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Subcutaneous immunoglobulin in CIDP and MMN: a short-term nationwide study

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Abstract

This multi-center Italian prospective observational study reports the 4 months follow-up data of 87 patients affected by chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) shifted from intravenous to subcutaneous immunoglobulin treatment. A therapeutic shift from intravenous to subcutaneous immunoglobulin was performed in 87 patients (66 CIDP; 21 MMN) affected by immune-mediated peripheral neuropathies with evidence of a sustained clinical response to intravenous immunoglobulin. Patients were evaluated by means of the Overall Neuropathy Limitation Scale, Medical Research Council Scale and Life Quality Index questionnaire, both at the time of therapeutic shift and after 4 months of subcutaneous immunoglobulin treatment. A sustained clinical efficacy was observed after the switch to subcutaneous immunoglobulin: the Overall Neuropathy Limitation Scale score improved in the group of 66 CIDP patients (P = 0.018), with only one subject reporting a worsening of 1 point, and remained stable in the group of 21 MMN patients (P = 0.841), with one subject reporting a worsening of two points. An improvement in the patient’s perception of therapeutic setting was reported in both groups. This large multi-center study confirms the short-term clinical equivalence of subcutaneous versus intravenous immunoglobulin and a possible improvement in the patient’s perception of therapeutic setting with the subcutaneous administration. However, further studies are required to extend the results to a longer observational period.

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Conflicts of interest

This research was funded by the “Associazione Neuropatie Croniche Piemonte ONLUS”. The sponsor had no role in the design of the study; the collection, analysis and interpretation of the data; the decision to approve publication of the finished manuscript. Dario Cocito received honoraria for lecturing from Baxter, CSL Behring, and Kedrion; he received personal compensation for serving in Advisory Board of CSL Behring, Kedrion and Lilly and travel grants to attend scientific meeting from Baxter, Grifols, Kedrion, and CSL Behring. Anna Mazzeo reports travel support for Scientific Meetings from CSL Behring and Kedrion. Raffaella Fazio received personal compensation for serving in Advisory Board of CSL Behring and Baxter, and travel grants from Baxter, Grifols, Kedrion and CLS Behring. Ada Francia received travel grants and honoraria from Biogenidec, Genzyme, Novartis, Almirall, Merck Serono, CSL Behring, Kedrion, Teva. Gabriele Siciliano received personal compensation for serving in Advisory Board from Grunenthal, Baxter and Grifols. Giovanni Antonini received honoraria for lecturing from Kedrion and travelgrant from Genzyme, Behring e Kedrion. Eduardo Nobile-Orazio reports personal compensation for serving in the Advisory Board of CSL Behring, Baxter, Kedrion and Novartis; he received honoraria for lecturing travel grants to attend scientific meetings from Baxter, CSL Behring, Grifols and Kedrion. Erdita Peci, Girolama Alessandra Marfia received travel grant to attend scientific meetings from CSL Behring. Aristide Merola, Paola Valentino, Rocco Liguori, Massimiliano Filosto, Angelo Maurizio Clerici, Stefania Lelli, Ilaria Cecconi, and Leonardo Lopiano declare no conflicts of interest.

Ethical standards

The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy

    Dario Cocito, Aristide Merola, Erdita Peci & Leonardo Lopiano

  2. Department of Neuroscience, Psychiatry and Anesthesiology, A.O.U. Policlinico “G. Martino”, Messina, Italy

    Anna Mazzeo

  3. Department of Neurology, IRCCS San Raffaele Milano, Milano, Italy

    Raffaella Fazio

  4. III Neurological Clinic, Policlinico Umberto I, Roma, Italy

    Ada Francia

  5. Department of Medical and Surgical Sciences, Neurological Clinic, University Magna Grecia of Catanzaro, Catanzaro, Italy

    Paola Valentino

  6. Neurological Clinic IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy

    Rocco Liguori

  7. Neuromuscular Diseases and Neuropathies Section, Neurological Clinic, University and A.O “Spedali Civili” of Brescia, Brescia, Italy

