Retrospective analysis of response to rituximab in chronic inflammatory demyelinating polyneuropathy refractory to first‐line therapy

Farzad Fatehi, Ali Asghar Okhovat, Akram Panahi, Bentolhoda Ziaaddini, Yusuf A. Rajabally*, Shahriar Nafissi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Few case reports/series describe the efficacy of rituximab in refractory chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which is preferred in the presence of anti-nodal/paranodal antibodies. We aimed at evaluating the clinical response to rituximab in a subset of patients with refractory CIDP for whom the anti-nodal/paranodal antibodies status was unknown, as not available in Iran. We retrospectively analyzed the response to rituximab in 14 Iranian patients with refractory CIDP (3 children, 11 adults), in whom the anti-nodal/paranodal antibodies status was unknown. The subjects were evaluated with the Medical Research Council (MRC) sum score (MRCSS), Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores, and electrophysiology, before and after treatment. Mean age was 34.4 ± 20.7 years, disease duration pre-rituximab treatment was 27.8 ± 18.8 (range: 6-60) months, and mean follow-up duration was 18.5 ± 11.0 (range: 4-36) months. Considering the INCAT sum score, one worsened during post-rituximab treatment, and three patients did not change. Considering MRCSS, notably, four patients achieved normalization of their MRCSS. Regarding the corticosteroid dose, two patients could discontinue prednisolone. As rated by a pre-defined scoring system, nerve conduction parameters improved significantly post-rituximab in the treated cohort (P = .006). All patients tolerated rituximab infusions without adverse effects. Rituximab may be effective in refractory CIDP, even though worsening may occur in some patients. Anti-nodal/paranodal antibodies assay, when available, and other criteria may help drive therapeutic decision-making on rituximab as second-line treatment.
Original languageEnglish
JournalJournal of the Peripheral Nervous System
Early online date1 Sep 2021
DOIs
Publication statusE-pub ahead of print - 1 Sep 2021

Keywords

  • anti-nodal/paranodal antibodies
  • chronic inflammatory demyelinating polyneuropathy
  • refractory
  • rituximab

Fingerprint

Dive into the research topics of 'Retrospective analysis of response to rituximab in chronic inflammatory demyelinating polyneuropathy refractory to first‐line therapy'. Together they form a unique fingerprint.

Cite this