Clinical outcome of CIDP one year after start of treatment: a prospective cohort study

Bus, Sander; Broers, Merel C.; Lucke, Ilse M.; Bunschoten, Carina; Lieverloo, G G A van; Adrichem, Max E.; Veen, R van; Lingsma, Hester F.; Goedee, H. Stephan; Pol, W. Ludo van der; Schaik, Ivo N. van; Doorn, Pieter A. van; Jacobs, Bart C.; Eftimov, Filip

doi:10.1007/s00415-021-10677-5

Cited by 12 publications

(12 citation statements)

References 51 publications

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“…OCBs also indicated to be very appreciable factor, as they were found in only one patient in non-CIDP group vs almost 30% of confirmed CIDP subjects, which follows the finding of a recent study. 27 Of great importance is another supportive criterion -response to therapy, that turned out to be very precise to distinguish between CIDP and non-CIDP groups. Thus, CIDP patients are still often treated by trials and errors.…”

Section: Resultsmentioning

confidence: 99%

Chronic inflammatory demyelinating polyradiculoneuropathy: Diagnostic problems in clinical practice in Serbia

Basta

Delic

Gunjic

et al. 2023

J Peripheral Nervous Sys

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Making diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is challenging since it can mimic a multitude of disorders, and is misdiagnosed in at least 50% of cases. We sought to determine the frequency of CIDP misdiagnosis in clinical practice in Serbia, to uncover CIDP mimics, and to identify factors that may aid in CIDP diagnosis. Our longitudinal retrospective cohort study included 86 eligible adult patients referred to the Neurology Clinic, University Clinical Centre of Serbia, with a diagnosis of CIDP. We also included 15 patients referred to us with different diagnoses that ended up having CIDP as their final diagnosis. Exactly half of patients referred as CIDP failed to meet the established diagnostic criteria (non‐CIDP) and were given an alternative diagnosis at the first hospitalization. At the 1‐year follow‐up, the diagnosis was further revised in four subjects. Confirmed CIDP patients usually had their initial diagnosis based on the nerve conduction studies (NCS), a typical presentation with symmetrical involvement of all four limbs, as well as higher frequencies of elevated protein levels and albuminocytologic dissociation in the cerebrospinal fluid (CSF). CIDP patients also responded better to immune therapy. We found that 52% of the patients initially referred to our Clinic as CIDP were given other diagnoses after a 1‐year follow‐up. Out of all CIDP cases, 27% had been unrecognized prior to referral to our Center. Utilization of clear and objective indicators ‐ conclusive NCS, improvement on therapy, and elevated CSF proteins may provide greater certainty in diagnosing CIDP.

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Section: Resultsmentioning

confidence: 99%

Chronic inflammatory demyelinating polyradiculoneuropathy: Diagnostic problems in clinical practice in Serbia

Basta

Delic

Gunjic

et al. 2023

J Peripheral Nervous Sys

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“…However, the heterogeneity of CIDP creates challenges and delays in diagnosis. The ICOS study indicated that the time between disease onset and treatment was 11 months, and delayed-treated patients had a more severe disability ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…Adverse events associated with citrate use, difficulty with venous access, and hemodynamic changes have been reported in plasma exchange patients. In some cohorts, 60–70% of the CIDP patients reported problems with mobility, self-care, usual activities, pain, or discomfort in IVIg and methylprednisolone ( 9 ). It is inspiring to be here and see how TCM can be used to ensure efficacy and safety in the literature review and case report.…”

Section: Discussionmentioning

confidence: 99%

“…Although first-line treatments can improve symptoms in some patients, they also require ongoing maintenance therapy and the patient's willingness to tolerate the adverse effects or financial burden. The International CIDP Outcome Study (ICOS) revealed that only one-third of CIDP patients were in remission 1 year after the start of first-line treatment, and residual symptoms and deficits were common regardless of treatment ( 9 ). There is also a lack of formal efficacy evidence for alternative immunomodulatory agents ( 4 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Beneficial effects and safety of traditional Chinese medicine for chronic inflammatory demyelinating polyradiculoneuropathy: A case report and literature review

Xie¹,

Li²,

Xie³

et al. 2023

Front. Neurol.

