Alemtuzumab in refractory chronic inflammatory demyelinating polyneuropathy

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Abstract

Objectives

Standard treatment for CIDP usually includes intravenous immunoglobulin or oral corticosteroids and a steroid-sparing agent but there are no formal guidelines for the management of refractory CIDP. Alemtuzumab is a humanised monoclonal antibody that has applications in multiple sclerosis and lymphoproliferative disorders but its use in the management of CIDP is unclear. We report two cases of refractory CIDP who responded to treatment with alemtuzumab.

Methods

Retrospective analysis of two patients that responded positively to alemtuzumab after failing conventional therapies for CIDP, including alternative immunosuppressants. Review of patient medical records, including diagnostic studies, chronology of previous treatments. The main outcomes measured were changes in functional capacity and electrophysiological testing after treatment with alemtuzumab.

Results

Both patients achieved remission of CIDP and improvement in function after one course of treatment with alemtuzumab. This was in the setting of aggressive clinical progression, repeated admissions and initial full dependence with activities of daily living. Alemtuzumab was tolerated by both patients with improvements noted over several months and increased independence that has been sustained to date.

Conclusions

Alemtuzumab appears to alter the course of treatment resistant CIDP and may potentially induce remission. Further studies would be valuable to determine the role of alemtuzumab in CIDP, as well as determine the long-term safety and efficacy in these patients.

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