section name header

Evidence summaries

Intravenous Immunoglobulin (Ivig) for Chronic Inflammatory Demyelinating Polyradiculoneuropathy (Cidp)

Intravenous immunoglobulin (IVIg) may improve disability in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), having probably similar efficacy to plasma exchange and oral prednisolone. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 8 RCTs with a total of 332 participants. Five studies (n=235) compared IVIg with placebo, one trial (n=20) with plasma exchange, one trial (n=32) with prednisolone, and one trial (n=46) with iv. methylprednisolone. A total of 2 g/kg of IVIg was administered in each trial over 2 to 5 days. A significantly higher proportion of participants improved in disability within one month after IVIg treatment as compared with placebo (RR 2.40, 95% CI 1.72 to 3.36; NNT for an additional beneficial outcome 3.03 (95% CI 2.33 to 4.55), 5 trials, n=235). Whether all these improvements are equally clinically relevant cannot be deduced because each trial used different disability scales and definitions of significant improvement. In 3 trials (n=84), the disability score could be transformed to the modified Rankin score, on which improvement of one point after IVIg treatment compared to placebo was not significant (RR 2.40, 95% CI 0.98 to 5.83). One placebo-controlled study (n=208) with a long-term follow-up showed that IVIg improves disability more than placebo over 24 and 48 weeks. The mean disability score revealed no significant difference between IVIg and plasma exchange at 6 weeks. There was no significant difference in improvement in disability on prednisolone compared with IVIg after 2 or 6 weeks, or on methylprednisolone compared to IVIg after 2 weeks or 6 months. There were no statistically significant differences in frequencies of side effects between the 3 types of treatment for which data were available (IVIg vs. placebo or steroids). Mild and transient adverse events were found in 49% of participants treated with IVIg, while serious adverse events were found in 6%.

Comment: The quality of evidence is downgraded by indirectness (short follow-up time) and imprecise results (limited study size for each comparison).

References

  • Eftimov F, Winer JB, Vermeulen M et al. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev 2013;12():CD001797. [PubMed].

Primary/Secondary Keywords