Intravenous immunoglobulin cessation trials in chronic inflammatory demyelinating polyneuropathy

<h3>Background</h3> Chronic inflammatory demyelinating neuropathy (CIDP) is the most common autoimmune neuropathy. 70-80% improve with first-line treatment, including IVIg. But 16-55% of patients enter remission over time, no longer requiring maintenance treatment. The only way to determine remission versus well-treated, active disease is to cease treatment and observe for deterioration using MCID change in MRC-SS, I-RODS and grip strength. <h3>Aims</h3> We examined trust compliance with national guidance and the success rate of IVIg cessation trials in patients with stable CIDP. <h3>Results</h3> 125 CIDP patients were on maintenance IVIg; 76 on stable treatment regimens and 45 clinically stable over 12 months. 9 patients had undergone recent treatment cessation trials between 2018-2021 demonstrating active disease, were re-established on IVIg and not rechallenged within the study period, leaving 36 eligible patients. 12/36 (33.3%) had a treatment cessation trial performed, with 8/12 (66.7%) remaining stable off treatment for ≥6 months. The median IVIg spend was £107,000 per person/year. Successful cessation in 8 patients equates to cost reduction of £850,000/year going forward. Optimal compliance with national guidance (66.7% stable off treatment in 36 eligible patients) could reduce IVIg spend by £1.7 million/year.