A controlled study of intravenous immunoglobulin in demyelinating neuropathy with IgM gammopathy

TLDR

Eleven patients with IgM‑associated demyelinating polyneuropathy were randomized in a double‑blind, 3‑month, monthly IVIg versus placebo trial, then crossed over after washout, with outcomes assessed by muscle strength, sensation, and neuromuscular symptom scores at baseline, 3 months, and end of treatment. IVIg produced modest benefit, improving strength in only 2 of 11 patients (28–38.5 points) and sensory scores in one patient, with no change in antibody titers, leading to the conclusion that only about 18 % of IgM paraproteinemic demyelinating neuropathy patients benefit.

Abstract

Abstract Eleven patients with demyelinating polyneuropathy associated with monoclonal IgM antibodies were randomized to receive IVIg or placebo, monthly, for 3 months in a double‐blind study. After a washout period, they crossed over to the alternate therapy. Response was gauged by evaluating muscle strength, sensation, and neuromuscular symptoms at baseline, after 3 months, and at treatment's end. After IVIg therapy, the strenght improved in only 2 of 11 patients, by 28 and 38.5 points from baseline, and declined after placebo. In 1 other patient, the sensory score improved by 13 points. Antibody titers to MAG/SGPG or gangliosides did not appreciably change. We conclude that IVIg has only a modest benefit to not more than 18% of patients with IgM paraproteinemic demyelinating neuropathy.