Les limites therapeutiques des polyradiculonevrites chroniques. [Treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)]

Details

Serval ID
serval:BIB_932993B91D74
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Les limites therapeutiques des polyradiculonevrites chroniques. [Treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)]
Journal
Revue Neurologique
Author(s)
Kuntzer  T.
ISSN
0035-3787 (Print)
Publication state
Published
Issued date
04/2006
Peer-reviewed
Oui
Volume
162
Number
4
Pages
539-43
Notes
English Abstract Journal Article Review --- Old month value: Apr
Abstract
Limits of treatment in chronic inflammatory demyelinating poly(radiculo)neuropathies (CIDP) patients are better known thanks to recent Cochrane reviews. (1) Randomized controlled trials have only focused on short-term effects, but most patients need long-term therapy, (2) There are three proven effective treatments available (prednisone; intravenous immunoglobulin or IVIg and plasma exchange or PE) which are useful in more than 60 p. 100 of patients, (3) New open studies indicated possible efficacy for mycophenolate, rituximab, etanercept, ciclosporine and interferons, and (4) Whether CIDP variants need specific treatment is still unknown. Many CIDP patients need treatment for years. The fear of side effects during long-term steroid treatment, the high costs of IVIg, the necessity for specialized equipment and the invasive nature of PE, are important factors determining the choice for one of these treatments. In most up-to-date treatment options, patients are initially treated with IVIg at a dosage of 2 g/kg administered for 25 days, clinical improvement can be judged within 10 days. The percentage of patients responding seems to be approximately 70 percent, with a very high chance (approximately 85 percent) that repeated administration of IVIg will be necessary, explaining why most neurologists add an immunosuppressive drug at this stage, but there is no consensus concerning the best drug to be used. Combinations of drugs are most likely to be useful in the next future, using IVIg, prednisone, and a immunosuppressor agent, such as mycophenolate, rituximab, etanercept, or ciclosporine. General measures to rehabilitate patients and to manage symptoms like fatigue and other residual findings are important.
Keywords
Adrenal Cortex Hormones/adverse effects/therapeutic use Anti-Inflammatory Agents/adverse effects/therapeutic use Case Management Combined Modality Therapy Humans Immunoglobulins, Intravenous/therapeutic use Immunosuppressive Agents/adverse effects/classification/therapeutic use Plasma Exchange Plasmapheresis Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapy/immunology/*therapy Randomized Controlled Trials
Pubmed
Web of science
Create date
25/01/2008 12:43
Last modification date
20/08/2019 14:56
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