Transcript
Patients’ preferences in CIDP treatment plans
Eduardo Nobile-Orazio highlights the importance of considering patient preferences and individual lifestyle when developing their personalized CIDP treatment plan. View transcript.
Eduardo Nobile-Orazio, MD, PhD
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When we discuss with the patient, we do not decide what to give. We might have an idea, but it is our policy to discuss about the pros and cons. So for instance, I say, "Okay, you can take steroids." So you take pills or you take intravenous, but usually you take pills, you don't have to come to the hospital. And so you do, but if you take steroids, you have to take, you know, so also gastro protector because of ulcers, because, you know, insomnia or other things and check for other things.
Or you may a just come once a week or once or twice a month, you know, to take immunoglobulin and you do that and then you go home and you do your normal life. Then we have therapy, we can change, you know, instead of giving intravenous, we can go to subcutaneous immunoglobulin, which can, you can be easily do at home. But we usually, of course, you know, if we can afford both therapy, if the patient is in a place where they cannot afford because they, you know, immunoglobulin, now you have to do immunoglobulin. I don't have the money to pay for that. So it depends on who pay for the treatment. But in more in general, I think it is crucial to explain the patient, you know, why you prefer to give a therapy that's better than the other and then you share the decision within, you know, it's not that you say you have to do this and that, no, that is not the policy. And even in the guideline there is no written that one of the missing point in the European Academy and PNS guideline is, doesn't tell you how to start treatment. They say, "Well you can choose one of the first treatment, which is IVRG steroids and plasma change." Actually, we do not suggest plasma changes starting therapies inconvenient, the patient has to come every time to the hospital.
Today it is more invasive. And so that is something we just, considering patient who has not respond to IVRG steroids. But between the two, you know, we have these two main party who pay for who cover the cost. And what is, you know, the, I would say that in Italy, most of the patient prefer to go to a immune intravenous immuno. It's very rare to have a patient and say, "Oh no, okay, I prefer to take the pills home," and, you know, not to take days off to come to the hospital. So, you know, there are things that you have to discuss with the patient.
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