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FcRn inhibitors in the treatment of CIDP
Alexander H Morrison1, Jeffrey A Allen2
1Department of Neurology, The Neuroscience Research Institute, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated syndrome that causes progressive and relapsing weakness and sensory loss. Evidence-based treatments that have been shown to lessen disability, improve impairment, and prevent relapse include immunoglobulins, corticosteroids, and plasma exchange. While these therapeutics are beneficial to most patients, not all patients respond, residual deficits are common even in responding patients, and each treatment is associated with a unique set of side effects and logistical limitations. The neonatal Fc receptor (FcRn) has emerged as a promising therapeutic target in IgG antibody-mediated diseases. Multiple FcRn inhibitors are now under development for CIDP with one, efgartigimod, now approved for treatment of CIDP. This review summarizes the pathobiology of CIDP, the current treatment landscape, and the rationale for FcRn inhibition in CIDP. It then reviews the data on FcRn inhibitors currently under investigation for CIDP with a focus on applying the clinical trial evidence to clinical practice.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated syndrome that causes progressive and relapsing weakness and sensory loss. Evidence-based treatments that have been shown to lessen disability, improve impairment, and prevent relapse include immunoglobulins, corticosteroids, and plasma exchange. While these therapeutics are beneficial to most patients, not all patients respond, residual deficits are common even in responding patients, and each treatment is associated with a unique set of side effects and logistical limitations. The neonatal Fc receptor (FcRn) has emerged as a promising therapeutic target in IgG antibody-mediated diseases. Multiple FcRn inhibitors are now under development for CIDP with one, efgartigimod, now approved for treatment of CIDP. This review summarizes the pathobiology of CIDP, the current treatment landscape, and the rationale for FcRn inhibition in CIDP. It then reviews the data on FcRn inhibitors currently under investigation for CIDP with a focus on applying the clinical trial evidence to clinical practice.
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