The role of IVIg in autoimmune neuropathies: the latest evidence.

Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) are the major immune neuropathies. Although a detailed understanding of the pathogenesis of these conditions is not yet available, the multiple effects of IVIg on the immune and inflammatory process recommend it as an agent worthy of investigation in these diseases. Following recent research, IVIg is now recommended as a first-line treatment option for moderate or severe GBS to be administered within two weeks of disease onset. With regard to CIDP, a Cochrane review demonstrated significant short-term improvements in disability and impairment with IVIg. The ICE (IGIV CIDP Efficacy trial) study group undertook the largest ever trial of IVIg for CIDP, which demonstrated for the first time the long-term efficacy of IVIg. The results of this ICE trial demonstrated the efficacy of IVIg in CIDP, with a significantly higher response rate versus placebo after 24 weeks of treatment (P = 0.0002). Furthermore, long-term maintenance with IVIg also significantly reduced the rate of relapse (P < 0.011). On the basis of available data, IVIg can be recommended as a first-line treatment option for GBS and CIDP. For MMN, although the evidence for IVIg is limited, there is no evidence to recommend other treatments.