Science News: Standardized Tapering off Subcutaneous Immunoglobulin in Chronic Inflammatory Demyelinating Polyneuropathy

Published March 15, 2024

Science News

Submitted by: Pritikanta Paul, MD
Edited by: Joshua Wilson, MD

Citation: Markvardsen LK, Sindrup SH, Christiansen I, Sheikh AM, Holbech JV, Andersen H. Standardized tapering off subcutaneous immunoglobulin in chronic inflammatory demyelinating polyneuropathy. J Neuromuscul Dis. 2023;10(5):787-796. doi:10.3233/JND-221615

Summary: Around one-third of chronic inflammatory demyelinating polyneuropathy (CIDP) patients experience symptom remission over time, making it advisable to regularly attempt reducing or discontinuing immunoglobulin treatment to detect clinical remission. Early identification of remission can lead to reduced treatment costs and fewer side effects. However, there is still a gap in understanding of how to safely and effectively taper off this treatment, particularly with subcutaneous immunoglobulin (SCIG).

The objective of this study was to determine the frequency of CIDP patients who entered remission after complete discontinuation of treatment with SCIG by employing a standardized tapering-off regimen. The study was conducted from March 2018 to June 2022, recruiting participants from four Danish neurological departments. Patients followed a stepwise tapering regimen, reducing the initial SCIG dose by 90%, 75%, 50%, 25%, and 0% every 12 weeks if no deterioration occurred. Clinical evaluation included disability scores, quality of life assessments, grip strength, and manual muscle testing using the Medical Research Council scoring. The clinical criteria for deterioration included an increase in disability scores or a decrease in grip strength.

Of the 55 patients enrolled with stable disease, 36% (N=20) successfully stopped SCIG without relapse. Of the remaining 35 participants who experienced relapse during the tapering process, 7 (13%) could not tolerate any dosage reduction, while 11 (20%) tolerated a 10% reduction, 13 (24%) tolerated a 25% reduction, and 3 (5%) tolerated a 50% reduction. One participant (2%) experienced deterioration after discontinuing treatment but recovered when treated with a 25% dosage. Patients who experienced relapse were more likely to have a higher baseline dosage of SCIG. Of those who relapsed, 97% could be stabilized by increasing SCIG to the last given dose prior to deterioration, with a median dose reduction of 10%.  

After 2 years, 90% of patients who discontinued SCIG remained in remission. Additionally, frequent clinical evaluation every 6 weeks did not significantly improve deterioration detection compared to less frequent evaluation (every 12 weeks). This study concluded that SCIG can be tapered off effectively in stable CIDP patients.

Comments: This study offers valuable insights into the gradual reduction of SCIG treatment in CIDP. A vast majority of AANEM audience are care providers for patients with CIDP and this study investigates treatment outcome with SCIG.