Vigorimeter grip strength in CIDP: a responsive tool that rapidly measures the
effect of IVIG--the ICE study.
Author(s): Vanhoutte EK(1), Latov N, Deng C, Hanna K, Hughes RA, Bril V, Dalakas MC,
Donofrio P, van Doorn PA, Hartung HP, Merkies IS.
Affiliation(s): Author information:
(1)Department of Neurology, Maastricht University Medical Centre, Maastricht, The
Netherlands.
Publication date & source: 2013, Eur J Neurol. , 20(5):748-55
BACKGROUND AND PURPOSE: In a recent trial in patients with chronic inflammatory
demyelinating polyradiculoneuropathy (CIDP), the ICE study, grip strength
measurement captured significantly more improvement in patients receiving immune
globulin (IGIV-C) intravenously than in those receiving placebo.
METHODS: We conducted a systematic analysis to determine the sensitivity of grip
strength as an indicator of meaningful clinical changes in CIDP.
RESULTS: A randomized double-blind trial was undertaken in 117 CIDP patients who
received IGIV-C or placebo every 3 weeks for up to 24 weeks. Grip strength and
inflammatory neuropathy cause and treatment (INCAT) disability scores were
assessed at each visit, and the responsiveness of each scale was compared. A
minimum clinically important difference cut-off value for grip strength (>8 kPa)
and INCAT score (>1 point) was applied to assess the proportion of responders to
IGIV-C versus placebo. This analysis showed that grip strength demonstrated
significant improvement earlier (as early as day 16) than the INCAT disability
scale in patients receiving IGIV-C compared with placebo. A significantly higher
proportion of improvers were seen in the IGIV-C group (37.5%-50.9%) than in the
placebo group (21.1%-25.9%) for grip strength at day 16, week 3, week 6 and the
end of the first period. Also, grip strength showed within the first 6 weeks in
the placebo group significantly more patients with a clinically meaningful
deterioration (>8 kPa), compared with the INCAT (>1-point deterioration)
findings.
CONCLUSIONS: Grip strength can be considered a sensitive tool for assessing
clinically relevant changes in patients with CIDP. Its use in daily practice is
suggested.
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