Alessandro; Bianchi, Francesca; Fiorina, Elisabetta; Pontecorvo, Simona; Piscosquito, Giuseppe; Manganelli, Fiore; Praitano, Maria Luigia; Piatti, Marialuisa; Torzini, Antonio; Luigetti, Marco; Macchia, Roberta.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 86, No. 7, 01.07.2015, p. 729-734.

Research output: Contribution to journalArticle

Nobile-Orazio, E, Cocito, D, Jann, S, Uncini, A, Messina, P, Antonini, G, Fazio, R, Gallia, F, Schenone, A, Francia, A, Pareyson, D, Santoro, L, Tamburin, S, Cavaletti, G, Giannini, F, Sabatelli, M, Beghi, E, Paolasso, I, De Toni Franceschini, L, Notturno, F, Clemenzi, A, Bianchi, F, Fiorina, E, Pontecorvo, S, Piscosquito, G, Manganelli, F, Praitano, ML, Piatti, M, Torzini, A, Luigetti, M & Macchia, R 2015, 'Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP', Journal of Neurology, Neurosurgery and Psychiatry, vol. 86, no. 7, pp. 729-734. https://doi.org/10.1136/jnnp-2013-307515
Nobile-Orazio, Eduardo ; Cocito, Dario ; Jann, Stefano ; Uncini, Antonino ; Messina, Paolo ; Antonini, Giovanni ; Fazio, Raffaella ; Gallia, Francesca ; Schenone, Angelo ; Francia, Ada ; Pareyson, Davide ; Santoro, Lucio ; Tamburin, Stefano ; Cavaletti, Guido ; Giannini, Fabio ; Sabatelli, Mario ; Beghi, Ettore ; Paolasso, Ilaria ; De Toni Franceschini, Luisa ; Notturno, Francesca ; Clemenzi, Alessandro ; Bianchi, Francesca ; Fiorina, Elisabetta ; Pontecorvo, Simona ; Piscosquito, Giuseppe ; Manganelli, Fiore ; Praitano, Maria Luigia ; Piatti, Marialuisa ; Torzini, Antonio ; Luigetti, Marco ; Macchia, Roberta. / Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP. In: Journal of Neurology, Neurosurgery and Psychiatry. 2015 ; Vol. 86, No. 7. pp. 729-734.
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abstract = "Background: We reported that 6-month therapy with intravenous immunoglobulin (IVIg) was more frequently effective or tolerated than intravenous methylprednisolone (IVMP) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We now retrospectively compared the proportion of patients who eventually worsened after discontinuing therapy and the median time to clinical worsening. Methods: By March 2013, data were available from 41 of the 45 patients completing the trial with a median follow-up after therapy discontinuation of 42 months (range 1-60). Three patients withdrew during the original study and one failed to respond to either of the therapies. No patient received a diagnosis alternative to CIDP during the follow-up. Results: Twenty-eight of the 32 patients treated with IVIg (as primary or secondary therapy after failing to respond to IVMP) improved after therapy (87.5{\%}) as compared with 13 of the 24 patients treated with IVMP as primary or secondary therapy (54.2{\%}). After a median follow-up of 42 months (range 1-57), 24 out of 28 patients responsive to IVIg (85.7{\%}) worsened after therapy discontinuation. The same occurred in 10 out of 13 patients (76.9{\%}) responsive to IVMP (p=0.659) after a median follow-up of 43 months (range 7-60). Worsening occurred 1-24 months (median 4.5) after IVIg discontinuation and 1-31 months (median 14) after IVMP discontinuation (p=0.0126). Conclusions: A similarly high proportion of patients treated with IVIg or IVMP eventually relapse after therapy discontinuation but the median time to relapse was significantly longer after IVMP than IVIg. This difference may help to balance the more frequent response to IVIg than to IVMP in patients with CIDP.",
author = "Eduardo Nobile-Orazio and Dario Cocito and Stefano Jann and Antonino Uncini and Paolo Messina and Giovanni Antonini and Raffaella Fazio and Francesca Gallia and Angelo Schenone and Ada Francia and Davide Pareyson and Lucio Santoro and Stefano Tamburin and Guido Cavaletti and Fabio Giannini and Mario Sabatelli and Ettore Beghi and Ilaria Paolasso and {De Toni Franceschini}, Luisa and Francesca Notturno and Alessandro Clemenzi and Francesca Bianchi and Elisabetta Fiorina and Simona Pontecorvo and Giuseppe Piscosquito and Fiore Manganelli and Praitano, {Maria Luigia} and Marialuisa Piatti and Antonio Torzini and Marco Luigetti and Roberta Macchia",
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T1 - Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP

