Second-Line Therapies for CIDP: When IVIg Isn’t Enough
Health ConditionsAutoimmune Diseases

Exploring Second-Line Therapies for CIDP

Exploring Second-Line Therapies for CIDP
Everyday Health
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Published on January 30, 2026
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Treatment for chronic inflammatory demyelinating polyneuropathy (CIDP), a chronic autoimmune condition that affects the protective layer around your nerves, usually starts with one of three options. Corticosteroids lower inflammation, plasma exchange filters out harmful antibodies from your blood, and intravenous immunoglobulin therapy (IVIg) calms your immune system’s response.

These treatments work well for most people, but 20 to 30 percent have refractory CIDP, which means they continue to have symptoms despite treatment.

 When your first medical therapy option doesn’t help, your provider may recommend switching treatment for CIDP.

How to Know When Your Current Treatment Has Hit a Plateau

While some people with CIDP can be cured, for many the goal of treatment is symptom improvement that remains stable. It’s not uncommon to experience a relapse or symptom flare-up. Many people have treatment-related fluctuations (TRFs), when symptoms get better right after a round of treatment, then temporarily worsen as it wears off. These don’t mean your medical regimen isn’t working.

Most treatments take three to six months to show significant improvement. If your symptoms continue to get worse, or if they stabilize at a level where they still disrupt your life, your provider may want to take a closer look at your care plan.

 You can help your provider figure out if returning symptoms are caused by TRFs, or if you’ve reached a plateau in your CIDP treatment, by keeping a daily treatment diary to record symptoms, energy levels, and how well you can move around.

Defining ‘Refractory’ CIDP

Refractory CIDP means treatment hasn’t improved your symptoms. Delayed diagnosis can make refractory CIDP more likely. When it doesn’t get diagnosed fast enough, nerve damage can build up, making the condition more difficult to treat.

“There are many variations of CIDP, and it is important to get a precise diagnosis,” says Kevin C. Gaffney, MD, a neurologist at Memorial Hermann Mischer Neuroscience Associates in the Woodlands, Texas. Each variant may respond differently to treatment. For example, first-line treatments don’t work well if you have CIDP in which specific autoantibodies (immune cells that attack healthy tissue) target gaps called nodes in the insulation covering your nerves.

“In patients with a diagnosis of CIDP who plateau or have an inadequate response to IVIg, the most important first step before escalating therapy is diagnostic reassessment,” says Jafar Kafaie, MD, a neurologist at Hackensack University Medical Center and the Northern Region Director of Neuromuscular Diseases for Hackensack Meridian Health in New Jersey.

By correctly identifying your CIDP variant through antibody or other tests, your provider can better target your treatment, says Dr. Kafaie.

New and Emerging Treatments: Biologics and ‘Immune Reboots’

When your first-line CIDP treatment stops improving your symptoms, your provider may try another primary treatment before moving on to a combination of therapies, says Kafaie. For example, if IVIg doesn’t give you the response you want, you could try corticosteroids or plasma exchange, he says.

Changing the type of IVIg might also make it work better, says Mill Etienne, MD, MPH, a neurologist and an associate professor of neurology and medicine at New York Medical College. “There are numerous formulations of IVIg available and I have had patients who respond to one formulation and not the other,” says Dr. Etienne. But if these changes still don’t do enough, you have other options.

Efgartigimod (Vyvgart Hytrulo)

Efgartigimod (Vyvgart Hytrulo) was approved by the U.S. Food and Drug Administration (FDA) in 2024 to treat CIDP in adults and is given as an injection into fat just under your skin.

 “This was the first medication proven to treat CIDP in over 30 years and the first to be approved by the FDA,” says Dr. Gaffney.
This drug, classified as an FcRn inhibitor, works by allowing your body to clear harmful antibodies from your blood more quickly so they cause less damage to your nerves.

But, like first-line treatments, FcRn inhibitors aren’t universally effective, which highlights the need to tailor treatment to specific variants.

B-Cell Therapies

B-cell therapies like rituximab (Rituxan) work by restricting part of the immune system that makes harmful antibodies, helping reduce ongoing nerve inflammation and symptoms, says Etienne. “By calming the disease process, these treatments may allow patients to move past a treatment plateau and regain additional strength or function.”

Given intravenously, rituximab has improved symptoms in more than 70 percent of participants in some research, and other studies suggest it can especially help those who haven’t responded to first-line therapies. It’s approved to treat a number of conditions, but it’s still investigational as a CIDP treatment.

Complement Inhibitors

Also investigational, complement inhibitors like empasiprubart block the complement cascade, which describes a chain reaction in your immune system designed to remove germs.

 In CIDP, this cascade plays a role in your immune system's attack on nerves, and these treatments interrupt that process.

Clinical Trials

Since treatment for refractory CIDP can present such a challenge, researchers are working to develop new treatments. Several drugs are currently being tested for safety and effectiveness in clinical trials. For example:

  • DNTH103 is another experimental complement inhibitor.
  • IMVT-1402 is an experimental FcRn inhibitor.
  • Nipocalimab (Imaavy) is an FcRn inhibitor that’s already approved to treat generalized myasthenia gravis.

