Intravenous immunoglobulin and intravenous methylprednisolone as optimal induction treatment in CIDP

1. Probable or definite CIDP according to the EFNS/PNS criteria 2010 (all CIDP phenotypes)
2. Age ≥ 18 years
3.1. Treatment naïve patients; or
3.2. Previously treated patients who have a relapse after a remission of at least 1 year; or
3.3. Patients treated with subjective or objective improvement after a single loading dose of IVIg in the last 3 months, and subsequent deterioration as judged by his or her treating physician.

A potential patient who meets any of the following criteria will be excluded from participation in this study:
1) Presence of IgM paraproteinemia and/or anti-MAG antibodies or CIDP specific antibodies associated with poor treatment response to IVIg
2) Use of drugs associated with a demyelinating neuropathy
3) Use of any immunosuppressive or immunomodulatory drugs in previous 6 months (except for a single loading dose of IVIg within 3 months or low dose prednisolone (20 mg or less) during a short period (maximum duration of two weeks).
4) Known serious adverse events with previous IVIg or corticosteroid treatment. Hypersensitivity to methylprednisolone or any component of the formulation. Hypersensitivity to the human immunoglobulins or to any of the excipients. Selective IgA deficiency patients who developed antibodies to IgA.
5) Systemic fungal infections, unless specific anti-infective therapy is employed.
6) Known hyperprolinaemia type I or II or known fructose intolerance.
7) One of more of the risk factors associated with increased risk of adverse events of IVIg or IVMP or conditions that could lead to unblinding of treatment (i.e. diabetes; IgA deficiency; gastric ulcers; psychosis; severe hypertension (180/110 mmHg or more on repeated measurements); hypocalcaemia (lower than 2.20 mmol/L, corrected for albumin); moderate or severe heart failure; severe cardiovascular disease (i.e. more than one myocardial infarction and or ischemic stroke); renal failure (glomerular filtration rate < 30 ml/min)
8) History of osteoporosis or osteoporotic fractures
9) Known active malignancy, currently treated with chemotherapy or immunomodulatory drugs, or with a life expectancy of less than 1 year.
10) Bodyweight more than 120 kg
11) Pregnancy or nursing mother; intention to become pregnant during the course of the study; female patients of childbearing potential either not using or not willing to use a medically reliable method of contraception for the entire duration of the study. A woman is considered of childbearing potential from menarche and until becoming post-menopausal, unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. Acceptable methods of contraception are: combined (oestrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (whether oral, intravaginal or transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (whether oral, injectable or implantable), progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action, male or female condom with or without spermicide, cap or diaphragm, intrauterine device (IUD), intrauterine hormone-releasing system (IUS), bilateral tubal occlusion, vasectomised partner (provided that partner is the sole sexual partner of the trial participant and that the vasectomised partner has received medical assessment of the surgical success).
12) Known cataract or cataract obvious on fundoscopy
13) Current psychosis or past history of psychosis
14) Poor dental status
15) Known pulmonary embolism or other deep venous thrombosis in patient’s medical history, without current anticoagulant therapy
16) Adults lacking capacity to give informed consent.
17) Lack of written informed consent