Practical Approach to Managing SCIg Treatment in Patients With Chronic Inflammatory Demyelinating Polyneuropathy

INTRODUCTION/AIMS: Guidelines for the management of chronic inflammatory demyelinating polyneuropathy (CIDP) recommend corticosteroids, intravenous immunoglobulin (IVIg), or plasma exchange for first-line therapies and subcutaneous immunoglobulin (SCIg) as a maintenance option. Literature on clinical experience with SCIg in CIDP maintenance therapy is limited. This study outlines practical approaches to SCIg transition and management optimization, considering the varying dosing recommendations in prescribing information and clinical guidelines. METHODS: This retrospective, multicenter study analyzed anonymized patient medical records from eight US centers. Patients with CIDP who transitioned to SCIg were included, and clinical practices regarding SCIg therapy management were analyzed. RESULTS: These 20 cases presented practical and clinical considerations for successful SCIg transition and maintenance. Switching decisions were guided by patient-physician assessment of treatment goals, benefits, and risks. The most common reason for switching (70%) was preference for site of care. Eight patients (40%) transitioned to a dose equivalent to their baseline IVIg dose. Overall, 12/19 patients (63%) remained stable following transition. Relapse-free rates were higher in patients who transitioned to a higher (67%) or lower (75%) than baseline dose versus those who received an equivalent dose (50%). All relapsed patients restabilized after increasing their SCIg dose. The final mean (SD) SCIg dose was 0.32 (0.15) g/kg/week. SCIg was well tolerated; 11 patients (55%) reported better tolerance versus IVIg. DISCUSSION: These patient cases provide practical guidance for SCIg therapy in CIDP maintenance, emphasizing individualized dosing strategies, ongoing monitoring, and patient-centered engagement. The findings help inform clinical decision-making to optimize long-term therapeutic outcomes.