Opinion
Video
Transitioning Patients From IVIg to Efgartigimod
Author(s):
Panelists discuss how a recent study highlights concerns about transitioning patients with chronic inflammatory demyelinating polyneuropathy (CIDP) from intravenous immunoglobulin (IVIg) to efgartigimod, emphasizing the need for a cautious, gradual approach, careful patient selection, and close monitoring to address issues like symptom exacerbation, delayed response, and safety risks.
Summary for Physicians:
This segment addresses concerns raised by recent data regarding the transition of patients with CIDP from IVIg to efgartigimod, a novel FcRn inhibitor approved for CIDP treatment. The discussion focuses on a specific study that highlighted potential risks and considerations in making this transition.
Key Points:
1. Study Overview: A recent study aimed to evaluate the effects of transitioning patients from IVIg to efgartigimod, in light of concerns regarding potential interactions or changes in disease management. The study primarily focused on:
- Patient Population: Patients with CIDP who were stable on IVIg therapy and transitioned to efgartigimod as part of the treatment regimen.
- Study Design: The study was observational or involved a small clinical cohort, and it examined the outcomes of switching from IVIg to efgartigimod, monitoring disease progression, safety, and treatment response.
2. Study Results: The findings from this study raised several concerns:
- Exacerbation of Symptoms: Some patients experienced a worsening of symptoms after transitioning from IVIg to efgartigimod. This included an increase in disability or relapse in previously stable patients.
- Delayed Response: Efgartigimod has a different mechanism of action (FcRn inhibition), which may take longer to show therapeutic effects compared with the rapid response seen with IVIg. As a result, patients who transitioned might have experienced a gap in symptom control, contributing to a temporary worsening of their condition.
- Safety Issues: Although efgartigimod has a generally favorable safety profile, some patients in the study experienced adverse events during the transition. These included mild to moderate infusion-related reactions and other adverse effects, which are common in biologic treatments, but were concerning due to the abrupt switch from IVIg.
- Comparative Effectiveness: Some patients who were stable on IVIg therapy did not demonstrate significant improvement with efgartigimod, raising questions about its comparative effectiveness in certain subsets of patients with CIDP, particularly those with milder forms of the disease or those well controlled on IVIg.
3. Implications for Clinical Practice:
- Gradual Transition: Based on these findings, clinicians may need to approach the transition from IVIg to efgartigimod cautiously. A gradual transition or overlap of therapies could help mitigate the risk of symptom exacerbation or relapse.
- Patient Selection: Careful patient selection is crucial when considering transitioning from IVIg to efgartigimod. Patients who are more refractory to IVIg or have disease that is less well controlled may be better candidates for efgartigimod.
- Monitoring: Close monitoring during and after the transition is essential to assess treatment efficacy, safety, and the risk of disease relapse.
In summary, while efgartigimod offers a promising new option for CIDP treatment, the study highlights the need for careful consideration when transitioning patients from IVIg to efgartigimod. Clinicians should weigh the potential risks and benefits, monitor patients closely, and consider a stepwise approach to ensure continued disease control.
