Chronic inflammatory demyelinating polyneuropathy responsive to mycophenolate mofetil therapy

Bedi, Gurdesh S; Brown, Andrew; Tong, Tao; Sharma, Khema R.

doi:10.1136/jnnp.2009.177576

Cited by 36 publications

(15 citation statements)

References 25 publications

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“…MM produces immunosuppression that is comparable to azathioprine without causing major bone marrow suppression. Several groups have reported improved strength and successful corticosteroid dosage reduction following therapy with MM [Gorson et al 2004;Bedi et al 2010]. The onset of improvement occurred within 3-4 months.…”

Section: Mycophenolate Mofetilmentioning

confidence: 99%

An update on the management of chronic inflammatory demyelinating polyneuropathy

Gorson

2012

Ther Adv Neurol Disord

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Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune mediated disorder of the peripheral nervous system with clinical features that include weakness, sensory loss, imbalance, pain and impaired ambulation which may lead to substantial disability. This review highlights current treatment strategies for CIDP, how best to utilize proven therapies such as intravenous immunoglobulin, oral prednisone, pulse dexamethasone, and plasma exchange, and when and how to use alternative immunosuppressive agents when first-line therapies are ineffective or poorly tolerated.

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Section: Mycophenolate Mofetilmentioning

confidence: 99%

An update on the management of chronic inflammatory demyelinating polyneuropathy

Gorson

2012

Ther Adv Neurol Disord

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“…CIDP and GBS can occur at any age but are most commonly reported in patients between 40 and 60 years old (GBS has a second peak in young adults), and are slightly more common in men.…”

Section: Epidemiologymentioning

confidence: 97%

Inflammatory Demyelinating Neuropathies

Lopate

Pestronk

2011

Curr Treat Options Neurol

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The primary goal of therapy in patients with the Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is improved strength and functional ability. Improvement in pain, sensory loss, gait disorder, and autonomic instability are other goals of therapy. Patients with very mild symptoms that do not interfere with activities of daily living can be observed for deterioration without treatment. For GBS, standard care includes plasma exchange (PE) or human immune globulin (HIG), both of which have similar efficacy. Supportive care in the intensive care unit may be needed for those patients with severe bulbar or respiratory weakness. We treat most patients with PE, usually performing an exchange every other day for a total of five exchanges. We use HIG in children, if there are antiglycolipid antibodies (eg, anti-GM1 or anti-GQ1b) or if there is a contraindication to PE, such as hemodynamic instability; severe renal, hepatic, or cardiac disease; or poor venous access. For CIDP, there are no guidelines concerning the initial choice of therapy. Corticosteroids, HIG, and PE have all been shown to be effective in prospective, randomized controlled trials, and comparison trials have shown equal efficacy among these three immunomodulating therapies. The choice of therapy depends on several factors including disease severity, concomitant illnesses, side-effect profile, potential drug interactions, venous access, age-related risks, and cost of treatment. In patients with moderate to severe symptoms, treatment with corticosteroids or HIG should be used. We usually use high-dose, intermittent methylprednisolone as the initial drug of choice. We believe intermittent corticosteroids are better than HIG because of their good safety profile, low cost, ease of administration (can be given intravenously or by mouth), and proven efficacy. If there is a major contraindication to corticosteroids, then HIG is offered. PE is less well tolerated and is primarily used as a third choice and only for a few weeks to months to induce initial improvement. Once symptoms are improving, the dose of corticosteroids or HIG should be tapered with the goal of eventual discontinuation depending on patient response. Patients who do not respond to initial therapy, experience adverse effects from the initial immunomodulating agent, or require chronic treatment can be treated with another first-line agent or one of several second-line agents.

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“…A retrospective single-center study evaluated the effect of mycophenolate mofetil in 8 out of 186 idiopathic CIDP patients with refractory CIDP who were intolerant to other treatments or as add-on therapy [15]. After median duration of 10 months, disability varied from moderate to severe.…”

Section: Immunosuppressive Therapiesmentioning

confidence: 99%

Advances in the treatment of chronic inflammatory demyelinating neuropathies in 2010

Lozeron

Adams

2011

J Neurol

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Chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon disease of the peripheral nerves. The diagnosis is based mainly on clinical presentation, cerebrospinal fluid (CSF) examination, and electrodiagnostic studies. Treatment of CIDP has at least two components: supportive care and specific therapy including primarily steroids, intravenous immunoglobulins (IVIg), and plasmapheresis (PE). This review summarizes progress in the treatment of CIDP published during the last year.

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Chronic inflammatory demyelinating polyneuropathy responsive to mycophenolate mofetil therapy

Abstract: Our pilot data suggest that MMF appears to be an effective therapy for patients with naive or refractory CIDP, and further controlled studies are warranted for their confirmation.

Cited by 36 publications

References 25 publications

An update on the management of chronic inflammatory demyelinating polyneuropathy

An update on the management of chronic inflammatory demyelinating polyneuropathy

Inflammatory Demyelinating Neuropathies

Advances in the treatment of chronic inflammatory demyelinating neuropathies in 2010

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