Immunoglobulin for chronic inflammatory demyelinating polyneuropathy
Mittal R, Milverton J, Schubert C, Parsons J
Record ID 32018002417
Original Title: MSAC application 1564
Authors' objectives: To compare the safety, clinical effectiveness and cost effectiveness of immunoglobulin (Ig) to steroids (glucocorticoids, GC) or plasma exchange (PE), for the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP). The clinical claim was for non-inferior effectiveness and superior safety. This report represents an update to a previously conducted systematic review and economic evaluation, and included an extended assessment of harms associated with the comparators to Ig, which informed the economic analysis.
Authors' results and conclusions: The evidence base for the use of Ig, GC and PE in CIDP was very small and of low quality, with studies generally too small to provide accurate safety data. Extended assessment of harms in the comparators included CIPD patients in mixed populations of patients with other neurological conditions, affecting the applicability of the results. PE was associated with a low rate of mild or moderate adverse events (AE) in a systematic review, and higher rates in retrospective studies. Serious AE were rare. The frequency of AE associated with GC use increased with duration of therapy, however only the most frequent events were reported; serious infection was reported in over a third of patients. AEs occurred in less than 2% of Ig intravenous infusions, and serious AE were rare. These findings were all uncertain due to the nature of the studies (including retrospective designs, small numbers) and the applicability of the mixed populations. This uncertainty carried into the re-calculated economic analysis, which found that the AE associated with long-term GC use drove a larger difference in quality-adjusted life years, which resulted in a lower ICER than when those AE were not considered in the model. The cost of Ig was the main driver in the financial analysis.
Project Status: Completed
Year Published: 2021
URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/2B740EDAE80B75DFCA25837E00096D86/$File/1564%20Final%20report.pdf
English language abstract: An English language summary is available
Publication Type: Other
- Demyelinating Diseases
- Immunoglobulins, Intravenous
- Polyradiculoneuropathy, Chronic Inflammatory Demyelinating
Organisation Name: Adelaide Health Technology Assessment
Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617
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