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Announcer Introduction:
You’re listening to Clinician’s Roundtable on ReachMD, and this episode is brought to you by CSL Behring.

Here’s your host, Dr. Jennifer Caudle.

Dr. Caudle:
Welcome to Clinician’s Roundtable on ReachMD. I'm your host, Dr. Jennifer Caudle, and joining me to provide his insights on how we can enhance patient-centered care for chronic inflammatory demyelinating polyneuropathy, or CIDP for short, is Dr. David Saperstein. He's the Director of the Center for Complex Neurology, EDS, and POTS in Phoenix, Arizona. He's also an Associate Professor of Clinical Neurology at the University of Arizona College of Medicine. Dr. Saperstein, thank you so much for being here today.

Dr. Saperstein:
Oh, thank you. Pleased to be here.

Dr. Caudle:
Well, so to start us off, can you talk to us about the current treatment options that are available for patients with CIDP?

Dr. Saperstein:
Sure. So there are options that are tried and true in the sense that we've got placebo-controlled data. So the big three that we try to utilize are corticosteroids, immunoglobulins, or plasmapheresis. Corticosteroids can be given orally or intravenously in pulse. They can have a number of side effects. Most patients are given IVIG or SCIG, so immunoglobulin in some form or another, and plasmapheresis is just very difficult in terms of the types of IV access that's needed or the availability. So that's less well utilized. And then there are oral immune suppressant drugs, or there's other medicines, like rituximab, and we certainly utilize those, although, in all actuality, all we have is the retrospective data, and we're not really certain who to use those in or how they work. So it's done on a case-by-case clinical basis.

Dr. Caudle:
Well, you talked a little bit about the answer to my next question, but can you expound on how you work with patients to select a treatment option? What are the things that go into those decisions?

Dr. Saperstein:
Sure, the two biggest factors are patient factors. So how quickly is their disease progressing? So do we need something that's going to work fast versus do we have some time to work with it? And of course, whether patient comorbidities, if they're diabetic, we're not going to want to use corticosteroids. If they have heart failure or renal issues or other issues that would make, for instance, a large protein and a volume load with IVIG difficult. And then we turn to the patient, and I will present to them, in broad strokes, how these treatments work, what the mechanics or the logistics are of them getting it, and involve them in a decision of what they think they'd like to try.

Dr. Caudle:
And now if we zero in on immunoglobulin therapy, how does it work? And how do you explain this approach to patients?

Dr. Saperstein:
Yeah, so immunoglobulin therapy, that's always a good question. It definitely works, and it works in different ways. And so I present it broadly, explaining to the patient that immunoglobulin or antibodies, and so we're flooding their system with antibodies from healthy people to help correct problems that their immune system is perpetrating. So there may be inappropriate antibodies, and the IVIG can neutralize those. The IVIG might help downregulate overall the way their immune system is inappropriately responding. It can affect how immune cells communicate with each other. So I explain how we're basically giving them good antibodies to help counteract effects of quote-unquote, bad or inappropriate antibody activity.

Dr. Caudle:
Understood. And as a quick follow-up to that, what counseling strategies do you use to help patients successfully transition from intravenous to subcutaneous immunoglobulin therapy?

Dr. Saperstein:
So I explain to them with the subcutaneous immunoglobulin that after they’re trained, going to need to be administering the treatment themselves, usually a caregiver or in some cases a nurse can. Then it's being injected in their abdomen or other areas. And so take them through briefly what issues with needles and how there's temporary fluid that is under their skin. And so I want them to understand what's involved, and that's key to have a good pitch and acceptance that they're on board, and they're okay with the different facets of it that they'll have to do.

Dr. Caudle:
Well, thank you for that. And for those of you who are just tuning in, you're listening to Clinician’s Roundtable on ReachMD. I'm your host, Dr. Jennifer Caudle, and I'm speaking with Dr. David Saperstein about patient-centered care for CIDP.

So, Dr. Saperstein, if we bring this all together, can you share a case that demonstrates the qualities of patient-centered care that we've been talking about today?

Dr. Saperstein:
Absolutely. So I was thinking about a couple of cases. Certainly, I could talk about a patient where they were just getting, no matter how we pre-medicated them or how slowly or how we adjusted the infusion of IVIG, they were still getting headaches, significant headaches after their IVIG, or they were having rapid treatment fluctuations. But what I wanted to highlight was a 67-year-old man, he had been on IVIG for years for his CIDP, he had been doing well. He retired, and he wanted to travel, and so getting IVIG every three weeks like he was, tethered him. He had to be near his infusion center or home where he was getting his infusions. It was logistically challenging, to say the least, to figure out how to set up IVIG in different states or places he traveled. And we discussed the fact that subq IG, he could do on his own, and the equipment and materials for that didn't need to be refrigerated, they can be kept at ambient temperatures. And he got trained on it, and switched over to SCIG, which is an easy process. So one week after IVIG, you'll typically start once-weekly doses of SCIG. And he's enjoyed it quite a bit. He's been on it for a couple of years now and is pleased with that therapy.

Dr. Caudle:
That's excellent. Well, thank you so much for sharing that case with us, Dr. Saperstein. And before we close, what kind of impact can patient-centered care have on the treatment of CIDP?

Dr. Saperstein:
Yeah, I think it's critical to get the patient involved and to factor in issues that are important to the patient because they're really going to determine how well or not so well the treatment goes or how pleased the patient is with it. And if you take the time to get some insight from the patient of what's important to them, you can matchmake the right treatment for that patient.

Dr. Caudle:
Excellent. With those impacts in mind, I'd like to thank my guest, Dr. David Saperstein, for joining us to discuss ways that we can improve patient-centered care for those with CIDP. Dr. Saperstein, it was great having you on the program.

Dr. Saperstein:
Well, thank you for having me. Thank you.

Announcer Close:
This episode of Clinician’s Roundtable was brought to you by CSL Behring. To access this and other episodes in this series, visit ReachMD.com/Clinicians Roundtable, where you can Be Part of the Knowledge. Thanks for listening!