Randomised controlled trial of methotrexate for chronic inflammatory demyelinating polyradiculoneuropathy (RMC trial): a pilot, multicentre study

Mahdi-Rogers, Mohamed; Rutterford, Clare; Hughes, Richard; Léger, Jean‐Marc; Nobile‐Orazio, Eduardo; Bergh, Peter Van den; Doorn, P. van; Schaik, Ivo N. van; Hadden, Robert D.M.; Choy, E.; Reilly, Michael P.; Winer, J B; Evers, E.; Créange, Alain; Guéguen, Antoine; Uzenot, D.; Béhin, Anthony; Nicolas, Guillaume; Pautot, Vivien; Uncini, Antonino; Manzoli, Claudia; Lauria, Giuseppe; Pareyson, Davide; Casellato, C.; Sabatelli, Mario; Conte, Amelia; Luigetti, Marco; Briani, Chiara; Lucchetta, Marta; Schenone, Angelo; Benedetti, Luana; Fiorina, E.; Brusse, Esther; Kooi, Anneke J. van der; Guiloff, R J; Rakowicz, Wojtek; Lecky, B. R. F.; Dougan, Charlotte F.; Marshall, David A.; Davies, N.; Busby, Mark; Lansbury, Alastair J.; Overell, James; Willison, Hugh J.; Rajabally, Yusuf A.; Kendall, Bradley J.; Gow, Deborah J.; Nixon, J.V.; Kulkarni, Omkar; Katifi, Haider; Hammans, Simon; Gibson, Andrea; McDermott, Clare; Cornblath, David R.; Chaudry, Vinay

doi:10.1016/s1474-4422(08)70299-0

Cited by 146 publications

(21 citation statements)

References 32 publications

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“…One parallel-group trial with a low risk of bias tested the efficacy of low-dose oral methotrexate, a well-tolerated immunosuppressant often used in rheumatoid arthritis (RMC 2009). It randomised 60 adults with CIDP with or without paraprotein (but not anti-myelin-associated-glycoprotein antibodies) to methotrexate (7.5 mg weekly for four weeks, then 10 mg weekly for four weeks, then 15 mg weekly for 32 weeks) or placebo.…”

Section: Resultsmentioning

confidence: 99%

“…According to low-quality evidence from one trial, there may be little or no difference between methotrexate and placebo in the change in disability as measured with either the Overall Neuropathy Limitations Scale (ONLS) or the Amsterdam Linear Disability score after 40 weeks’ treatment (RMC 2009). There were more serious adverse events with methotrexate than with placebo.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews

Oaklander

Lunn

Hughes

et al. 2017

Cochrane Database of Systematic Reviews

122

142

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews

Oaklander

Lunn

Hughes

et al. 2017

Cochrane Database of Systematic Reviews

122

142

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“…The guideline also has advised the addition of corticosteroids or an immunosuppressive agent when frequent IVIg is required [1]. However, many CIDP patients might be overtreated [2,3,4,5]. Recent investigations demonstrated that grip strength is a sensitive tool for assessing clinically relevant changes during repeated IVIg in patients with CIDP [6,7].…”

Section: Introductionmentioning

confidence: 99%

Optimization of Intravenous Immunoglobulin in Chronic Inflammatory Demyelinating Polyneuropathy Evaluated by Grip Strength Measurement

et al. 2013

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Background: Optimal dose and timing of repeated intravenous immunoglobulin therapy (IVIg) for intractable chronic inflammatory demyelinating polyneuropathy (CIDP) patients have not been determined. The aim of this study was to optimize dose and timing of IVIg for CIDP patients who need frequent IVIg using daily grip strength measurement. Methods: Repeated IVIg were administered for two intractable CIDP patients. Grip strength was recorded at home every day to access the clinical change in symptoms, and dose and timing of IVIg were optimized based on the results. Results: The decrement on grip strength was a sensitive indicator of symptom exacerbation. 100 g of IVIg had a limited effect for each patient. In one patient, symptoms maintained after monthly 60 g of IVIg. In another, 100 g of IVIg every 7 weeks resulted in a marked improvement. After receiving 20 g of IVIg weekly, each patient showed further improvement. Conclusion: Optimal dose and timing possibly vary in each individual patient. Dose titration of IVIg is necessary to avoid over- and undertreatment. The daily self-monitoring of grip strength is a helpful tool for clinical assessment in CIDP.

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“…Underlying such variability, there is probably also a broad spectrum of immune events and molecular mechanisms that might explain the heterogeneity of response to treatments. Various immunosuppressants have been reported as being efficient in isolated cases [8,18]; nevertheless, randomized control trials (RCT) of most of these drugs have failed to show any evidence of efficacy [9,11]. Again, these discrepancies may stress the heterogeneity and complexity of mechanisms in CIDP.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of immunosuppressants in CIDP has been suggested by some studies [6,7,8], but randomized controlled trials have failed to show any effect of immunosuppressants to date [9,10,11]. Other drugs have been used to treat patients with CIDP in a few series [12].…”

Section: Introductionmentioning

confidence: 99%

Natalizumab as a Disease-Modifying Therapy in Chronic Inflammatory Demyelinating Polyneuropathy - A Report of Three Cases

Vallat

Mathis²,

Ghorab³

et al. 2015

Eur Neurol

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Background: Several treatments are available to treat the immune-mediated chronic inflammatory demyelinating polyneuropathy (CIDP). Among these treatments, intravenous immunoglobulins, corticosteroids and plasma exchanges are validated and widely used. A few immunosuppressive drugs have been tried, but they had little efficiency. Methods: We describe three CIDP patients treated by Natalizumab (acting against cellular adhesion and T-cell migration) after a failure of the validated treatments. Results: We observed a long-term improvement in one patient, a dramatic improvement over a significant duration in another patient and stabilization in the last one. Conclusion: This open label study provides evidence for the value of Natalizumab as second-line treatment for individual patients with a high dependency on waning efficacy of first-line therapies. CIDP is characterized by heterogeneity of clinical phenotypes, electrophysiological and pathological features, and various variable courses types of evolution. The different responses to drugs of our patients are consistent with some reported cases and may reflect the spectrum of lesional mechanisms and the molecular dysfunctions in CIDP.

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Randomised controlled trial of methotrexate for chronic inflammatory demyelinating polyradiculoneuropathy (RMC trial): a pilot, multicentre study

Cited by 146 publications

References 32 publications

Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews

Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews

Optimization of Intravenous Immunoglobulin in Chronic Inflammatory Demyelinating Polyneuropathy Evaluated by Grip Strength Measurement

Natalizumab as a Disease-Modifying Therapy in Chronic Inflammatory Demyelinating Polyneuropathy - A Report of Three Cases

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