Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy: a double blind, placebo controlled study.

Vermeulen, M.; Doorn, Pieter A. van; Brand, Anneke; Strengers, P. F. W.; Jennekens, F. G. I.; Busch, H. F. M.

doi:10.1136/jnnp.56.1.36

Cited by 200 publications

(120 citation statements)

References 16 publications

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“…IVIG is widely used as a first-line initial and maintenance treatment for CIDP. Several prospective placebo-controlled clinical trials consistently demonstrated that administration of IVIG improves neurologic disability (17)(18)(19), and provides long-term benefits to patients with CIDP (7). IVIG is thought to act through several pathways, including complement inactivation and neutralization of idiotypic antibodies (6).…”

Section: Induction Of Fc␥riib Expression In Memory B Cells In Cidp Pamentioning

confidence: 99%

Impaired inhibitory Fcγ receptor IIB expression on B cells in chronic inflammatory demyelinating polyneuropathy

Tackenberg

Jelčić

Baerenwaldt

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

219

178

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The inhibitory Fc-γ receptor FcγRIIB, expressed on myeloid and B cells, has a critical role in the balance of tolerance and autoimmunity, and is required for the antiinflammatory activity of intravenous Ig (IVIG) in various murine disease models. However, the function of FcγRIIB and its regulation by IVIG in human autoimmune diseases are less well understood. Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common treatable acquired chronic polyneuropathy, and IVIG is widely used as a first-line initial and maintenance treatment. We found that untreated patients with CIDP, compared with demographically matched healthy controls, showed consistently lower FcγRIIB expression levels on naive B cells, and failed to up-regulate or to maintain up-regulation of FcγRIIB as B cells progressed from the naive to the memory compartment. Concomitantly, the rare −386C/−120A FcγRIIB promoter polymorphism resulting in reduced promoter activity previously associated with autoimmune phenotypes was overrepresented in CIDP. Also, FcγRIIB protein expression was up-regulated on monocytes and B cells after clinically effective IVIG therapy. Thus, our results suggest that the inhibitory FcγRIIB is impaired at a critical B cell differentiation checkpoint in CIDP, and that modulating FcγRIIB expression might be a promising approach to efficiently limit antibody-mediated immunopathology in CIDP.

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Section: Induction Of Fc␥riib Expression In Memory B Cells In Cidp Pamentioning

confidence: 99%

Impaired inhibitory Fcγ receptor IIB expression on B cells in chronic inflammatory demyelinating polyneuropathy

Tackenberg

Jelčić

Baerenwaldt

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

219

178

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“…Two Class II studies 13,14 comparing IVIg with placebo demonstrated IVIg benefits comparable with those shown in the Class I studies.…”

Section: Chronic Inflammatory Demyelinating Polyneuropathymentioning

confidence: 92%

“…[11][12][13][14] In a Class I crossover study, 11 117 patients received a loading dose of 2 g/kg and then 1 g/kg of IVIg or placebo (albumin) every 3 weeks. Patients were switched to the alternate treatment for worsening or no improvement.…”

Section: Chronic Inflammatory Demyelinating Polyneuropathymentioning

confidence: 99%

Evidence-based guideline: Intravenous immunoglobulin in the treatment of neuromuscular disorders [RETIRED]

et al. 2012

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“…Based on a Cochrane review, disability is reduced in 54% of CIDP patients within the first 6 weeks after IVIg therapy [Eftimov et al 2013]. Several trials and case series have demonstrated a response rate of even 60% during a short observation period over 24 weeks of IVIg treatment [Dyck et al 1982;Vermeulen et al 1993;Waniewski et al 1994;Hahn et al 1996b;Mendell et al 2001;Mehndiratta and Hughes, 2002;Hughes et al 2008b;Frauger et al 2011].…”

Section: Introductionmentioning

confidence: 99%

Two years’ long-term follow up in chronic inflammatory demyelinating polyradiculoneuropathy: efficacy of intravenous immunoglobulin treatment

Ellrichmann

Gold

Ayzenberg

et al. 2016

Ther Adv Neurol Disord

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Background: Administration of intravenous immunoglobulins (IVIgs) is established for longterm treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Prevention of secondary axonal loss going along with permanent clinical disability and muscular atrophy is a major aim in CIDP therapy. To assess long-term clinical efficacy of IVIg treatment despite heterogenous disease course and variable complaints reported by the patients, long-term electrophysiological monitoring was performed for systematic evaluation of therapeutic efficacy of IVIg. Methods: A total of 21 patients with CIDP treated with IVIg 1 g/kg bodyweight every 3-6 weeks were examined electrophysiologically every 12 months over a period of 2 years. Results: Assessment of clinical symptoms, using the Inflammatory Neuropathy Cause and Treatment (INCAT) and Hughes functional grading score (F-score) revealed improvement of motor and sensory symptoms over a period of 2 years. As electrophysiological results remained stable, IVIg treatment seems to be suitable to prevent axonal loss in CIDP. Conclusions: This study confirms efficacy of IVIg as firstline therapy in CIDP. Doses and frequency of IVIg application should be adapted based on clinical evaluation and analysis of long-term electrophysiological findings.

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Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy: a double blind, placebo controlled study.

Cited by 200 publications

References 16 publications

Impaired inhibitory Fcγ receptor IIB expression on B cells in chronic inflammatory demyelinating polyneuropathy

Impaired inhibitory Fcγ receptor IIB expression on B cells in chronic inflammatory demyelinating polyneuropathy

Evidence-based guideline: Intravenous immunoglobulin in the treatment of neuromuscular disorders [RETIRED]

Two years’ long-term follow up in chronic inflammatory demyelinating polyradiculoneuropathy: efficacy of intravenous immunoglobulin treatment

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