AU - Nobile-Orazio, Eduardo

AU - Cocito, Dario

AU - Jann, Stefano

AU - Uncini, Antonino

AU - Messina, Paolo

AU - Antonini, Giovanni

AU - Fazio, Raffaella

AU - Gallia, Francesca

AU - Schenone, Angelo

AU - Francia, Ada

AU - Pareyson, Davide

AU - Santoro, Lucio

AU - Tamburin, Stefano

AU - Cavaletti, Guido

AU - Giannini, Fabio

AU - Sabatelli, Mario

AU - Beghi, Ettore

AU - Paolasso, Ilaria

AU - De Toni Franceschini, Luisa

AU - Notturno, Francesca

AU - Clemenzi, Alessandro

AU - Bianchi, Francesca

AU - Fiorina, Elisabetta

AU - Pontecorvo, Simona

AU - Piscosquito, Giuseppe

AU - Manganelli, Fiore

AU - Praitano, Maria Luigia

AU - Piatti, Marialuisa

AU - Torzini, Antonio

AU - Luigetti, Marco

AU - Macchia, Roberta

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background: We reported that 6-month therapy with intravenous immunoglobulin (IVIg) was more frequently effective or tolerated than intravenous methylprednisolone (IVMP) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We now retrospectively compared the proportion of patients who eventually worsened after discontinuing therapy and the median time to clinical worsening. Methods: By March 2013, data were available from 41 of the 45 patients completing the trial with a median follow-up after therapy discontinuation of 42 months (range 1-60). Three patients withdrew during the original study and one failed to respond to either of the therapies. No patient received a diagnosis alternative to CIDP during the follow-up. Results: Twenty-eight of the 32 patients treated with IVIg (as primary or secondary therapy after failing to respond to IVMP) improved after therapy (87.5%) as compared with 13 of the 24 patients treated with IVMP as primary or secondary therapy (54.2%). After a median follow-up of 42 months (range 1-57), 24 out of 28 patients responsive to IVIg (85.7%) worsened after therapy discontinuation. The same occurred in 10 out of 13 patients (76.9%) responsive to IVMP (p=0.659) after a median follow-up of 43 months (range 7-60). Worsening occurred 1-24 months (median 4.5) after IVIg discontinuation and 1-31 months (median 14) after IVMP discontinuation (p=0.0126). Conclusions: A similarly high proportion of patients treated with IVIg or IVMP eventually relapse after therapy discontinuation but the median time to relapse was significantly longer after IVMP than IVIg. This difference may help to balance the more frequent response to IVIg than to IVMP in patients with CIDP.

AB - Background: We reported that 6-month therapy with intravenous immunoglobulin (IVIg) was more frequently effective or tolerated than intravenous methylprednisolone (IVMP) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We now retrospectively compared the proportion of patients who eventually worsened after discontinuing therapy and the median time to clinical worsening. Methods: By March 2013, data were available from 41 of the 45 patients completing the trial with a median follow-up after therapy discontinuation of 42 months (range 1-60). Three patients withdrew during the original study and one failed to respond to either of the therapies. No patient received a diagnosis alternative to CIDP during the follow-up. Results: Twenty-eight of the 32 patients treated with IVIg (as primary or secondary therapy after failing to respond to IVMP) improved after therapy (87.5%) as compared with 13 of the 24 patients treated with IVMP as primary or secondary therapy (54.2%). After a median follow-up of 42 months (range 1-57), 24 out of 28 patients responsive to IVIg (85.7%) worsened after therapy discontinuation. The same occurred in 10 out of 13 patients (76.9%) responsive to IVMP (p=0.659) after a median follow-up of 43 months (range 7-60). Worsening occurred 1-24 months (median 4.5) after IVIg discontinuation and 1-31 months (median 14) after IVMP discontinuation (p=0.0126). Conclusions: A similarly high proportion of patients treated with IVIg or IVMP eventually relapse after therapy discontinuation but the median time to relapse was significantly longer after IVMP than IVIg. This difference may help to balance the more frequent response to IVIg than to IVMP in patients with CIDP.

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