Treatment response amplitude and timing in chronic inflammatory demyelinating polyneuropathy with routine care: Study of a UK cohort.
Rajabally, Yusuf A Min, Young Gi Nazeer, Kabir K Englezou, Christina
Rajabally, Yusuf A
Min, Young Gi
Nazeer, Kabir K
Englezou, Christina
Abstract
Background and purpose: The amplitude, timing, and determinants of improvement with available treatments are uncertain in chronic inflammatory demyelinating polyneuropathy (CIDP). Our primary objective was to quantify categorized outcomes with routine care.
Methods: We retrospectively studied treatment response within 36 months from initiation in 112 consecutive subjects with CIDP. Response was classified into a proposed new "CIDP treatment-response category" (CT-RC), based on achieved endpoints. Determinants of the CT-RC, of timing of maximum improvement, and of treatment discontinuation were ascertained.
Results: The CT-RC demonstrated high concurrent validity with current outcome measures. Thirty-six subjects (32.1%) achieved a "complete response," 37 (33%) a "good partial response," 10 (8.9%) a "moderate partial response," and 15 (13.4%) a "poor partial response." Fourteen subjects (12.5%) were "nonresponsive." The CT-RC was independently predicted only by age. Mean time to maximum improvement was 12.1 months (range = 1-36) and was not associated with any pretreatment covariate. Treatment discontinuation occurred in 24 of 62 (38.2%) partial responders and was only associated with shorter pretreatment disease duration. Nonresponders were older and received a similar number of treatments compared to responders.
Conclusions: CT-RC classification indicates persistent disability in >60% of treatment responders in CIDP. Timing of maximum improvement is variable, frequently delayed, and unpredictable. Treatment withdrawal without deterioration is achievable in approximately 40% of subjects and may be more likely with prompt treatment. Treatment withdrawal in partial responders and limited escalation in nonresponders suggest implication of physician- and patient-related factors in suboptimal response. More effective treatments/treatment methods and better understanding of other factors influencing response are needed in CIDP.
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Date
2024-07-09
Type
Article
Subject
Neurology
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Citation
Rajabally YA, Min YG, Nazeer KK, Englezou C. Treatment response amplitude and timing in chronic inflammatory demyelinating polyneuropathy with routine care: Study of a UK cohort. Eur J Neurol. 2024 Oct;31(10):e16399. doi: 10.1111/ene.16399. Epub 2024 Jul 9. PMID
Journal / Source Title
European Journal of Neurology
DOI
10.1111/ene.16399
PMID
38980202
Publisher
Wiley
Publisher’s URL
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-1331