Therapeutic strategy for CIDP (chronic inflammatory demyelinating polyneuropathy)].

Masahiro Iijima, Haruki Koike, Gen Sobue

Department of Neurology, Nagoya University Graduate School of Medicine.

Nihon rinsho. Japanese journal of clinical medicine 2013 May

filter terms:

First line therapies (FLTs) for chronic inflammatory demyelinating polyneuropathy (CIDP) are corticosteroids, intravenous immunoglobulin (IVIg), and plasmapheresis. However, no studies have determined which is superior for particular phenotypes. Furthermore, the efficacy of complementary therapies such as immunosuppressants is not supported by qualified and/or large-sized randomized controlled trials. Therefore, those complementary therapies cannot be regarded as the second line therapies for CIDP. Since the immune-modulating function of each FLT is expected to be different, the selection of other FLTs when a particular one shows no responsiveness is appropriate. When a patient does not respond to any FLT, it may be a good opportunity to re-evaluate the diagnosis before starting complementary therapies. Currently, important information concerning FTPs is being updating. For example, intermittent and continuous IVIg is a maintenance therapy for frequent relapsing patients. In addition, intermittent pulsed oral dexamethasone has been shown to have similar effectiveness as conservative continuous oral prednisolone. Finally, IVIg is superior in the speed of its efficacy over pulsed intravenous methylprednisolone, although methylprednisolone has an advantage of decreased clinical relapsing after treatment ends. Further study of FLTs is required, such as whether a combination of IVIg and corticosteroids is reasonable as an induced therapy for CIDP.

Citation

Masahiro Iijima, Haruki Koike, Gen Sobue. Therapeutic strategy for CIDP (chronic inflammatory demyelinating polyneuropathy)]. Nihon rinsho. Japanese journal of clinical medicine. 2013 May;71(5):855-60