Weighing Treatment Options for CIPD

Treatment for chronic inflammatory demyelinating polyneuropathy (CIPD) varies as the disorder is considered rare. Presenters at the Asembia 2019 Specialty Pharmacy Summit discussed diagnosis methods and multiple therapy options that patients might undergo. 

CIPD is a neurological disorder caused by damage to the myelin sheath—the fatty layer that surrounds nerve fibers—that causes weakness, impairment, or paralysis of the limbs according to the National Institute of Neurological Disorders and Stroke.

Symptoms of CIPD include numbness or tingling, weakness of the arms or legs, and limb fatigue among others. Tuan Vu, MD, professor of neurology, University of South Florida, Tampa, FL explained that diagnosis could consist of electrodiagnostic studies, CSF examinations, spinal root MRIs, a variety of blood tests, and in rare cases, nerve biopsies. Though he noted biopsies are uncommon, they can be useful to exclude other conditions like amyloidosis, vasculitic, toxic, or hereditary neuropathy.

Treatment options include corticosteroids, immunosuppressants, plasmapheresis (PLEX), and immunoglobulin (IVIg and SCIg), which is believed to be the most effective long-term option, explained Dr Vu. “Other therapeutic agents are on the horizon; biologics and stem cell therapy may be options for some treatment-resistant patients.”

Certified immunoglobulin nurse, Amy E Clarke, RN IgCN, director, clinical program service, Nursing Diplomat Infusion, Cincinnati, OH, added that immunoglobulin therapy is considered clinically effective.

“Product choice should be made based on patient comorbidities and product characteristic,” said Ms Clarke. “Although products are not interchangeable, there are varying characteristics that may affect tolerance.”

Ms Clarke went on to explain that immunoglobulin products are stabilized with sugars or amino acids and can be administered intravenously or subcutaneously. She stressed the importance of considering the various locations of care based on patient preference, the goal of therapy, and a collaborative patient provider relationship.

Therapy could be administered in an ambulatory infusion suite, physician’s office, outpatient hospital-based infusion clinic, or potentially at home provided policy and safety protocols are in place and well-communicated.

“From a pharmacy perspective, it is imperative that the pharmacist selects the appropriate product, site, and route based on patient comorbidities, risk factors, preference, and reimbursement considerations,” said Ms Clarke.

—Edan Stanley