[Efficacy and availability of intravenous immunoglobulin in chronic inflammatory demyelinating polyneuropathy]

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated polyradiculoneuropathy. Well-designed randomized controlled trials have indicated that three types of therapeutics(corticosteroids, intravenous immunoglobulin (IVIg), and plasmapheresis) are useful. IVIg is considered as first-line therapeutics due to its feature with convenience to use and less adverse effects compared to other therapeutics. A standard IVIg regimen for CIDP is 2 g/kg within 5 days. Recently, new types of immunoglobulins are expected to be superior in purity and production cost than conventional immunoglobulins. The efficacy of new immunoglobulins will be evaluated in the near future. About IVIg responsiveness, axonal dysfunction concomitant with demyelination has been indicated as an important factor of IVIg responsiveness in CIDP. Further study also supports that a specific haplotype of single nucleotide polymorphisms (SNPs) of TAG-1, which concerns axon-myelin interaction, could be associated with IVIg responsiveness. Recent research has examined IVIg for its mechanisms as an anti-inflammation function through a T(H)2 cytokine pathway. Those cytokines may be controlled by sialylated Fc in the immunoglobulin preparation. These findings may be followed by the development of more efficient and reasonable IVIg preparations.