Predicting treatment responses to IV immunoglobulins

IV immunoglobulins (IVIg) play an important role in the treatment of various immune-mediated diseases. The use of IVIg has revolutionized the therapy of numerous neurologic autoimmune disorders1 and is a mainstay for the treatment of immune-mediated neuropathies.2 In most subforms, including Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and multifocal motor neuropathy, IVIg has shown remarkable effectiveness and therefore finds much broader application than other established treatments, such as corticosteroids or plasma exchange. In CIDP, the therapeutic relevance of IVIg has just recently been highlighted by the positive results of the Immune Globulin Intravenous CIDP Efficacy (ICE) trial, demonstrating short- and long-term benefits in a large cohort of affected patients.3 However, even though there is overwhelming evidence that IVIg is effective in CIDP, a proportion of patients consistently does not respond to this treatment, which has been attributed to the marked heterogeneity of the disease course and to interindividual differences in the aberrant immune response that causes CIDP. The problem of variable response is magnified when one …