Treatments for Chronic Inflammatory Demyelinating Polyradiculoneuropathy (Cidp): an Overview of Systematic Reviews

Summary

A Cochrane review [Abstract] 1 included 23 studies from 5 Cochrane systematic reviews.

• Corticosteroids:It is uncertain whether daily oralprednisone improved impairment compared to no treatment (1 trial, n=28). Six months' treatment with high-dose monthly oral dexamethasone did not improve disability more than daily oral prednisolone (1 trial, n=41).
• Plasma exchange:Twice-weekly plasma exchange produced more short-term improvement in disability than sham exchange (2 trials, n=59).
• Intravenous immunoglobulin:Intravenous immunoglobulin (IVIg) produced more short-term improvement than placebo (5 trials, n=269). Adverse events were more common with IVIg than placebo but serious adverse events were not (3 trials, n=315). There was little or no difference in short-term improvement of impairment with plasma exchange in comparison to IVIg (1 trial, n=19).There was little or no difference in short-term improvement of disability with IVIg in comparison to oral prednisolone (1 trial, n=29) or IV methylprednisolone (1 trial, n=45). There was little or no difference in disability after 3 months of IVIg compared to oral prednisone (1 study, n=35).
• Other immunomodulatory treatments:It is uncertain whether the addition of azathioprine (2 mg/kg) to prednisone improved impairment in comparison to prednisone alone (1 trial, n=27). Observational studies show that adverse effects truncate treatment in 10% of people.Methotrexate 15 mg/kg did not allow more patients to reduce corticosteroid or IVIg doses by 20% when compared to placebo (1 trial, n=60). Serious adverse events were no more common with methotrexate than with placebo.Interferon beta-1a (IFN beta-1a) did not allow more people to withdraw from IVIg as compared with placebo (2 trials, n=77).

Not all trials routinely collected adverse event data. Adverse effects occur with all interventions and reliable comparisons can not be made of adverse events between the interventions included in the Cochrane reviews.