Randomized, controlled crossover study of IVIg for demyelinating polyneuropathy and diabetes

Authors: Ari Breiner, MD, MSc, FRCPC, Carolina Barnett Tapia, MD, PhD, Leif Erik Lovblom, MSc, Bruce A. Perkins, MD, MPH, FRCPC, Hans D. Katzberg, MD, MSc, FRCPC, and Vera Bril, MD, FRCPC

Published: Neurol Neuroimmunol Neuroinflamm, 2019; 6: e586

Abstract: Objective: To determine whether IV immunoglobulin (IVIg) is more effective than placebo at reducing disability in patients with diabetes and demyelinating polyneuropathy features.

Methods: This is a double-blinded, single-center, randomized, controlled crossover trial of IVIg treatment vs placebo. The primary outcome measure was the mean change in Overall Neuropathy

Limitation Scale (ONLS) scores during the IVIg phasecompared with the placebo phase. Secondary outcomes include changes in the Rasch-built Overall Disability Scale, Medical Research Council sum scores, grip strength, electrophysiologic measurements, quality of life, and adverse effects.

Results: Twenty-five subjects were recruited between March 2015 and April 2017. The mean change in ONLS scores was −0.2 points during the IVIg phase and 0.0 points during the placebo phase (p

= 0.23). Secondary outcomes did not show significant differences between IVIg and placebo.

Conclusions: IVIg did not reduce disability, improve strength, or quality of life in patients with demyelinating polyneuropathy features and diabetes after 3 months of treatment in comparison with placebo. Therefore, careful consideration of the primary diagnosis is required before immunomodulatory therapy.

Classification of evidence: This study provides Class I evidence that for patients with diabetes and demyelinating polyneuropathy features, IVIg did not significantly reduce disability.