Safety and tolerability of immune globulin intravenous in chronic inflammatory demyelinating polyradiculoneuropathy

Background Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a common inflammatory neuropathy that can be progressive, stepwise progressive, or relapsing and remitting. Objectives To further evaluate the long-term safety and tolerability of immune globulin intravenous, 10% caprylate–chromatography purified immune globulin intravenous in CIDP. Design Randomized multicenter trial. Setting Hospitals and outpatient clinics. Patients Adults with CIDP (n = 113). Interventions Immune globulin intravenous, 10% caprylate–chromatography purified (2 g/kg of body weight) or placebo was infused as a baseline loading dose, followed by a maintenance dose (1 g/kg) every 3 weeks for up to 24 weeks. Patients who responded were rerandomized into a double-blind extension phase of immune globulin intravenous, 10% caprylate–chromatography purified (1 g/kg) or placebo every 3 weeks for up to 24 weeks. Patients who relapsed during the extension phase were withdrawn from the study. Main Outcome Measures Additional analyses of safety and tolerability. Results Overall, 113 patients and 95 patients were exposed to immune globulin intravenous, 10% caprylate–chromatography purified and placebo, respectively. Exposure to immune globulin intravenous, 10% caprylate–chromatography purified was approximately twice that of placebo (1096 vs 575 infusions). Most maintenance dose courses were administered over 1 day in the immune globulin intravenous, 10% caprylate–chromatography purified (89.1% of 783 dose courses) and placebo (91.1% of 359 dose courses) groups. The most common drug-related adverse events (AEs) with immune globulin intravenous, 10% caprylate–chromatography purified were headache (4.0 per 100 infusions) and pyrexia (2.4 per 100 infusions). Five drug-related serious AEs (pulmonary embolism, pyrexia, vomiting, and 2 headache events) were reported in 3 patients (2.7%) exposed to immune globulin intravenous, 10% caprylate–chromatography purified. The incidence of drug-related serious AEs was higher after loading dose infusions than after maintenance dose infusions (4 AEs vs 1 AE). Age, weight, CIDP severity, and previous immune globulin intravenous exposure had no substantial effect on the percentage of patients with AEs, including serious AEs. Conclusion Data support a favorable safety and tolerability profile for administration of immune globulin intravenous, 10% caprylate–chromatography purified as CIDP maintenance therapy. Trial Registration clinicaltrials.gov Identifier:NCT00220740