Repurposing MS immunotherapies for CIDP and other autoimmune neuropathies: unfulfilled promise or efficient strategy?

Abstract

Despite advances in the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and other common autoimmune neuropathies (AN), still-many patients with these diseases do not respond satisfactorily to the available treatments. Repurposing of disease-modifying therapies (DMTs) from other autoimmune conditions, particularly multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD), is a promising strategy that may accelerate the establishment of novel treatment choices for AN. This approach appears attractive due to homologies in the pathogenesis of these diseases and the extensive post-marketing experience that has been gathered from treating MS and NMOSD patients. The idea is also strengthened by a number of studies that explored the efficacy of DMTs in animal models of AN but also in some CIDP patients. We here review the available preclinical and clinical data of approved MS therapeutics in terms of their applicability to AN, especially CIDP. Promising therapeutic approaches appear to be B cell–directed and complement-targeting strategies, such as anti-CD20/anti-CD19 agents, Bruton’s tyrosine kinase inhibitors and anti-C5 agents, as they exert their effects in the periphery. This is a major advantage because, in contrast to MS, their action in the periphery is sufficient to exert significant immunomodulation.

Outcome measures in pediatric chronic inflammatory demyelinating polyradiculoneuropathy

“…However, we are unable to comment on the optimal IVIG frequency in children using our study results. We anticipate the use of above‐mentioned outcome measures in future clinical trials investigating IVIG, PLEX, and novel immunomodulatory therapies in children with CIDP 21,34,35 …”

“…use of above-mentioned outcome measures in future clinical trials investigating IVIG, PLEX, and novel immunomodulatory therapies in children with CIDP. 21,34,35 The limitations in this study include retrospective study design and lack of healthy age-and sex-matched controls to compare the grip strength. When using a dynamometer in young children, variables to be considered include hand size, ability to follow directions, and monitoring for compensations at the shoulder, elbow, or wrist that could potentially impact reliability.…”

Kinesin-5 inhibition improves neural regeneration in experimental autoimmune neuritis

“…Experimental set-ups often concentrate on diminishing the inflammatory reaction or promoting neuro-protection. In EAN, the time-point of disease induction is known and neuro-protective or anti-inflammatory treatments start during the disease induction phase or with the beginning of the first symptoms [ 43 ]. In GBS, an induction phase also occurs, as several GBS patients report an infectious event weeks before symptom onset.…”

Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Current Therapeutic Approaches and Future Outlooks

“…90 There are no current trials in CIDP, although this is a potentially important drug class for future consideration and availability of long-term data on haematological disorders may facilitate their application in the field of inflammatory neuropathy. 91,92…”