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Predictive value of clinical, electrophysiological and immunological features for response to IVIg in patients with CIDP
Author(s) -
Isoardo G,
Rota E,
Ciaramitaro P,
Tavella A,
Poglio F,
Prolasso I,
Cocito D
Publication year - 2004
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/j.1085-9489.2004.009209l.x
Subject(s) - medicine , immunofixation , gastroenterology , weakness , antibody , surgery , monoclonal , monoclonal antibody , immunology
Aims: To investigate the features which are most predictive of IVIg response in patients with CIDP. Methods: We included 38 consecutive CIDP diagnosed according to Rotta et al . (2000). Anti‐MAG antibodies (Ab) assay and serum immunofixation were performed in all. IVIg (0.4 g/Kg/day) were the first treatment in all patients. Response to IVIg was defined as increase by at least 1 grade of the Rankin scale score at 1 month. The following features were considered: 1) proximal as well as distal weakness, 2) pure clinical sensory pattern, 3) disease duration lower than 12 months, 4) conduction block in at least 1 motor nerve, 5) mean lower/upper limbs motor nerve CMAP amplitude lower than 50% of lower limit of normal, 6)M monoclonal gammopathy, and 7) anti‐MAG Ab. Likelihood ratio (LR) of the features significantly associated with treatment response was evaluated in order to determine the increase or decrease of response to IVIg probability. Results: Twenty‐six patients were classified as responders and 12 as non‐responders. Age (60.6 ± 9.7 vs. 63.6 ± 9.4 years), disease duration (24 vs. 42 months) and sex ratio (18 vs. 9 male) were not different among the groups. Presence of conduction block in at least one motor nerve was associated significantly with treatment response (responders 50% vs. non‐responders 8.3%, p: 0.02) and presence of anti‐MAG Ab was associated with treatment failure (non‐responders 50% vs. responders 7.6%, p: 0.007). The remaining features were not significantly associated with treatment response. LR of presence on conduction block was 6, whereas LR of anti‐MAG Ab was 0.15. Considering 70% as mean percentage of responders, the finding of conduction blocks increase the probability of response to IVIg to 89%, whereas the finding of anti‐MAG antibody decreases this probability to 25%. Conclusion: Presence of conduction blocks and absence of anti‐MAG antibodies seem to be good predictors of response to IVIg in patients with CIDP.