Efficacy of Intravenous Immunoglobulin in Patients With IgG Monoclonal Gammopathy and Polyneuropathy

Gorson, Kenneth C.; Ropper, Allan H.; Weinberg, David H.; Weinstein, Robert S.

doi:10.1001/archneur.59.5.766

Cited by 50 publications

(22 citation statements)

References 32 publications

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“…Patients were diagnosed with MGUSN when immunoglobulin (Ig)M or IgG was detectable in the serum, with and without antineural antibodies 29, 30. Due to the small sample size, MGUSN patients were subsumed into the CIDP group for further analysis as per previous suggestions 29, 31, 32…”

Section: Methodsmentioning

confidence: 99%

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Stettner

Hinrichs

Guthoff

et al. 2015

Ann Clin Transl Neurol

105

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ObjectiveThere is an unmet need for better diagnostic tools to further delineate clinical subsets of heterogeneous chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) to facilitate treatment decisions. Corneal confocal microscopy (CCM) is a noninvasive and reproducible nerve imaging technique. This study evaluates the potential of CCM as a diagnostic surrogate in CIDP and MMN.MethodsIn a cross‐sectional prospective approach, 182 patients and healthy controls were studied using CCM to quantify corneal nerve damage and immune cell infiltration.ResultsPatients with CIDP and MMN had a reduction in corneal nerve fiber (CNF) measures and an increase in corneal immune cell infiltrates. In CIDP, CNF parameters decreased with increasing duration of disease. The number of dendritic cells in proximity to CNFs was increased in patients with early disease and correlated with the degree of motor affection. A further reduction in CNF parameters and an increase in nondendritic cells were observed in patients with painful neuropathy. In CIDP patients with antineuronal antibodies the number of nondendritic cells was increased.InterpretationOur findings suggest that CNF loss may reflect severity of neuropathy and quantification of distinct cells around the CNF plexus may help in stratifying CIDP subtypes, clinical course, and disease activity. However, further longitudinal studies are required before CCM can be considered as a valid surrogate endpoint for patients with CIDP and MMN.

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Section: Methodsmentioning

confidence: 99%

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Stettner

Hinrichs

Guthoff

et al. 2015

Ann Clin Transl Neurol

105

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“…39 From these Class I studies we can conclude that IVIG benefits only a minority of patients with the neuropathy associated with IgM paraproteinemia. Gorson et al 40 reported more encouraging results describing improvement in 40% of patients with the neuropathy associated with an IgG monoclonal protein after receiving IVIG.…”

Section: Monoclonal Gammopathy Of Undetermined Significance-associatementioning

confidence: 99%

Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the aanem AD HOC committee

et al. 2009

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Intravenous immunoglobulin (IVIG) is a therapeutic biologic agent that has been prescribed for over two decades to treat various neuromuscular conditions. Most of the treatments are given off-label, as little evidence from large randomized trials exists to support its use. Recently, IGIV-C has received an indication for the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP). Because of the lack of evidence, an ad hoc committee of the AANEM was convened to draft a consensus statement on the rational use of IVIG for neuromuscular disorders. Recommendations were categorized as Class I-IV based on the strength of the medical literature. Class I evidence exists to support the prescription of IVIG to treat patients with Guillain-Barré syndrome (GBS), CIDP, multifocal motor neuropathy, refractory exacerbations of myasthenia gravis, Lambert-Eaton syndrome, dermatomyositis, and stiff person syndrome. Treatment of Fisher syndrome, polymyositis, and certain presumed autoimmune neuromuscular disorders is supported only by Class IV studies, whereas there is no convincing data to substantiate the treatment of inclusion body myopathy (IBM), idiopathic neuropathies, brachial plexopathy, or diabetic amyotrophy using IVIG. Treatment with IVIG must be administered in the context of its known adverse effects. There is little evidence to advise the clinician on the proper dosing of IVIG and duration of therapy.

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“…A cumulative dose of 2 g/kg body weight IVIg was applied under which 10 out of 25 patients improved within 2 weeks in the first trial [77], whereas in the other only two out of 11 patients exhibited clinical amelioration after 3 months [78]. A retrospective analysis of 20 patients with IgG-MGUS revealed an improvement in eight out of 20 patients studied after a full cycle of 2 g/kg IVIg [79].…”

Section: Polyneuropathy Associated With Monoclonal Gammopathymentioning

confidence: 99%

Intravenous immunoglobulins in the treatment of immune neuropathies

Kieseier

Hörste

Lehmann

et al. 2008

Current Opinion in Neurology

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Efficacy of Intravenous Immunoglobulin in Patients With IgG Monoclonal Gammopathy and Polyneuropathy

Cited by 50 publications

References 32 publications

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the aanem AD HOC committee

Intravenous immunoglobulins in the treatment of immune neuropathies

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