5 answers about immunoglobulin infusions for CIDP

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neuromuscular condition that causes damage and inflammation to the myelin sheath, the insulating layer of fatty substances and proteins that protects nerve fibers and also conducts nerve signals.

When myelin becomes damaged, nerve fibers function less well—and in the case of CIDP, this can cause muscle weakness, loss of feeling in the limbs, abnormal sensation (such as tingling and pain), problems with coordination and balance, and many other symptoms.

While there is no cure for CIDP, there are effective treatments available. If you are diagnosed with CIDP, immunoglobulin therapy will likely be one of the first treatments that you discuss with your healthcare providers.

Here are five things to know about immunoglobulin therapy.

What is immunoglobulin therapy?

Immunoglobulins function as antibodies, proteins that the immune system uses to remove viruses, harmful bacteria, chemicals, and other potentially harmful substances. Antibodies bind to unwanted substances, which marks them for removal by the immune system. With immunoglobulin therapy, a person receives a concentrated infusion of immunoglobins that have been collected from donated blood plasma.

How does immunoglobulin therapy treat CIDP?

There are still many unanswered questions about CIDP, including what exactly causes the disorder. Research supports the idea that CIDP is an autoimmune disease or an immune mediated disease—a disorder where the immune system makes antibodies that bind to healthy tissue, or a disorder related to some other abnormal immune system activity.

Immunoglobulin therapy helps regulate immune system activity. While the exact mechanism of how it helps reduce disease activity in CIDP is unknown, it has been proven to be a safe and effective therapy.

How is immunoglobulin therapy administered?

Intravenous immunoglobulin (IVIg) is an infusion of immunoglobulin that goes directly into a vein. If your healthcare provider recommends immunoglobulin therapy, the initial dose (or doses) will be given as IVIg. The initial dose or doses are called induction therapy. The goal is to get CIDP into remission as quickly as possible with a highly concentrated dose of immunoglobulin.

Immunoglobulin can also be given as a subcutaneous infusion, where it is infused into the layer of fatty tissue under the skin. This method is not used as induction therapy, but it can be used as maintenance therapy. Maintenance therapy refers to follow up doses that are given after remission has been achieved, to help keep the disease in remission. Like many aspects of treating CIDP, the dosing schedule for maintenance therapy can vary from one person to the next.

With training from a healthcare provider, subcutaneous immunoglobulin infusions (SCIg) can be self-administered, or administered with the help of a caregiver.

Which method should you choose for maintenance therapy?

This is a conversation to have with your healthcare provider. Both IVIg and SCIg have potential advantages. For example, intravenous infusions require a person to visit a healthcare provider or medical center for every dose, which can be inconvenient. But IVIg has the benefit of always being supervised by a healthcare team.

Subcutaneous infusions can be given at home, but a person or caregiver will need to be trained on how to perform the infusion properly.

Because IVIg and SCIg use different formulations, there may be differences in how a person responds to each. Both methods are still being studied.

What if CIDP doesn’t respond to immunoglobulin therapy?

There are other treatment options available. If you do not respond to immunoglobulin therapy, your healthcare provider may recommend adding another therapy or switching to a different therapy. Corticosteroids, immunosuppressive drugs, and plasma exchange are other potential treatment options.