Treatment responsiveness in CIDP patients with diabetes is associated with unique electrophysiological characteristics, and not with common criteria for CIDP

Abstract

Objectives: Characterize treatment responsiveness in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients with diabetes mellitus (DM). Methods: We performed a retrospective chart review of CIDP subjects assessed between 1997 and 2013 and compared treatment response rates in those with and without DM, using different sets of criteria. Results: 99 CIDP patients were included, 34 CIDP+DM and 65 CIDP−DM patients, both having similar treatment response rates. CIDP patients fulfilling European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria had higher treatment response rates. Responders fulfilled a higher number of American Academy of Neurology (AAN) and EFNS/PNS criteria and had a higher number of demyelinating features in the total cohort and in CIDP−DM but not in CIDP+DM patients. CIDP+DM responders, however, had unique electrophysiologic characteristics. Conclusion: Fulfilling EFNS/PNS and AAN criteria, and higher number of demyelinating features, are associated with higher treatment response rates in CIDP−DM but not in CIDP+DM patients, implying the need for adjusting current criteria to predict treatment response rates in CIDP−DM patients.

Keywords:

• chronic inflammatory demyelinating polyradiculoneuropathy
• criteria
• demyelination
• diabetic neuropathy
• type 1 diabetes
• type 2 diabetes

Acknowledgements

All authors reviewed the manuscript for scholarly content and accuracy. V Bril is the corresponding author and guarantor of this manuscript and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial & competing interests disclosure

H Katzberg has received research grants and speaker support from Grifols; research grants, advisory board honoraria and speaker support from CSL Behring; speaker/travel support from Genzyme Canada. BA Perkins serves as an advisor to Neurometrix Inc. V Bril has been a consultant for Grifols, CSL, Lilly, Pfizer, Bionevia and Eisai and Dainnipon Sumitomo and has received research support from all of these organizations. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues.

• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients with diabetes mellitus (DM) have more severe neuropathy, as evidenced by clinical and electrophysiological examinations, probably due to coexistence of two different mechanisms causing neuropathy.

• CIDP patients with and without DM have similar response rates.

• European Federation of Neurological Societies/Peripheral Nerve Society and American Academy of Neurology criteria, as well as the number of demyelinating features, predict higher treatment response rates in CIDP patients without DM, but not in CIDP patients with DM.

• CIDP patients with DM responding to treatment have lower median motor nerve action potential amplitudes, longer peroneal F-wave latencies and higher percentage of tibial nerve conduction blocks.

• In contrast, CIDP patients without DM responding to treatment have lower percentage of absent peroneal nerve response.

• Adjusting current CIDP criteria might be needed in order to predict treatment response rates in CIDP patients without DM.