RT Journal Article
SR Electronic
T1 Quantifying Treatment-Related Fluctuations in CIDP
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1876
OP e1886
DO 10.1212/WNL.0000000000011703
VO 96
IS 14
A1 Allen, Jeffrey A.
A1 Pasnoor, Mamatha
A1 Dimachkie, Mazen M.
A1 Ajroud-Driss, Senda
A1 Brannagan, Thomas H.
A1 Cook, Albert A.
A1 Walton, Timothy
A1 Fiecas, Mark B.
A1 Kissel, John T.
A1 Merkies, Ingemar
A1 Gorson, Kenneth C.
A1 Lewis, Richard A.
YR 2021
UL http://n.neurology.org/content/96/14/e1876.abstract
AB Objective The objective of this study was to explore the extent of IV immunoglobulin (IVIG) treatment-related fluctuations (TRFs) by using home collection of daily grip strength in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and to use that information to develop evidence-based treatment optimization strategies.Methods This prospective observational study included 25 patients with well-defined CIDP. Participants recorded grip strength daily for 6 months. Disability and gait metrics were collected weekly. Serum immunoglobulin G levels were obtained at peak, trough, and midcycle IVIG intervals. Day-to-day grip strength changes <10% were considered random. To identify patients with TRFs, 3-day averaged grip strength was calculated on each consecutive day after an IVIG infusion. TRFs were defined as ≥10% 3-day averaged grip strength difference compared to the pre-IVIG baseline.Results Participants successfully recorded grip strength on all but 9% of recordable days. Twelve patients (48%) were classified as low/no fluctuaters and 13 (52%) as frequent fluctuaters. In the frequent fluctuating group, grip strength improved over 1 week and thereafter was relatively stable until the third week after infusion. Grip strength was significantly correlated with measures of disability.Conclusions Grip strength collection by patients at home is reliable, valid, and feasible. A change in grip strength by ≥10% is a useful, practical, and evidence-based approach that may be used to identify clinically meaningful TRFs. From these data, we propose a treatment optimization strategy for patients with CIDP on chronic IVIG that may be applied to routine clinic care during both face-to-face and virtual video or telephone patient encounters.Trial Registration Information ClinicalTrials.gov Identifier: NCT02414490.CIDP=chronic inflammatory demyelinating polyradiculoneuropathy; COVID-19=coronavirus disease 2019; GRIPPER=IVIg Treatment-Related Fluctuations in CIDP Patients Using Daily Grip Strength Measurements; I-RODS=Inflammatory Rasch-Built Overall Disability Scale; IgG=immunoglobulin G; IVIG=IV immunoglobulin; ONLS=Overall Neuropathy Limitations Scale; TRF=treatment-related fluctuation; TRF-d=TRF deterioration; TRF-i=TRF improvement; TUG=Timed Up and Go