Long-term treatment of chronic inflammatory demyelinating polyradiculoneuropathy with plasma exchange or intravenous immunoglobulin

Abstract

To assess long-term treatment of chronic idiopathic demyelinating polyradiculoneuropathy (CIDP) with plasma exchange (PE) and intravenous immunoglobulin (IVIg), we studied 105 patients retrospectively by case-notes and follow-up. Thirty-three were treated with PE; 23 responded well. Twenty-two were treated with IVIg; 14 responded well and one had a hypotensive reaction during the first infusion. For both treatments, responders were more likely to be female and younger, and to have a shorter duration of symptoms. Most patients required only one course of treatment. Seven patients received repeated courses of PE for 8.1-59.7 months; seven received repeated courses of IVIg for 6-51 months. Transient complications occurred with PE: hypotension in three, difficulty in gaining venous access in three, and haematoma, bleeding diathesis, hypocalcaemia, and septicaemia in one patient each. Four patients transferred from long-term PE to IVIg, but the fifth responded to PE only. Two patients who were transferred from PE to IVIg were eventually able to stop all treatments. Long-term use of IVIg was free of any significant complications. Both PE and IVIg are possible long-term treatments for CIDP, but both are expensive, and PE had more side-effects.