PMID- 34936164
OWN - NLM
STAT- MEDLINE
DCOM- 20220427
LR  - 20220427
IS  - 1529-8027 (Electronic)
IS  - 1085-9489 (Linking)
VI  - 27
IP  - 1
DP  - 2022 Mar
TI  - Predicting long-term trends in inflammatory neuropathy outcome measures using 
      latent class modelling.
PG  - 84-93
LID - 10.1111/jns.12481 [doi]
AB  - Immunoglobulin (Ig) is used to treat chronic inflammatory demyelinating 
      polyradiculoneuropathy (CIDP) and multifocal motor neuropathy with conduction 
      block (MMNCB). Regular infusions may be used for symptom control. Disease 
      activity is monitored with clinical outcome measurements. We examined outcome 
      measure variation during clinically stable periods in Ig-treated CIDP and MMNCB 
      patients. We explored utility of serial outcome measurement in long-term outcome 
      prediction. Retrospective longitudinal analysis of a single neuroscience centre's 
      Ig-treated CIDP and MMNCB patients, 2009-2020, was performed. Mean and percentage 
      change for grip strength, Rasch-built overall disability scales (RODS) and MRC 
      sum scores (MRC-SS) during periods of clinical stability were compared to 
      score-specific minimal clinically important differences (MCID). Latent class 
      mixed modelling (LCMM) was used to identify longitudinal trends and factors 
      influencing long-term outcome. We identified 85 CIDP and 23 MMNCB patients (1423 
      datapoints; 5635 treatment-months). Group-averaged outcome measures varied little 
      over time. Intra-individual variation exceeded MCID for RODS in 44.2% CIDP and 
      16.7% MMNCB datapoints, grip strength in 10.6% (CIDP) and 8.8%/27.2% (MMNCB 
      right/left hand) and MRC-SS in 43.5% (CIDP) and 20% (MMNCB). Multivariate LCMM 
      identified subclinical trends towards improvement (32 patients) and deterioration 
      (73 patients) in both cohorts. At baseline, CIDP 'deteriorators' were older than 
      'improvers' (66.2 vs 57 years, P = .025). No other individual factors predicted 
      categorisation. The best model for 'deteriorator' identification was contiguous 
      sub-MCID decline in more than one outcome measure (CIDP: sensitivity 74%, 
      specificity 59%; MMNCB: sensitivity 73%, specificity 88%). Outcome measure 
      interpretation determines therapeutic decision-making in Ig-dependent neuropathy 
      patients, but intra-individual variation is common, often exceeding MCID. Here we 
      show sub-MCID contiguous changes in more than one outcome measurement are a 
      better predictor of long-term outcome.
CI  - (c) 2021 Peripheral Nerve Society.
FAU - Keh, Ryan Yann Shern
AU  - Keh RYS
AUID- ORCID: 0000-0001-6434-9496
AD  - Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern 
      Care Alliance NHS Foundation Trust, Manchester, UK.
AD  - MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and 
      Neurosurgery, Queen Square, University College London Hospitals NHS Foundation 
      Trust, London, UK.
FAU - Selby, David Antony
AU  - Selby DA
AD  - Division of Musculoskeletal and Dermatological Sciences, University of 
      Manchester, Manchester, UK.
FAU - Jones, Sam
AU  - Jones S
AD  - Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern 
      Care Alliance NHS Foundation Trust, Manchester, UK.
FAU - Gosal, David
AU  - Gosal D
AD  - Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern 
      Care Alliance NHS Foundation Trust, Manchester, UK.
FAU - Lavin, Timothy
AU  - Lavin T
AD  - Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern 
      Care Alliance NHS Foundation Trust, Manchester, UK.
FAU - Lilleker, James B
AU  - Lilleker JB
AD  - Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern 
      Care Alliance NHS Foundation Trust, Manchester, UK.
AD  - Division of Musculoskeletal and Dermatological Sciences, University of 
      Manchester, Manchester, UK.
FAU - Carr, Aisling S
AU  - Carr AS
AD  - MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and 
      Neurosurgery, Queen Square, University College London Hospitals NHS Foundation 
      Trust, London, UK.
AD  - Institute of Neurology, University College London, London, UK.
FAU - Lunn, Michael P
AU  - Lunn MP
AUID- ORCID: 0000-0003-3174-6027
AD  - MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and 
      Neurosurgery, Queen Square, University College London Hospitals NHS Foundation 
      Trust, London, UK.
AD  - Institute of Neurology, University College London, London, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220110
PL  - United States
TA  - J Peripher Nerv Syst
JT  - Journal of the peripheral nervous system : JPNS
JID - 9704532
RN  - 0 (Immunoglobulins)
SB  - IM
MH  - Hand Strength
MH  - Humans
MH  - Immunoglobulins
MH  - Outcome Assessment, Health Care
MH  - *Polyneuropathies
MH  - *Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapy
MH  - Retrospective Studies
OTO - NOTNLM
OT  - CIDP
OT  - MMNCB
OT  - immunoglobulin
EDAT- 2021/12/23 06:00
MHDA- 2022/04/28 06:00
CRDT- 2021/12/22 13:03
PHST- 2021/12/17 00:00 [revised]
PHST- 2021/11/26 00:00 [received]
PHST- 2021/12/18 00:00 [accepted]
PHST- 2021/12/23 06:00 [pubmed]
PHST- 2022/04/28 06:00 [medline]
PHST- 2021/12/22 13:03 [entrez]
AID - 10.1111/jns.12481 [doi]
PST - ppublish
SO  - J Peripher Nerv Syst. 2022 Mar;27(1):84-93. doi: 10.1111/jns.12481. Epub 2022 Jan 
      10.