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Subcutaneous immunoglobulin in responders to intravenous therapy with chronic inflammatory demyelinating polyradiculoneuropathy.

AbstractBACKGROUND AND PURPOSE:
We hypothesized that subcutaneous administration of immunoglobulins (SCIG) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is feasible, safe and superior to treatment with saline for the performance of muscle strength.
METHODS:
Thirty patients with motor involvement in maintenance therapy with intravenous immunoglobulin (IVIG) fulfilling the EFNS/PNS criteria for CIDP, aged 18-80 years, were randomized either to SCIG at a dose corresponding to their pre-study IVIG dose or to subcutaneous saline given twice or thrice weekly for 12 weeks at home. At the start and end of the trial as well as 2 weeks before (-2, 0, 10, 12 weeks), isokinetic strength performance of four predetermined and weakened muscle groups was measured. Also, an Overall Disability Sum Score (ODSS), 40-m-walking test (40-MWT), nine-hole-peg test, Neurological Impairment Score (NIS), Medical Research Council (MRC) score, grip strength, standardized electrophysiological recordings from three nerves, and plasma IgG levels were evaluated.
RESULTS:
SCIG treatment was well tolerated in all 14 patients. Six patients complained of mild side-effects at the injection site. In the SCIG group there was an increase of isokinetic muscle strength of 5.5 ± 9.5% (P < 0.05) as compared with a decline of 14.4 ± 20.3% (P < 0.05) in the placebo group; the difference between the two groups being significant (P < 0.01). ODSS, NIS, MRC, grip strength and 40-MWT improved following SCIG versus saline.
CONCLUSIONS:
SCIG treatment in CIDP is feasible, safe and effective, and seems an attractive alternative to IVIG.
AuthorsL H Markvardsen, J-C Debost, T Harbo, S H Sindrup, H Andersen, I Christiansen, M Otto, N K Olsen, L L Lassen, J Jakobsen,
JournalEuropean journal of neurology (Eur J Neurol) Vol. 20 Issue 5 Pg. 836-42 (May 2013) ISSN: 1468-1331 [Electronic] England
PMID23294032 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Copyright© 2013 The Author(s) European Journal of Neurology © 2013 EFNS.
Chemical References
  • Immunoglobulin G
  • Immunoglobulins
  • Immunoglobulins, Intravenous
  • Immunologic Factors
Topics
  • Disability Evaluation
  • Double-Blind Method
  • Female
  • Humans
  • Immunoglobulin G (blood)
  • Immunoglobulins (administration & dosage, blood, therapeutic use)
  • Immunoglobulins, Intravenous (pharmacokinetics, therapeutic use)
  • Immunologic Factors (administration & dosage, pharmacokinetics, therapeutic use)
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Muscle Strength (drug effects, physiology)
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating (blood, drug therapy, physiopathology)

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