If you want to find out about possible CIDP trials available to you, you can search ClinicalTrials.gov or go through advocacy organizations such as the GBS/CIDP Foundation International, filtering for recruiting trials in your region, says Etienne. You can also ask your neurologist, who may know about ongoing or upcoming trials you may be eligible for.

Shared Decision-Making: Preparing for the Conversation

Before you see a specialist about a possible CIDP treatment switch, it’s important to gather some information. Your provider will want to know about changes in symptoms, such as the following.

  • Arm or leg weakness
  • Symptoms that fluctuate over weeks or months
  • Challenges with movement or lifting
  • Falls or trouble walking
  • Difficulty with fine motor skills like buttoning a shirt
  • Tripping or shuffling your feet
  • Tingling or burning in your hands or feet

Once your provider has this information, they can look at your history of treatments, doses, and how often you take your medication to decide on next steps.

You can include loved ones and caregivers in the decision-making process by asking them what symptoms and changes they have noticed and inviting them to an appointment if you’re comfortable. For a child with CIDP, you can help them feel more control over their diagnosis by allowing them a say in scheduling decisions, describing their own symptoms at provider visits, and explaining their condition to friends.

Etienne urges people with CIDP to be honest and specific with their doctor about how they are really doing if symptoms have plateaued or worsened. “Treatment is often not escalated unless the ongoing impact is clearly communicated,” says Etienne. And if new or emerging therapies aren’t being discussed, you may choose to request a referral to a neuromuscular specialist with more expertise in CIDP.

As a neurologist visit approaches, it can help to prepare questions ahead of time.

Questions to Ask Your Neurologist

  • How will we verify that the new therapy is working?
  • Is my current CIDP considered "refractory"?
  • Do I have any CIDP variants?
  • What are the risks and benefits of switching to an FcRn inhibitor?
  • What kinds of side effects can I expect from my treatments?
  • What alternative treatments can I try alongside medical treatment?
  • Am I a candidate for any current clinical trials?
  • Can you recommend any support groups for CIDP?

Monitoring Your Transition

As you transition to a new medication, it can take time to feel better. In one study of 112 people with CIDP, the time it took for maximum symptom improvement averaged about 12 months after starting a treatment.

 Another study of 44 people found that almost a third didn’t respond to their medication until at least 12 weeks after starting it.

Once you begin a new treatment, keep track of any side effects so you can tell your provider about them. These may include:

  • Fever or chills
  • Nausea or diarrhea
  • Sore throat
  • Headache
  • Urinary tract infections
  • Respiratory tract infection
Throughout any medication changes, physical and occupational therapy can help you minimize disruptions to your daily life. A therapist can teach you exercises to build strength, reduce stiffness, walk better, and take care of yourself.

The Takeaway

  • When treatment for chronic inflammatory demyelinating polyneuropathy doesn’t work, you can ask your neurologist about trying a new medication.
  • CIDP treatment typically starts with corticosteroids, plasma exchange, or IVIg therapy, but if your symptoms persist, your provider may recommend an FcRn blocker, B-cell therapy, or complement inhibitors.
  • If you want to find out more about available treatment options, your neurologist can give you the most up-to-date information on approved CIDP treatments and experimental medications.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  4. Caballero-Ávila M et al. A Pathophysiological and Mechanistic Review of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Therapy. Frontiers in Immunology. April 14, 2025.
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  8. How VYVGART Works in the Body. Argenx.
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  11. Van de Walle I et al. Randomized Phase I Trial Outcomes Show Safe and Sustainable Inhibition of Classical and Lectin Complement Pathways by Empasiprubart. Nature Communications. August 16, 2025.
  12. Children with CIDP. GBS/CIDP Foundation International.
  13. Questions to Ask Your Healthcare Provider. GBS/CIDP Foundation International. June 20, 2024.
  14. Rajabally YA et al. Treatment Response Amplitude and Timing in Chronic Inflammatory Demyelinating Polyneuropathy With Routine Care: Study of a UK Cohort. European Journal of Neurology. July 9, 2024.
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Meet Our Experts
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Rachana K. Gandhi Mehta, MBBS

Medical Reviewer

Rachana K. Gandhi Mehta, MBBS, is an associate professor in the department of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina. She specializes in the diagnosis and management of neuromuscular disorders, with a clinical focus on conditions such as myasthenia gravis, autoimmune neuromuscular disorders, and amyloidosis-related neuropathy, and also conducts various electrodiagnostic procedures.

Dr. Mehta is a strong advocate for integrating research and patient care. She has published extensively in peer-reviewed journals, and her research interests include myasthenia gravis, chronic inflammatory demyelinating polyneuropathy (CIDP), amyloid neuropathy, and utilizing neuromuscular ultrasound for various neuromuscular disorders. In addition to her clinical and research endeavors, Dr. Mehta is actively involved in teaching and mentoring neuromuscular fellows, residents, and medical students.

She completed her medical degree (MBBS) at Pramukhswami Medical College, Sardar Patel University, India, followed by an internship and neurology residency at Cleveland Clinic Florida, where she served as chief resident. She then pursued advanced fellowship training in neuromuscular medicine at Duke University Medical Center in Durham, North Carolina. She is board-certified in neurology, neuromuscular medicine, and electrodiagnostic medicine.

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Abby McCoy, RN

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Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.

McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.

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