    Massimiliano Filosto

  8. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    Gabriele Siciliano

  9. Neurology and Stroke Unit, A.O. Hospital Varese, Circolo and Fondazione Macchi, University of Insubria, Varese, Italy

    Angelo Maurizio Clerici

  10. Unit of Neurology, Hospital San Giacomo Apostolo, Castelfranco Veneto, Italy

    Stefania Lelli

  11. Department of Neuroscience, Policlinico tor Vergata, Rome, Italy

    Girolama Alessandra Marfia

  12. Neurological Sciences, University “La Sapienza” of Rome, Rome, Italy

    Giovanni Antonini

  13. Child Neuropsychiatry Unit, Hospital Sant’Orsola Malpighi Bologna, Bologna, Italy

    Ilaria Cecconi

  14. Neurology 2, Department of Translational Medicine, IRCCS Istituto Clinico Humanitas, University of Milano, Rozzano, Italy

    Eduardo Nobile-Orazio

Authors
  1. Dario Cocito
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  2. Aristide Merola
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  3. Erdita Peci
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  4. Anna Mazzeo
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  5. Raffaella Fazio
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  6. Ada Francia
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  7. Paola Valentino
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  8. Rocco Liguori
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  9. Massimiliano Filosto
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  10. Gabriele Siciliano
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  11. Angelo Maurizio Clerici
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  12. Stefania Lelli
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  13. Girolama Alessandra Marfia
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  14. Giovanni Antonini
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  15. Ilaria Cecconi
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  16. Eduardo Nobile-Orazio
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  17. Leonardo Lopiano
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Consortia

SCIg and Chronic Dysimmune Neuropathies Italian Network

Corresponding author

Correspondence to Dario Cocito.

Additional information

A list of contributors can be found in “Appendix 1”.

Appendix 1

Appendix 1

Contributors from the “SCIg and Chronic Dysimmune Neuropathies Italian Network”.

Dario Cocito, Erdita Peci, Aristide Merola, Alberto Romagnolo, Department of Neuroscience, University of Turin; Antonio Toscano, Anna Mazzeo, Luca Gentile, Massimo Russo, Department of Neuroscience, Psychiatry and Anesthesiology, A.O.U. Policlinico “G. Martino” Messina; Raffaella Fazio, Daniela Velardo, Department of Neurology, IRCCS San Raffaele Milano; Ada Francia, Simona Pontecorvo III Neurological Clinic, Policlinico Umberto I Roma; Paola Valentino, Rita Nisticò, Neurological Clinic, Department of Medical and Surgical Sciences, University Magna Grecia of Catanzaro; Rocco Liguori, Vincenzo Angelo Donadio, Neurological Clinic IRCCS, Institute of Neurological Sciences of Bologna; Massimiliano Filosto, Neurological Clinic—Neuromuscular Diseases and Neuropathies Section, University and A.O “Spedali Civili” of Brescia; Gabriele Siciliano, Erica Schirinzi, Department of Clinical and Experimental Medicine, University of Pisa; Giorgio Bono, Maurizio Clerici, Sc Neurology and Stroke Unit, A.O. Hospital Varese—Circolo and Fondazione Macchi, University of Insubria; Stefania Lelli, Tiziana Rosso, Operative Unit of Neurology, Hospital San Giacomo Apostolo, Castelfranco Veneto; Girolama Alessandra Marfia, Giorgia Mataluni, Dipartment of Neuroscience, Policlinico tor Vergata; Giovanni Antonini, Alessandro Clemenzi, Neurological Sciences, University “La Sapienza” of Rome; Ilaria Cecconi, Michele Suprani, U.O Child Neuropsychiatry, Hospital Sant’Orsola Malpighi Bologna; Eduardo Nobile-Orazio, Neurology 2, Department of Translational Medicine, University of Milano, IRCCS Istituto Clinico Humanitas, Rozzano.

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Cocito, D., Merola, A., Peci, E. et al. Subcutaneous immunoglobulin in CIDP and MMN: a short-term nationwide study. J Neurol 261, 2159–2164 (2014). https://doi.org/10.1007/s00415-014-7444-2

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  • DOI: https://doi.org/10.1007/s00415-014-7444-2

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