Chronic Inflammation, CIDP, Demyelinating Polyneuropathy
Conditions
Brief summary
Chronic inflammatory demyelinating polyradiculoneuritis (CIDP) is a rare autoimmune neuropathy characterized by significant clinical and therapeutic heterogeneity. Despite the availability of effective treatments, the response to intravenous immunoglobulins remains highly variable, and there are currently no validated biomarkers that can predict this response. At the same time, high-resolution nerve ultrasound now makes it possible to identify different morphological profiles that may reflect distinct pathophysiological mechanisms. This prospective, observational, single-center study, conducted at the Nice University Hospital, aims to determine whether nerve ultrasound profiles are associated with therapeutic response, clinical severity, and various biomarkers in the blood and cerebrospinal fluid. It includes two predefined cohorts: 20 patients with newly diagnosed PIDC, enrolled before the initiation of immunomodulatory treatment (Group 1), and 10 patients with refractory PIDC and clinically significant disability despite adequate prior treatment (Group 2). The ultimate goal is to develop a stratification strategy that will enable more personalized care for patients with PIDC.
Interventions
OTHERRefractory CIDP
Participants with refractory CIDP will continue or receive treatments according to routine clinical practice. The study does not assign or modify treatment and is limited to observational phenotyping and biomarker analyses.
OTHERStandard-of-care treatment for CIDP
Participants will receive treatment according to routine clinical practice. In Group 1, first-line treatment will usually consist of intravenous immunoglobulin (IVIg), with subsequent therapeutic decisions made by the treating neurologist according to clinical response and standard care. No investigational intervention is assigned by the study protocol.
Sponsors
Centre Hospitalier Universitaire de Nice
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Male or female aged 18 years or older. * Diagnosis of CIDP according to the 2021 EAN/PNS criteria; eligible phenotypes include typical CIDP, asymmetric CIDP (MADSAM/Lewis-Sumner syndrome), and pure motor CIDP. Pure sensory CIDP is excluded. * Ability to undergo protocol assessments, including clinical evaluation, electrophysiological studies, nerve ultrasound, and blood sampling. * Ability to provide written informed consent. * Affiliation with a health insurance system or equivalent. Group 1-specific criteria: * Newly diagnosed CIDP. * No previous immunomodulatory treatment for CIDP before baseline study assessment. * Planned initiation of IVIg according to standard clinical practice. Group 2-specific criteria: * Established CIDP with persistent clinically relevant disability. * Documented inadequate, partial, transient, or absent response despite adequate prior therapy, according to the final refractory disease definition. * Stable treatment exposure before inclusion according to the final protocol.
Exclusion criteria
* Pure sensory CIDP. * Alternative cause of neuropathy, including hereditary, metabolic, toxic, or other acquired neuropathies judged to better explain the clinical picture. * Motor neuron disease, myopathy, neuromuscular junction disorder, or another neurological or neuromuscular condition interfering with clinical, electrophysiological, or ultrasound interpretation. * CIDP mimic or alternative diagnosis. * Active infection likely to influence study assessments. * Active malignancy or other major systemic condition likely to confound biomarker interpretation. * Concomitant autoimmune or inflammatory disease likely to materially influence cytokine or complement measurements. * Severe psychiatric or cognitive disorder interfering with participation. * Participation in another interventional trial when incompatible with the present protocol. * Inability or unwillingness to comply with study procedures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical response status to first-line intravenous immunoglobulin (IVIg) for group 1 | month 3 | Clinical response status at Month 3 after initiation of first-line IVIg in treatment-naïve patients with newly diagnosed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Response categories will be predefined and may include remission, responder, partial responder, and non-responder, based primarily on adjusted INCAT and Hand Grip Strength. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical response status | Month 6 and Month 12 | Clinical response status assessed in Group 1 using predefined response categories |
| Clinical response status - Hand Grip Strength | Month 6 and Month 12 | Hand Grip Strength assessed in Group 1 using a dynamometer. measure in kg |
| Clinical response status - Medical Research Council (MRC) Sum Score | Month 6 and Month 12 | Medical Research Council (MRC) Sum Score assessed in Group 1 to evaluate global muscle strength. The total MRC score ranges from 0 to 60 |
| Clinical response status - Inflammatory Rasch-built Overall Disability Scale (I-RODS) | Months 6 and 12 | Inflammatory Rasch-built Overall Disability Scale (I-RODS) score assessed in Group 1 to evaluate to evaluate activity- 24 items, score from 0 to 48 |
| Clinical response status - Timed Up and Go (TUG) | Month 6 and Month 12 | Timed Up and Go (TUG) test performed in Group 1 to evaluate functional mobility - measure in seconds |
| Clinical response status - Pain Visual Analog Scale (VAS) | Months 6 and 12 | Pain intensity assessed in Group 1 with Visual Analog Scale (VAS) from 0 to 10 |
| Clinical response status - Patient Global Impression of Severity (PGI-S) | Months 6 and 12 | Patient Global Impression of Severity (PGI-S) assessed in Group 1. 1-item questionnaire |
| Clinical response status - Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI-SHP) | Months 6 and 12 | Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI-SHP) score assessed in Group 1.6-items |
| Association between biomarkers and ultrasound phenotypes | Baseline, Month 3, Month 6, and Month 12 | statistical analysis of association of biological elements |
| Association between biomarkers and clinical severity | Baseline, Month 3, Month 6, and Month 12 | statistical analysis of association of biological and clinical elements |
| Association between biomarkers and refractory disease | Baseline, Month 3, Month 6, and Month 12 | statistical analysis of association of biological elements |
Contacts
CONTACTAngela Puma
CONTACTAbderhmane Slioui
Outcome results
None listed