Daily grip strength response to intravenous immunoglobulin in chronic immune neuropathies

Doneddu, Pietro Emiliano; Hadden, Robert D.M.

doi:10.1002/mus.26898

Cited by 14 publications

(25 citation statements)

References 21 publications

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“…12 Especially when rolling 5-day mean grip strength values are calculated, changes of ≥8 kPa may be clinically meaningful and capable of distinguishing between treatment response and random day-to-day grip strength fluctuations. 13 While both absolute and relative cutoffs may have a role in detecting a clinically meaningful change, we elected a percentage approach because it contextualizes the degree of change proportional to the patient's baseline strength. By using these parameters, we were able to identify a population of patients with frequent IVIGassociated TRFs and another population who were stable over multiple treatment cycles.…”

Section: Discussionmentioning

confidence: 99%

Quantifying Treatment-Related Fluctuations in CIDP

et al. 2021

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ObjectiveThe objective of this study was to explore the extent of IV immunoglobulin (IVIG) treatment-related fluctuations (TRFs) by using home collection of daily grip strength in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and to use that information to develop evidence-based treatment optimization strategies.MethodsThis prospective observational study included 25 patients with well-defined CIDP. Participants recorded grip strength daily for 6 months. Disability and gait metrics were collected weekly. Serum immunoglobulin G levels were obtained at peak, trough, and midcycle IVIG intervals. Day-to-day grip strength changes <10% were considered random. To identify patients with TRFs, 3-day averaged grip strength was calculated on each consecutive day after an IVIG infusion. TRFs were defined as ≥10% 3-day averaged grip strength difference compared to the pre-IVIG baseline.ResultsParticipants successfully recorded grip strength on all but 9% of recordable days. Twelve patients (48%) were classified as low/no fluctuaters and 13 (52%) as frequent fluctuaters. In the frequent fluctuating group, grip strength improved over 1 week and thereafter was relatively stable until the third week after infusion. Grip strength was significantly correlated with measures of disability.ConclusionsGrip strength collection by patients at home is reliable, valid, and feasible. A change in grip strength by ≥10% is a useful, practical, and evidence-based approach that may be used to identify clinically meaningful TRFs. From these data, we propose a treatment optimization strategy for patients with CIDP on chronic IVIG that may be applied to routine clinic care during both face-to-face and virtual video or telephone patient encounters.Trial Registration InformationClinicalTrials.gov Identifier: NCT02414490.

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Section: Discussionmentioning

confidence: 99%

Quantifying Treatment-Related Fluctuations in CIDP

et al. 2021

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“…Our study used three different outcome measures along with MCID based cut-off values to define improvement. We recognize that these criteria do not always reflect clinical practice and that a less static, more patient-tailored assessment may be more suitable to define meaningful improvement and treatment (non) responders [47,[49][50][51]. We advocate a multimodal approach in those patients with expected limited improvement, for example in patients with severe axonal damage at presentation or those with only minimal disability or impairment, if treatment is considered justified at all.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of CIDP one year after start of treatment: a prospective cohort study

et al. 2021

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Objective To assess clinical outcome in treatment-naive patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Methods We included adult treatment-naive patients participating in the prospective International CIDP Outcome Study (ICOS) that fulfilled the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria for CIDP. Patients were grouped based on initial treatment with (1) intravenous immunoglobulin (IVIg), (2) corticosteroid monotherapy or (3) IVIg and corticosteroids (combination treatment). Outcome measures included the inflammatory Rasch-built overall disability scale (I-RODS), grip strength, and Medical Research Council (MRC) sum score. Treatment response, treatment status, remissions (improved and untreated), treatment changes, and residual symptoms or deficits were assessed at 1 year. Results Forty patients were included of whom 18 (45%) initially received IVIg, 6 (15%) corticosteroids, and 16 (40%) combination treatment. Improvement on ≥ 1 of the outcome measures was seen in 31 (78%) patients. At 1 year, 19 (48%) patients were still treated and fourteen (36%) patients were in remission. Improvement was seen most frequently in patients started on IVIg (94%) and remission in those started on combination treatment (44%). Differences between groups did not reach statistical significance. Residual symptoms or deficits ranged from 25% for neuropathic pain to 96% for any sensory deficit. Conclusions Improvement was seen in most patients. One year after the start of treatment, more than half of the patients were untreated and around one-third in remission. Residual symptoms and deficits were common regardless of treatment.

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“…A recent study showed that the daily self-monitoring of GS demonstrated improvement after IVIg in some patients with CINs that may be indicative of treatment dependency, although this was not prospectively confirmed. 11 In this study,…”

Section: Introductionmentioning

confidence: 87%

“…9,10 This figure was confirmed by a recent study showing that random fluctuations ≥8 kPa occurred in 27% of patients. 11 It is also uncertain whether frequent measurements with outcome measures may provide useful information to guide clinical decision on adjustment of treatment. A recent study showed that the daily self-monitoring of GS demonstrated improvement after IVIg in some patients with CINs that may be indicative of treatment dependency, although this was not prospectively confirmed.…”

Section: Introductionmentioning

confidence: 99%

Home monitoring of maintenance intravenous immunoglobulin therapy in patients with chronic inflammatory neuropathy

Doneddu

Mandia

Gentile

et al. 2020

J Peripheral Nervous Sys

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To evaluate the utility of different outcome measures to monitor dose adjustment of intravenous immunoglobulin (IVIg) therapy in patients with chronic inflammatory neuropathy (CIN). We assessed the adjustment of IVIg maintenance therapy in 20 patients (10 CIDP and 10 MMN) by regularly monitoring grip strength (GS) using a Martin Vigorimeter, RODS, and quality of life using the SF‐36 questionnaire. These measures were regularly performed by the patient at home. We also assessed the extended MRC sumscore (eMRC sumscore) at each outpatient visit for IVIg infusion. We also enrolled 30 healthy controls to measure any possible training effect of GS with time and to analyze random fluctuation of GS. Clinically relevant change was detected by eMRC sumscore in 14 (93%) patients, by RODS in 11 (73%) patients, and by GS in 8 (53%) patients. Early sensitivity was greatest for RODS (73%), followed by GS (53%), and eMRC sumscore (27%). This differed from CIDP, with an early change in RODS in 100% of patients, and MMN with an early change in GS in 75%. None of the outcome measures alone was sufficient to detect clinically significant changes in all patients. Home monitoring of outcome measures objectively assisted clinical decision during individualization of IVIg treatment. We recommend a multimodal approach using different outcome measures to monitor the individual patient with CIN.

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Daily grip strength response to intravenous immunoglobulin in chronic immune neuropathies

Cited by 14 publications

References 21 publications

Quantifying Treatment-Related Fluctuations in CIDP

Quantifying Treatment-Related Fluctuations in CIDP

Clinical outcome of CIDP one year after start of treatment: a prospective cohort study

Home monitoring of maintenance intravenous immunoglobulin therapy in patients with chronic inflammatory neuropathy

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