2
|
Allen JA, Pasnoor M, Dimachkie MM, Ajroud-Driss S, Brannagan TH, Cook AA, Walton T, Fiecas MB, Kissel JT, Merkies I, Gorson KC, Lewis RA. Quantifying Treatment-Related Fluctuations in CIDP: Results of the GRIPPER Study. Neurology 2021; 96:e1876-e1886. [PMID: 33593867 DOI: 10.1212/wnl.0000000000011703] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jeffrey A Allen
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Mamatha Pasnoor
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mazen M Dimachkie
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Senda Ajroud-Driss
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Thomas H Brannagan
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Albert A Cook
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Timothy Walton
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark B Fiecas
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - John T Kissel
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ingemar Merkies
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kenneth C Gorson
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Richard A Lewis
- From the Department of Neurology (J.A.A.), and School of Public Heath (M.B.F.), Division of Biostatistics, University of Minnesota, Minneapolis; Department of Neurology (M.P., M.M.D.), University of Kansas Medical Center, Kansas City; Department of Neurology (S.A.-D.), Northwestern University, Chicago, IL; Department of Neurology (T.H.B.), Columbia University Medical Center, New York, NY; Neurology at Johns Creek (A.A.C.), LLC, Atlanta, GA; BriovaRx (T.W.), Lenexa, KS; Department of Neurology (J.T.K.), Ohio State University, Columbus; Department of Neurology (I.M.), Maastricht University Medical Centre+; Curaçao Medical Center (I.M.), Willemstad, the Netherlands; Department of Neurology (K.C.G.), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA; and Department of Neurology (R.A.L.), Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
3
|
Kuitwaard K, Brusse E, Jacobs BC, Vrancken AFJE, Eftimov F, Notermans NC, van der Kooi AJ, Fokkink WJR, Nieboer D, Lingsma HF, Merkies ISJ, van Doorn PA. Randomized trial of intravenous immunoglobulin maintenance treatment regimens in chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 2020; 28:286-296. [PMID: 32876962 PMCID: PMC7820989 DOI: 10.1111/ene.14501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022]
Abstract
Background and purpose High peak serum immunoglobulin G (IgG) levels may not be needed for maintenance intravenous immunoglobulin (IVIg) treatment in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and such high levels may cause side effects. More frequent lower dosing may lead to more stable IgG levels and higher trough levels, which might improve efficacy. The aim of this trial is to investigate whether high frequent low dosage IVIg treatment is more effective than low frequent high dosage IVIg treatment. Methods In this randomized placebo‐controlled crossover trial, we included patients with CIDP proven to be IVIg‐dependent and receiving an individually established stable dose and interval of IVIg maintenance treatment. In the control arm, patients received their individual IVIg dose and interval followed by a placebo infusion at half the interval. In the intervention arm, patients received half their individual dose at half the interval. After a wash‐out phase patients crossed over. The primary outcome measure was handgrip strength (assessed using a Martin Vigorimeter). Secondary outcome indicators were health‐related quality of life (36‐item Short‐Form Health Survey), disability (Inflammatory Rasch‐built Overall Disability Scale), fatigue (Rasch‐built Fatigue Severity Scale) and side effects. Results Twenty‐five patients were included and were treated at baseline with individually adjusted dosages of IVIg ranging from 20 to 80 g and intervals ranging from 14 to 35 days. Three participants did not complete the trial; the main analysis was therefore based on the 22 patients completing both treatment periods. There was no significant difference in handgrip strength change from baseline between the two treatment regimens (coefficient −2.71, 95% CI −5.4, 0.01). Furthermore, there were no significant differences in any of the secondary outcomes or side effects. Conclusions More frequent lower dosing does not further improve the efficacy of IVIg in stable IVIg‐dependent CIDP and does not result in fewer side effects.
Collapse
Affiliation(s)
- K Kuitwaard
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Albert Schweitzer hospital, Dordrecht, The Netherlands
| | - E Brusse
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B C Jacobs
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A F J E Vrancken
- Department of Neurology, Brain Centre Rudolf Magnus University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N C Notermans
- Department of Neurology, Brain Centre Rudolf Magnus University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A J van der Kooi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W-J R Fokkink
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Nieboer
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - H F Lingsma
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - I S J Merkies
- Department of Neurology, Curaçao Medical Centre Willemstad, Willemstad, Curaçao.,Department of Neurology, School of Medical Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P A van Doorn
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|