Short and long-term effect of IVIg in demyelinating neuropathy associated with MGUS, experience of a monocentric study.
Details
Serval ID
serval:BIB_9B0851BF6276
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Short and long-term effect of IVIg in demyelinating neuropathy associated with MGUS, experience of a monocentric study.
Journal
Revue neurologique
ISSN
0035-3787 (Print)
ISSN-L
0035-3787
Publication state
Published
Issued date
12/2011
Peer-reviewed
Oui
Volume
167
Number
12
Pages
897-904
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
The optimal treatment for demyelinating neuropathy associated with MGUS and anti-MAG neuropathy is not known.
We retrospectively studied the efficacy of IVIg in 14 patients with DN-MGUS (seven IgM and seven IgG/A) and seven with anti-MAG neuropathies, treated in our reference center between 2002 and 2007. Patients were clinically evaluated before the first infusion, after the first infusion, and after the last IVIg treatment.
Anti-MAG neuropathy: after a single infusion, one patient improved and six were stable. At last follow-up (mean: 15.6months [range: 3.5-31], mean number of IVIg courses: 8 [2-33]), one patient maintained her improvement from baseline. DN-MGUS: after a single infusion, nine patients improved (64%), four were stable and one deteriorated further. The factor predictive of short-term response to IVIg was relapsing neuropathy responding better in the walking score analysis (Fisher exact test: P=0.005). At last follow-up (mean: 22.6months [range 2-72], mean number of IVIg courses: seven [1-24]), neurological status improved in four patients, five patients remained stable, including three who are still under regular IVIg, and four had deteriorated. Improvement from baseline persisted for a prolonged period in two patients after IVIg were stopped. Patients who were responders on Norris after the first IVIg course were significantly better responders at long-term follow-up than the others (P=0.001). We report no serious adverse effect.
IVIg are not very efficient in the management of anti-MAG neuropathies. Nevertheless, they have a frequent short-term beneficial effect in DN-MGUS, which was maintained at long-term follow-up in one-third of our patients. When a DN-MGUS patient is regularly treated by IVIg courses, frequent periodic clinical evaluations must be performed to determine when to stop treatment and switch to another one.
We retrospectively studied the efficacy of IVIg in 14 patients with DN-MGUS (seven IgM and seven IgG/A) and seven with anti-MAG neuropathies, treated in our reference center between 2002 and 2007. Patients were clinically evaluated before the first infusion, after the first infusion, and after the last IVIg treatment.
Anti-MAG neuropathy: after a single infusion, one patient improved and six were stable. At last follow-up (mean: 15.6months [range: 3.5-31], mean number of IVIg courses: 8 [2-33]), one patient maintained her improvement from baseline. DN-MGUS: after a single infusion, nine patients improved (64%), four were stable and one deteriorated further. The factor predictive of short-term response to IVIg was relapsing neuropathy responding better in the walking score analysis (Fisher exact test: P=0.005). At last follow-up (mean: 22.6months [range 2-72], mean number of IVIg courses: seven [1-24]), neurological status improved in four patients, five patients remained stable, including three who are still under regular IVIg, and four had deteriorated. Improvement from baseline persisted for a prolonged period in two patients after IVIg were stopped. Patients who were responders on Norris after the first IVIg course were significantly better responders at long-term follow-up than the others (P=0.001). We report no serious adverse effect.
IVIg are not very efficient in the management of anti-MAG neuropathies. Nevertheless, they have a frequent short-term beneficial effect in DN-MGUS, which was maintained at long-term follow-up in one-third of our patients. When a DN-MGUS patient is regularly treated by IVIg courses, frequent periodic clinical evaluations must be performed to determine when to stop treatment and switch to another one.
Keywords
Adult, Aged, Aged, 80 and over, Demyelinating Diseases/complications, Demyelinating Diseases/drug therapy, Female, Follow-Up Studies, Hospitals, Humans, Immunoglobulins, Intravenous/administration & dosage, Immunoglobulins, Intravenous/therapeutic use, Infusion Pumps, Male, Middle Aged, Monoclonal Gammopathy of Undetermined Significance/complications, Monoclonal Gammopathy of Undetermined Significance/drug therapy, Retrospective Studies, Time Factors, Treatment Outcome
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Create date
12/12/2017 17:32
Last modification date
20/08/2019 15:02