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CIDP – IVIg Wear-Off Management — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularCIDP – IVIg Wear-Off ManagementSCE Neurology

A patient with CIDP improves reproducibly after each maintenance IVIg infusion but deteriorates in the final week before the next four-weekly dose. Objective strength follows the same pattern. What adjustment is most rational?

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Correct answer: C — Confirm end-of-dose deterioration and individualise IVIg by shortening the interval or redistributing the dose

The best answer is “Confirm end-of-dose deterioration and individualise IVIg by shortening the interval or redistributing the dose”. Documented end-of-dose wear-off supports individual dose/interval optimisation while periodically testing the lowest effective regimen. “Declare irreversible progression and stop IVIg immediately” is plausible in a different neurological context, but the decisive findings here argue against it. “Add indefinite high-dose corticosteroid without reassessment” is plausible in a different neurological context, but the decisive findings here argue against it. “Switch automatically to plasma exchange after one fluctuation” is plausible in a different neurological context, but the decisive findings here argue against it. “Increase the interval because improvement proves placebo response” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: EAN/PNS guideline on diagnosis and treatment of CIDP: https://pubmed.ncbi.nlm.nih.gov/34085743/