Long-term treatment of chronic inflammatory demyelinating polyradiculoneuropathy with plasma exchange or intravenous immunoglobulin

To assess long-term treatment of chronic idiopathic demyelinatingpolyradiculoneuropathy (CIDP) with plasma exchange (PE) andintravenous immunoglobulin (IVIg), we studied 105 patients retrospectivelyby case-notes and follow-up. Thirty-three were treated withPE; 23 responded well. Twenty-two were treated with IVIg; 14responded well and one had a hypotensive reaction during thefirst infusion. For both treatments, responders were more likelyto be female and younger, and to have a shorter duration ofsymptoms. Most patients required only one course of treatment.Seven patients received repeated courses of PE for 8.1–59.7months; seven received repeated courses of IVIg for 6–51months. Transient complications occurred with PE: hypotensionin three, difficulty in gaining venous access in three, andhaematoma, bleeding diathesis, hypocalcaemia, and septicaemiain one patient each. Four patients transferred from long-termPE to IVIg, but the fifth responded to PE only. Two patientswho were transferred from PE to IVIg were eventually able tostop all treatments. Long-term use of IVIg was free of any significantcomplications. Both PE and IVIg are possible long-term treatmentsfor CIDP, but both are expensive, and PE had more side-effects.