This is another very, very interesting thing because within the Neuritis Network, which is a huge German network focusing on research in immune-mediated neuropathies with several university hospitals included, we checked how everybody is managing their CIDP patients, and we found that the dosing patterns and treatment sequences varied considerably and sometimes also differed from the guideline recommendations...
This is another very, very interesting thing because within the Neuritis Network, which is a huge German network focusing on research in immune-mediated neuropathies with several university hospitals included, we checked how everybody is managing their CIDP patients, and we found that the dosing patterns and treatment sequences varied considerably and sometimes also differed from the guideline recommendations. Within this network, we wanted to retrospectively assess the dosing patterns and also how patients with CIDP are generally treated. Among nine centres, more than 600 patients were looked at, and here we found that in the first line almost half of the patients were initiated with IVIg, so to say intravenous immunoglobulins. The other half was initiated on glucocorticoids, with the vast majority being initiated on intravenous glucocorticoids, namely intravenous methylprednisolone. Only a very small proportion of patients actually followed the recommendations of oral dexamethasone. That was quite interesting. Last eight patients within this survey were initiated on oral immunosuppressant agents such as azathioprine, and they continued over the whole disease course on this medication. In the second line, we found that most patients initiated on IVIg also stayed on IVIg. A small proportion of the patients was switched to subcutaneous IVIg. Of the patients initiated on glucocorticoids, the vast majority changed to IVIg irrespective, either they were initiated on intravenous or oral glucocorticoids. In the last therapeutic line, the third line, at data cutoff, we found that almost two-thirds of the patients were treated with IVIg, and equally small proportions of patients were on intravenous glucocorticoids and subcutaneous IG. Only 16 patients within this whole multicentric cohort were treated with oral glucocorticoids at the end of the survey. What is also very interesting is that 20% of the patients needed additional second-line immunosuppressants such as azathioprine, MTX, mycophenolate mofetil, and ciclosporin. Another 20% also needed escalation therapies, for example rituximab, bortezomib, cyclophosphamide. Lastly, of the patients treated with IVIg, 20% were on dosages exceeding largely the recommended dosage of 1 g/kg body weight per four weeks, reaching up to 2.5 g/kg body weight. So, in conclusion, what we found here in this survey is that patients with CIDP are not only treated very differently between the different centres, but also differ largely from what is recommended in the guidelines.
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