Current treatment of chronic inflammatory demyelinating polyradiculo-neuropathy (CIDp)

Abstract

Chronic inflammatory demyelinating polyradiculo-neuropathy (CIDP) is a sensorimotor neuropathy that evolves over at least 2 months with either a progressive or a relapsing remitting course. variants of CIDP with distinct clinical presentations have been described and their recognition is important because of varied treatment responses. the goals of treatment are to improve weakness, prevent disability, and induce and sustain a remission. It is important to achieve these goals in a cost-effective manner with minimal treatment-related adverse effects. the firstline treatments for CIDP include intravenous immunoglobulin (IvIg), prednisone, and plasma exchange (Pe). these treatments have been shown to be effective, but whether one treatment is better than the others (in terms of improving weakness and inducing a remission) remains unclear . In general, about 66% of patients respond to one of the firstline treatments (corticosteroids, IvIg, or Pe) long-term immunosuppressants, such as azathioprine, methotrexate and mycophenolate mofetil, can be used, when the primary treatment is not sufficient or as steroid or IvIg-sparing agents. In intractable cases, cyclophosphamide with or without stem cell rescue has been shown to be effective. advice about foot care, exercise, diet,treatment of neuropathic pain ,driving and life style management should be considered. Depending on the needs of the patient, orthoses, physiotherapy, occupational therapy, psychological support and referral to a rehabilitation specialist should be considered. recent advances have provided new strategies and options for management of this syndrome. In this article, we review the recent insights and treatment strategies along with our experience in the management of patients with CIDP.