Dose response study of intravenous immunoglobulin in CIDP

• Conditions: Chronic inflammatory demyelinating polyradiculoneuropathy.; MedDRA version: 18.1Level: LLTClassification code 10035325Term: Plasma immunoglobulin G decreasedSystem Organ Class: 100000004848; Therapeutic area: Diseases [C] - Nervous System Diseases [C10]

• Registration Number: EUCTR2012-005150-34-NL
• Lead Sponsor: Erasmus MC

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2014-07-23
• Last Update Posted: 7 December 2015

Recruitment & Eligibility

• Status: Authorised-recruitment may be ongoing or finished
• Sex: All
• Target Recruitment: 17

Inclusion Criteria

1.Diagnosis of CIDP or acute-onset CIDP made by a consultant neurologist, fulfilling the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) clinical diagnostic criteria.
2. Age 18 years or older.
3. Significant improvement following the first use of IVIg, defined as a decrease of = 1 grade on the modified Rankin disability scale.
4. To indicate that the patient is still IVIg dependent and has active CIDP, he/she must have shown either an objective deterioration (decrease in muscle strength measured with the vigorimeter and/or MRC sum score following reduction of IVIg dose or lengthening of the IVIg interval or an objective improvement (measured with the vigorimeter and/or MRC sum score) following an increase in IVIg dose or shortening of the IVIg interval at some time during the 9 months before randomisation.
5. Ongoing intermittent treatment with 10% liquid IVIg (Kiovig) for at least 2 infusions. The dose must have been not changed within the 8 weeks prior to the study.
6. EMG findings compatible with CIDP showing peripheral nerve demyelination at least once during their illness.
7. Signed informed consent by the patient.
Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 12
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 5

Exclusion Criteria

1. Known IgA deficiency or known allergic reaction to IVIg.
2. Hand grip strength measured by the Martin Vigorimeter ? the median value (kPa) for an age and sex matched healthy control.
3. Maintenance dose < 15 gram of IVIg every infusion or an infusion interval < 14 days.
4. Known hereditary neuropathy or severe concomitant diseases such as HIV infection, Lyme disease, chronic active hepatitis, congestive heart failure, systemic lupus erythematosus, drug or toxin induced neuropathy, vasculitis, and malignancies.
5. Multifocal motor neuropathy (MMN), fulfilling the European Federation of Neurological Societies /Peripheral Nerve Society criteria.
6. IgM paraprotein with anti-myelin-associated glycoprotein (MAG) antibodies.
7. Atypical CIDP with pure sensory or persistent unifocal impairment or significant central nervous system involvement.
8. Participation in a controlled trial of an investigational medicinal product within the past 12 weeks.
9. Severe known abnormalities in liver, kidney function or serum glucose level.
10. Treatment with > 20 milligrams of prednisone a day.
11. Treatment with other immunosuppressives (e.g. methotrexate, azathioprine, prednisone) if the dosage has been changed within 8 weeks prior to start of the study.

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Secondary Objective: The secondary objective is to investigate whether high frequency low dosage of IVIg results in less adverse events compared to low frequency high dosage. ;Timepoint(s) of evaluation of this end point: Hand grip strenght will be measusured before very infusion, and this endpoint will be evaluated at the end of the trial. ;Primary end point(s): Hand grip strength (Vigorimeter) will be used as the primary outcome measure. A difference in the (mean of the 4) Vigorimeter changes from baseline between the two groups of > 8 kPa (mean of both hands) is considered clinically relevant. A difference of > 8 kPa in Vigorimeter change from baseline in favour of the group treated with half the dosage and interval as compared with the other treatment group will be considered a clinical relevant improvement. ;Main Objective: The main objective is to investigate whether high frequency low dosage IVIg treatment is more effective than low frequency high dosage as maintenance treatment for CIDP

Secondary Outcome Measures

Name	Time	Method
Secondary end point(s): Changes in the R-ODSS, R-FSS, and SF-36 will be used as secondary outcome measures. The secondary objective will be to record the occurrence of side-effects. ;Timepoint(s) of evaluation of this end point: Questionnaires will be filled-in just before every infusion, and this endpoint will be evaluated at the end of the trial.