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CIDP – IVIg Dose Reduction Trial — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularCIDP – IVIg Dose Reduction TrialSCE Neurology

A 50-year-old man with CIDP on maintenance IVIg has his dose and frequency optimised. His neurologist wants to confirm that IVIg is still needed (rather than the CIDP having remitted). How should this be assessed?

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Correct answer: C — Periodic trial IVIg dose reduction (titration) — gradually reduce the dose or extend the interval while monitoring for clinical deterioration; if stable at a reduced dose, attempt supervised withdrawal to determine whether CIDP has remitted

CIDP can remit in some patients. NICE and EAN/PNS guidelines recommend periodic reassessment of ongoing IVIg need through supervised dose reduction/interval extension. If the patient remains stable at a lower dose, a trial withdrawal under close monitoring (clinical assessment + NCS) can determine whether the CIDP has remitted. Approximately 30% of CIDP patients can eventually discontinue IVIg. Abrupt cessation risks rapid deterioration in those who still need treatment. A: Reassessment is important to avoid unnecessary treatment. C: Abrupt cessation risks relapse. D: NCS are helpful but clinical assessment drives the decision. E: LP is not the primary reassessment tool.

Reference: EAN/PNS CIDP Guidelines (2021); NICE IVIg Commissioning