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Papers of the Week

Papers: 20 Aug 2022 - 26 Aug 2022

2022 Aug 22

Muscle Nerve

Treatment of Chronic Inflammatory Demyelinating Polyneuropathy.


Allen JA, Lewis RA
Muscle Nerve. 2022 Aug 22.
PMID: 35994242.


Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic peripheral polyneuropathy that results in disability through immune mediated nerve injury, but which not uncommonly has residual and irreversible neurologic deficits after the active inflammatory component of the disorder has been treated. Management of the condition entails addressing both the abnormal immune activity that drives ongoing or active deficits while also managing residual symptoms through supportive interventions. Immune based treatments are grounded in several important principles. First, early treatment is guided by evidence-based proven effective therapies that sequentially escalate depending on the response. Second, optimization or personalization of first line treatments is needed in order to understand the ideal dose for any given patient, and whether long term treatment is needed at all. Third, although many immunosuppressive agents may be utilized in non-responding patients or when intravenous immunoglobulin (IVIG)/corticosteroid sparing intervention is desired, all are unproven and require a delicate balance between risk, cost, and unknown likelihood of benefit that is tailored to each individual patient's unique circumstances. There is no reliable disease activity biomarker that can be used to guide treatment – a reality that makes it very challenging to optimize treatment to individual patient needs. Serial clinical assessments are key to understanding the value of continued immunotherapy or if long-term therapy is needed at all. Regardless of the immunotherapy status of a patient, equally important is addressing residual deficits through supportive interventions including physical therapy, adaptive equipment, pain management, and emotional support. This article is protected by copyright. All rights reserved.