Drug therapy for chronic idiopathic axonal polyneuropathy

Warendorf, Janna K; Vrancken, Alexander F.J.E.; Schaik, Ivo N. van; Hughes, Richard; Notermans, Nicolette C.

doi:10.1002/14651858.cd003456.pub3

Cited by 12 publications

(9 citation statements)

References 138 publications

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“…The pathogenesis of CIAP is per definition unknown although there are several prevailing etiological hypotheses such as metabolic, vascular, and neurodegenerative causes. No disease-modifying treatment options are available in CIAP today ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Microangiopathy—A Potential Contributing Factor to Idiopathic Polyneuropathy: A Mini Review

Samuelsson

2018

Front. Neurol.

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Chronic idiopathic axonal polyneuropathy (CIAP) is a slowly progressive predominantly sensory axonal polyneuropathy. The prevalence of CIAP increases with age. The pathogenic cause of CIAP is unknown although there are several prevailing etiological hypotheses. In this mini review, we focus on the hypothesis of disturbed microcirculation in the vasa nervorum of peripheral nerves as a pathogenic cause of CIAP. There is an association between CIAP and metabolic risk factors. Furthermore, the phenotype of CIAP resembles diabetic neuropathy both clinically and electrophysiologically. In sural nerve biopsies from patients with diabetes mellitus, structural abnormalities indicating microangiopathy in the endoneurial microvessels are well documented. Similarly, sural microvessel abnormalities have been shown in patients with atherosclerotic non-diabetic peripheral vascular disease. However, the reported histopathological alterations of microvasculature in sural nerves of CIAP patients are inconsistent. Two studies report microangiopathic changes in CIAP sural nerves comparable with those found in patients with diabetic neuropathy. Conversely, another recent study showed no significant differences in the microangiopathic parameters in the endoneurial microvessels in the sural nerve biopsies from CIAP patients compared to controls without polyneuropathy. However, this CIAP patient group was younger compared to the patient groups in the other two studies. A general limitation with the published morphological studies are that different methods have been used in the assessment of microangiopathy, and there is also a risk of subjectivity in the results. Immunohistochemistry studies of sural nerves with verification of microangiopathy using specific biomarkers would be of great interest to develop.

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Section: Introductionmentioning

confidence: 99%

Microangiopathy—A Potential Contributing Factor to Idiopathic Polyneuropathy: A Mini Review

Samuelsson

2018

Front. Neurol.

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“…The lack of trials is an opportunity for further research to define efficacious therapies. 25 Limitations of this study include that it was open-label and lacked a placebo-control. Since a per-protocol analysis was performed, only patients that completed the study submitted survey data.…”

Section: Discussionmentioning

confidence: 99%

A secondary analysis of PAIN‐CONTRoLS: Pain's impact on sleep, fatigue, and activities of daily living

et al. 2022

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Introduction/Aims: Peripheral neuropathies commonly affect quality of life of patients due to pain, sleep disturbances, and fatigue, although trials have not adequately explored these domains of care. The aim of this study was to assess the impact of nortriptyline, duloxetine, pregabalin, and mexiletine on pain, sleep, and fatigue in patients diagnosed with cryptogenic sensory polyneuropathy (CSPN). Methods: We implemented a Bayesian adaptive design to perform a 12-wk multisite, randomized, prospective, open-label comparative effectiveness study in 402 CSPN patients. Participants received either nortriptyline (n = 134), duloxetine (n = 126), pregabalin (n = 73), or mexiletine (n = 69). At prespecified analysis timepoints, secondary outcomes, Patient Reported Outcomes Measurement Information System (PROMIS) surveys including Short Form (SF)-12, pain interference, fatigue, and sleep disturbance, were collected.Results: Mexiletine had the highest quit rate (58%) due to gastrointestinal side effects, while nortriptyline (38%) and duloxetine (38%) had the lowest quit rates. If tolerated for the full 12 wk of the study, mexiletine had the highest probability (>90%) of positive outcomes for improvements in pain interference and fatigue.There was no significant difference among the medications for sleep disturbance or SF-12 scores. Adverse events and lack of efficacy were the two most common reasons for cessation of therapy.

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“…Randomized clinical trials (RCTs) evaluating analgesic therapies in this population however are missing. [1] Since 2010 we regularly see these patients in our Institute for Neuropathic Pain in the Netherlands. Our mission is to treat neuropathic pain patients with effective treatments with (nearly) no side effects.…”

Section: Introductionmentioning

confidence: 99%

Neuropathic pain due to chronic idiopathic axonal neuropathy: fast pain reduction after topical phenytoin cream application

Hesselink¹,

Kopsky²

2018

Open J Pain Med

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Drug therapy for chronic idiopathic axonal polyneuropathy

Cited by 12 publications

References 138 publications

Microangiopathy—A Potential Contributing Factor to Idiopathic Polyneuropathy: A Mini Review

Microangiopathy—A Potential Contributing Factor to Idiopathic Polyneuropathy: A Mini Review

A secondary analysis of PAIN‐CONTRoLS: Pain's impact on sleep, fatigue, and activities of daily living

Neuropathic pain due to chronic idiopathic axonal neuropathy: fast pain reduction after topical phenytoin cream application

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