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Evidence summaries

Azathioprine, Interferon Beta-1a or Methotrexate for Chronic Inflammatory Demyelinating Polyradiculoneuropathy

There is insufficient evidence to decide whether azathioprine, interferon beta or methotrexate are beneficial in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Level of evidence: "D"

A Cochrane review 1,[Abstract] included 4 trials, one of azathioprine (n=27, open trial), two of interferon beta-1a (n=77) and one of methotrexate (n=60). The participants fulfilling standard diagnostic criteria for CIDP. A disability outcome at least one year after randomisation was selected as the primary outcome. None of these trials showed significant benefit in the primary outcome (measured only in the methotrexate study) or secondary outcomes selected for this review. Severe adverse events occurred no more frequently than in the placebo groups for methotrexate and interferon beta-1a, but participant numbers were low. There was no adverse event reporting in the azathioprine study.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment and short follow-up time), imprecise results (small study sample) and indirectness (differences in outcomes).

    References

    • Mahdi-Rogers M, Brassington R, Gunn AA et al. Immunomodulatory treatment other than corticosteroids, immunoglobulin and plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev 2017;5():CD003280. [PubMed]

Primary/Secondary Keywords