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Current treatments for CIDP

From Saint Elizabeth’s Medical Center/Tufts University School of Medicine, Boston, MA.

Address correspondence and reprint requests to Dr. Allan H. Ropper, 736 Cambridge Street, Boston, MA 02135; e-mail: Allan_Ropper_MD{at}cchcs.org

This article reviews the efficacy and tolerability of currently available therapies, including intravenous immunoglobulin (IVIg), corticosteroids, and plasma exchange (PE), for treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Data show that current therapies are effective in approximately two-thirds of patients. However, they fail to provide a durable clinical response. Furthermore, current treatments have several limitations that make them problematic for long-term therapy. IVIg dosing is required approximately every 2 to 8 weeks in most patients to maintain improvement. It is expensive, time-consuming to administer, and availability can be a problem. Furthermore, IVIg is a blood product that is associated with rare thromboembolic events. Corticosteroids have poor safety and tolerability profiles, and PE is invasive, time-consuming, expensive, and can be performed only at specialized centers. An alternative to single-agent therapy with current treatments is the use of combination therapy. Combination therapy may increase the duration of response, provide increased efficacy or independent efficacy in unresponsive patients, and reduce the need for standard therapies. Research is needed to find agents suitable for single and combination therapy in CIDP.

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