Current Treatment Pathway for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in England: Insights From a Qualitative Validation With Clinical Experts
Author(s)
Lorenzo Celico, MA1, Maria De Francesco, MSc2, Emily Ord, PhD3, Peter Graham, MSc3, Sara Graziadio, PhD4.
1Consultant, HEOR Value Hub, Brussels, Belgium, 2HEOR Value Hub, Lanaken, Belgium, 3Argenx, Ghent, Belgium, 4HEOR Value Hub, Brussels, Belgium.
1Consultant, HEOR Value Hub, Brussels, Belgium, 2HEOR Value Hub, Lanaken, Belgium, 3Argenx, Ghent, Belgium, 4HEOR Value Hub, Brussels, Belgium.
OBJECTIVES: To characterise the current treatment pathway for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in England. The findings aim to provide a practical foundation for future evaluations of treatment strategies and help identify areas of unmet need.
METHODS: An online qualitative workshop was conducted in May 2025 with five neurologists experienced in CIDP management in England. Experts reviewed a proposed CIDP care pathway developed from prior guideline analysis, market research and clinical expert interviews. The workshop focused on treatment sequencing and clinical criteria to define management strategies. Facilitated discussion was supported by structured visual materials and thematic prompts. Post workshop, minutes were validated by participants and thematically analysed to identify points of convergence and variation. The pathway will be validated with an independent panel of experts.
RESULTS: Three clinicians expressed preference for corticosteroids as the initial therapy, in line with NHS England guidance, reserving first line immunoglobulin (Ig) for severe cases requiring rapid response or patients contraindicated to corticosteroids. One clinician consistently used Ig as first-line, and another reported making the choice based on individual patient preference and clinical profile. Ig was reported as widely used as second-line therapy following suboptimal response to corticosteroids. All clinicians used structured dependency testing to guide Ig dose tapering and treatment interruption. However, a subset of patients remains dependent on high-dose or frequent Ig, reflecting an ongoing treatment burden. Clinicians also noted that some patients continue Ig despite poor tolerability, highlighting another area of unmet need. Plasma exchange (PLEX) was described as a last-resort treatment due its invasiveness, infection risk, and logistical challenges.
CONCLUSIONS: CIDP care in England varies across clinicians, shaped by a balance between clinician judgement, patient preference, and resource constraints. Despite this variation, common decision points were identified allowing the definition of a representative care pathway. This pathway can help inform future decision-making.
METHODS: An online qualitative workshop was conducted in May 2025 with five neurologists experienced in CIDP management in England. Experts reviewed a proposed CIDP care pathway developed from prior guideline analysis, market research and clinical expert interviews. The workshop focused on treatment sequencing and clinical criteria to define management strategies. Facilitated discussion was supported by structured visual materials and thematic prompts. Post workshop, minutes were validated by participants and thematically analysed to identify points of convergence and variation. The pathway will be validated with an independent panel of experts.
RESULTS: Three clinicians expressed preference for corticosteroids as the initial therapy, in line with NHS England guidance, reserving first line immunoglobulin (Ig) for severe cases requiring rapid response or patients contraindicated to corticosteroids. One clinician consistently used Ig as first-line, and another reported making the choice based on individual patient preference and clinical profile. Ig was reported as widely used as second-line therapy following suboptimal response to corticosteroids. All clinicians used structured dependency testing to guide Ig dose tapering and treatment interruption. However, a subset of patients remains dependent on high-dose or frequent Ig, reflecting an ongoing treatment burden. Clinicians also noted that some patients continue Ig despite poor tolerability, highlighting another area of unmet need. Plasma exchange (PLEX) was described as a last-resort treatment due its invasiveness, infection risk, and logistical challenges.
CONCLUSIONS: CIDP care in England varies across clinicians, shaped by a balance between clinician judgement, patient preference, and resource constraints. Despite this variation, common decision points were identified allowing the definition of a representative care pathway. This pathway can help inform future decision-making.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD30
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Health Technology Assessment
Disease
Neurological Disorders, Rare & Orphan Diseases, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)