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated neuropathy. First-line treatments for CIDP include corticosteroids, intravenous immunoglobulin, and plasma exchange. However, the application is always limited by high costs, effectiveness, and adverse events. This study investigated a new potentially effective and safe therapeutic treatment to alleviate CIDP symptoms and improve the quality of life. In the present case, a 47-year-old rural woman presented with weakness and numbness of progressive extremities. She was diagnosed with CIDP based on abnormal cerebrospinal fluid and electromyography. The patient was treated with intravenous dexamethasone for 1 week and with Huangqi-Guizhi-Wuwu and Bu-Yang-Huan-Wu decoctions for 90 days. Surprisingly, after the treatment, the weakness and numbness were eliminated, and the quality of life improved. The varying INCAT, MRC, and BI scores also reflected the treatment effects. After 8 months of discharge, the symptoms did not relapse during the follow-up. We also searched “traditional Chinese medicine (TCM)” and “CIDP” in PubMed, EMBASE, the Web of Science, the Cochrane Library, the Chinese National Knowledge Infrastructure Databases, Wanfang Data, and the Chongqing Chinese Science and Technology Periodical Database. Finally, only ten studies were included in the literature review. Three studies were randomized controlled trials, and seven were case reports or case series. There were 419 CIDP patients, but all study sites were in China. Nine TCM formulas involving 44 herbs were reported, with Huang Qi (Astragalus membranaceus) being the most important herb. In conclusion, the case and literature demonstrated that TCM treatment might be a more effective, low-cost, and safe option for treating CIDP. Although these preliminary findings are promising, a larger sample size and higher-quality randomized clinical trials are urgently required to confirm our findings.

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“…In most patients (94%) started with IVIG, neurological symptoms improved. Remission was found in 44% of patients started with combined treatment [ 44 ].…”

Section: Chronic Inflammatory Demyelinating Polyneuropathymentioning

confidence: 99%

Principles of Therapeutic Apheresis in Neurological Disease

Strasser¹

2023

Transfus Med Hemother

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Background: Therapeutic plasma exchange (TPE) is a well-known apheresis technology since many years and is available worldwide. Myasthenia gravis is one of the first neurological diseases successfully treated with TPE. TPE is also frequently applied in acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré syndrome). Both neurological disorders are immunologically mediated and might cause life-threatening symptoms in patients. Summary: There is a large body of evidence from many randomized controlled trials (RCTs) that the application of TPE in myasthenia gravis crisis or in acute Guillain-Barré syndrome is effective and safe. Thus, TPE is recommended as first-line therapy with a grade 1A recommendation during the critical course of these neurological diseases. Even chronic inflammatory demyelinating polyneuropathies characterized by complement-fixing autoantibodies to myelin are successfully treated with TPE. The plasma exchange reduces inflammatory cytokines, complements activating antibodies, and leads to an improvement of neurological symptoms. TPE is no standalone treatment but often combined with immunosuppressive therapy. Recent studies (clinical trials, retrospective analysis, meta-analysis, and systematic reviews) evaluate special apheresis technology (i.e., immunoadsorption [IA], small volume plasma exchange), compare different treatments of these neuropathies, or report on the therapy of rare immune-mediated neuropathies in case reports. Key Messages: TA is a well-established treatment and is safe in acute progressive neuropathies (myasthenia gravis, Guillain-Barré syndrome) with an immune etiology. TPE has been applied for decades and thus has the best evidence so far. The indication for IA depends on the availability of that technology and the evidence by RCTs in special neurological diseases. The treatment with TA should improve the clinical outcome of patients, reducing acute or chronic (chronic inflammatory demyelinating polyneuropathies) neurological symptoms. The informed consent of the patient should carefully weight risks and benefits of the apheresis treatment and consider alternative therapies.

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Clinical outcome of CIDP one year after start of treatment: a prospective cohort study

Cited by 12 publications

References 51 publications

Chronic inflammatory demyelinating polyradiculoneuropathy: Diagnostic problems in clinical practice in Serbia

Chronic inflammatory demyelinating polyradiculoneuropathy: Diagnostic problems in clinical practice in Serbia

Beneficial effects and safety of traditional Chinese medicine for chronic inflammatory demyelinating polyradiculoneuropathy: A case report and literature review

Principles of Therapeutic Apheresis in Neurological Disease

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