• Stefano Jann, Raffaella Fazio, Dario Cocito, Antonio Toscano, Angelo Schenone, Gerolama Alessandra Marfia, Giovanni Antonini, Luisa De Toni Franceschini, Anna Mazzeo, Marina Grandis, Daniele Velardo, Giorgia Mataluni, and Erdita Peci.
• Department of Neurology, Niguarda General Hospital, Milan, Italy.
• Pain Med. 2020 Mar 1; 21 (3): 576-585.

ObjectivesThe efficacy and safety of high-dose intravenous immunoglobulin (IVIG) in treatment-resistant diabetic painful polyneuropathy (DPN) were assessed.DesignThis was a randomized, double-blind, placebo-controlled, multicenter trial (EudraCT 2010-023883-42).SettingThis trial was conducted at eight sites in Italy with a neurology specialist level of care.SubjectsTwenty-six diabetic patients with DPN who reported baseline severity of pain >60 units (mm) on a VAS scale at enrollment and were resistant to antidepressants and antiepileptic drugs were enrolled; 23 were randomized (11 in the IVIG arm and 12 in the placebo arm). All patients completed the study and were evaluated. All patients were Caucasian, 15 were male, and 21 had a diagnosis of type II diabetes.MethodsIVIG (0.4 g/kg/d) or placebo was given for five consecutive days. Pain intensity (visual analog scale, Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey, Clinical/Patient Global Impression of Change questionnaires) assessments were performed at visits: baseline, start of therapy (one week later), end of therapy (five days later), and follow-up (four and eight weeks later).ResultsThe study achieved its prespecified primary end point of ≥50% pain reduction at four weeks after IVIG, achieved in seven of 11 patients (63.6%) in the IVIG group vs zero of 12 in the placebo group (P = 0.0013). Only two adverse events were reported during the study: one patient in the treatment arm reported a mild "dermatitis psoriasiform," whereas one patient from the placebo group reported a mild "influenza."ConclusionsTreatment with IVIG at the dose given was efficacious and safe for patients with DPN resistant to standard therapies.© 2020 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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