CIDP Learning Zone
Transcript: Long-term complications associated with CIDP
Eduardo Nobile-Orazio, MD, PhD
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speakers and is not adjusted by Medthority.
The main long-term complication is the fact that the patient does not respond. There are a few percent, which is less than 10% of the patients, who do not improve, maybe who do not improve, maybe, you know, within all the therapy we have. We have about 85% of treated patients that they improve with therapy. So, there is this 15% of the patients, of course, where they do not respond. So, the first point, if the patient, you know, sometimes responds to treatment can be also helpful in confirming the diagnosis. Another one is anti-MAG neuropathy, but that is a very slow, progressive, it's difficult to ascertain, you know, in this patient. But you know, in this patient, we do not.
So if you have a patient who do not respond to therapy, the first thing you have to think, "Well, I made a wrong diagnosis." So that is a point. Even though I have to say the most frequently used therapy are intravenous immunoglobulin steroids, and is also known that if patient does not respond to other, 50% of the patient who do not respond to one of the two, they'll respond, you know, to the other therapy. But still, you know, whenever you have a patient who do not respond, you start to say, "Maybe I'm wrong. "Maybe I just want to see a patient "that this patient has CIDP," it doesn't have a source. Start to think again and reconsider the diagnosis. Over the long term about complication. Well, the complication say for steroids, you know, if the long use of steroids. But the point is that steroids, you know, are easy to use. You know, you give pills, you know, don't admit the patient or you know, but they have, you know, some long term side effects, you know, diabetes, agitation, hypertrichosis, ulcers, you know, but you know, it's not all the country you can afford to use this, you know, to use immunoglobulin because they're expensive.
So even in Italy there are some place where, you know, the administration of the hospital prefer that you start with steroids, and if they don't work, you know, we go with immunoglobulin. Immunoglobulin are much faster in their use. You know, you usually see an improvement within one or two months, you know. If you don't respond to two months of therapy in immunoglobulin, it's very unlikely that the patient will respond. So, and also in this, you have to reconsider the diagnosis, but of course, you know, the lack of response doesn't exclude the diagnosis. The complication of IVIG are kind of very infrequent. In patient where at the beginning when we were using a lot and there was this willingness to reduce the administration of immunoglobulin and sometimes we were given immunoglobulin faster than, you know, usual. And so there was some case of thrombosis, a few cases were reported with brain ischemia, I mean brain infarct, or patient who were at risk for arteriosclerosis or myocardial infarct, but these are very rare conditions. Most of the patient, let's say 95% of the patient do not have complication because and the other things is if you have kidney disease, the renal insufficiency, you should not give this therapy. So in the decision of the initial therapy, one of the things you have to consider, if the patient has any contraindication to the use of IVIG.
If you have thrombosis, something like that, thrombophilic condition, you know, immunoglobulin might be contraindicate. If you have renal insufficiency, immunoglobulin can be contraindicate. If you have diabetes, steroids are contraindicated. If you have, you know, liver pathology, you know, steroids might not be the first choice. So there is a number, if you have gastric ulcer, of course, you know, because steroids are not indicated. If you have manic depressive, steroids are not indicated. So it is also important to always to consider the patient as a whole and not just, you know, the symptom of the disease, then forget about the other disease. When it's talking about the patient, first you have to think about, you know, the diagnosis. Then you think about the test you might do, and then you also have to think and ask about all the other concomitant pathology the patient might have because this will lead you in the decision of the therapy.