Despite the well-recognized importance of immunoglobulin therapy individualization during the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP), the pathway to best achieve optimization is unknown. There are many pharmacokinetic and immunobiologic variables that can potentially influence the appropriateness of any individual therapy. Although identification of specific autoantibodies and their targets has only been accomplished in a minority of patients with CIDP, already the diagnostic and treatment implications of specific autoantibody detection are being realized. Individual variability in IgG pharmacokinetic properties including IgG catabolic rates and distribution, as well as the IgG level necessary for disease control also require consideration during the optimization process. For optimization to be successful there must be a measure of treatment response that has a clinically meaningful interpretation. There are currently available well-defined and validated clinical assessment tools and outcome measures that are well suited for this purpose. While there remains much to learn on how best to manipulate immunopathology and immunoglobulin pharmacokinetics in the most favorable way, there currently exists an understanding of these principles to a degree sufficient to begin to develop rational and evidence-based treatment optimization strategies.

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Keywords Autoimmune neuromuscular diseases, Chronic inflammatory demyelinating polyneuropathy, Immune-mediated neuropathies, Intravenous immunoglobulin, Pharmacokinetics
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Journal Journal of the Peripheral Nervous System
Note ∗From a symposium on “Individualized Therapy in CIDP” chaired by Jeffrey A. Allen (University of Minnesota, Minneapolis, MN, USA) at the Annual Meeting of the Peripheral Nerve Society in Sitges, Spain, July 2017, featuring Luis Querol, Krista Kuitwaard and Robert D. Hadden as speakers
Allen, J.A. (Jeffrey A.), Berger, M. (Melvin), Querol, L, Kuitwaard, K, & Hadden, R.D.M. (2018). Individualized immunoglobulin therapy in chronic immune-mediated peripheral neuropathies*. Journal of the Peripheral Nervous System. doi:10.1111/jns.12262