Emerging Targeted Therapies in CIDP

In "Emerging Targeted Therapies in CIDP," the panelists in neurology and neuromuscular medicine explore the emerging role of FcRn antagonists as a more mechanistically precise alternative to broad immunoglobulin therapy. While immunoglobulin therapy remains effective, its precise mechanism of action in CIDP is incompletely understood, likely involving multiple pathways. By contrast, FcRn antagonists offer a targeted approach by specifically reducing circulating IgG levels, though panelists note this precision is complicated by the heterogeneous and incompletely characterized pathophysiology of CIDP.

The ADHERE trial is cited as demonstrating FcRn antagonist efficacy in relapse prevention compared to placebo, though no head-to-head comparative data with immunoglobulin therapies currently exists. The absence of reliable biomarkers to identify ideal candidates for targeted therapy is highlighted as a significant gap, with paranodal antibody testing noted as one of the few available tools, applicable to only approximately 2% of CIDP patients.

Panelists favor FcRn antagonists for patients with well-established CIDP who face challenges with immunoglobulin tolerability, access, or logistics, as well as those with suboptimal immunoglobulin response. For partially responsive patients, distinguishing ongoing demyelination from residual axonal degeneration is emphasized as critical when considering escalation. When transitioning from immunoglobulin to FcRn antagonists, panelists recommend a four-to-six week washout period to avoid precipitous drops in serum immunoglobulin levels, with short-term corticosteroid bridging as a practical interim strategy.

The next episode in this series, "Monitoring CIDP Treatment Response with Objective Outcome Measures," features the panelists discussing the importance of objective outcome measures in evaluating treatment response in CIDP, reviewing a range of clinical and electrophysiologic tools used in practice, and sharing practical guidance on monitoring frequency and timing, particularly when transitioning between therapies.