Redefining Treatment Success in CIDP

As the treatment landscape for chronic inflammatory demyelinating polyneuropathy (CIDP) continues to evolve, so too does the definition of treatment success. While preventing further neurologic decline has historically been the primary objective, emerging data suggest that clinicians may be able to set more ambitious goals centered on minimizing disability and restoring function.

In this NeurologyLive® Special Report, Karissa Gable, MD, FAAN, professor of neurology at Duke University, and Jeffrey Allen, MD, associate professor of neurology at the University of Minnesota, discuss findings from a post hoc analysis of the ADHERE and ADHERE+ studies presented at the 2026 Peripheral Nerve Society Annual Meeting. Throughout the series, the panel examines what achieving low disability with subcutaneous efgartigimod PH20 (Vyvgart Hytrulo) may mean for patients with CIDP and how these findings could influence treatment expectations and clinical practice.

The discussion begins by exploring one of the most fundamental questions clinicians face when treating CIDP: what should the ultimate therapeutic goal be? Rather than focusing solely on neurologic examination findings, Gable and Allen discuss the importance of improving quality of life, establishing realistic expectations, accounting for irreversible nerve damage, and partnering with patients to define outcomes that are both clinically meaningful and personally important.

Jeffrey Allen, MD:

I think we all want to make patients better, and we all have expectations of improving their condition. But really, it comes down to how patients feel and whether they experience a meaningful improvement in their quality of life and overall health after starting treatment.

When I think about initiating therapy and defining our goals, I want to move patients to a better state of health, improve their disability, and reduce that disability in a meaningful way. Earlier this June, we published a paper in Neurology outlining treatment goals and proposing new definitions for disease activity and treatment response. I won't go into those details here, but I think it provides a helpful framework for thinking about improvement after starting therapy in CIDP.

Of course, it's important to set appropriate expectations whenever we talk about improvement because not everything gets better. Residual deficits are very common, and it can be difficult to know what has the capacity to improve and what does not. Setting realistic expectations, helping patients achieve a better state of health, and doing so while minimizing treatment burden are always priorities for me.

Karissa Gable, MD, FAAN:

Yeah, I completely agree. When I'm counseling patients about prognosis and treatment expectations, I also like to start by asking patients what their own goals are. What activities have been affected by the disease that they would like to return to? From there, we work together to establish realistic expectations, recognizing that there may be limitations depending on disease severity, duration of symptoms, the degree of axonal loss, and any residual deficits that remain.

Ultimately, the goal is to optimize therapy so patients have as few residual symptoms as possible and can get back to the activities that are most important to them while improving their overall quality of life.