Neurology Xagena

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Chronic inflammatory demyelinating polyradiculoneuropathy: therapeutic options

Chronic inflammatory demyelinating polyradiculoneuropathy is a rare acquired immune-mediated progressive or relapsing disorder causing peripheral neuropathic disease of duration more than two months.
Many individuals with chronic inflammatory demyelinating polyradiculoneuropathy fail to make a long-term recovery with current treatment regimes.

The aim of a study was to prospectively review the literature to determine the effectiveness of therapies for chronic inflammatory demyelinating polyradiculoneuropathy.

Articles published during the period 1990-2012 were searched for studies to treat adults with chronic inflammatory demyelinating polyradiculoneuropathy.

Nine placebo-controlled double-blinded randomised trials were reviewed to treat subjects with chronic inflammatory demyelinating polyradiculoneuropathy exhibiting various degrees of effectiveness.
The most effect treatments were; three randomised controlled trials using intravenous Immunoglobulin, a study comparing pulsed Dexamethasone and short term Prednisolone and Rituximab ( MabThera, Rituxan ) all showed promising results and were well tolerated.

IVIg and corticosteroids remain first line treatments for CIDP. Therapies using monoclonal antibodies, such as Rituximab and Natalizumab ( Tysabri ) offer the most promise for treatment of chronic inflammatory demyelinating polyradiculoneuropathy however they also need further research, as does the use of stem cell therapy for treating chronic inflammatory demyelinating polyradiculoneuropathy.

Large randomised controlled trials and better patient selection are required to address responsiveness of CIDP patients to conventional treatments to elucidate mechanisms of action and future directions for therapeutic improvement. ( Xagena )

Bright RJ et al, BMC Neurol 2014; 14: 26