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Comparative Study
. 2018 Sep;265(9):2052-2059.
doi: 10.1007/s00415-018-8948-y. Epub 2018 Jul 2.

Corticosteroids in Chronic Inflammatory Demyelinating Polyneuropathy : A Retrospective, Multicentre Study, Comparing Efficacy and Safety of Daily Prednisolone, Pulsed Dexamethasone, and Pulsed Intravenous Methylprednisolone

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Free PMC article
Comparative Study

Corticosteroids in Chronic Inflammatory Demyelinating Polyneuropathy : A Retrospective, Multicentre Study, Comparing Efficacy and Safety of Daily Prednisolone, Pulsed Dexamethasone, and Pulsed Intravenous Methylprednisolone

G G A van Lieverloo et al. J Neurol. .
Free PMC article

Abstract

Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) can be treated with corticosteroids or intravenous immunoglobulins. Various corticosteroid regimens are currently used in CIDP, but it is unknown whether they are equally efficacious. In this retrospective study, we compared efficacy and safety of three corticosteroid regimens in CIDP patients.

Methods: We included treatment naïve patients that fulfilled the EFNS/PNS criteria for CIDP. Patients were treated with corticosteroids according to the local protocol of three CIDP expertise centres. Corticosteroid regimens consisted of daily oral prednisolone, pulsed oral dexamethasone, or pulsed intravenous methylprednisolone. Outcomes were number of responders to treatment, remission rate of treatment responders, overall probability of 5-year remission, and the occurrence of adverse events.

Results: A total of 125 patients were included. Sixty-seven (54%) patients received daily prednisone or prednisolone, 37 (30%) pulsed dexamethasone, and 21 (17%) pulsed intravenous methylprednisolone. Overall, 60% (95% CI 51-69%) responded to corticosteroids, with no significant difference between the three treatment regimens (p = 0.56). From the 75 responders, 61% (95% CI 50-73%) remained in remission, during a median follow-up of 55 months (range 1-197 months). The probability of responders reaching 5-year remission was 55% (95% Cl 44-70%), with no difference between the three groups. Adverse events leading to a change in treatment occurred in ten patients (8%). Two patients had a serious adverse event.

Conclusion: Corticosteroids lead to improvement in 60% of patients and to remission in 61% of treatment responders. There were no differences between treatment modalities in terms of efficacy and safety.

Keywords: (Cortico)steroids; CIDP; Immunosuppressive treatment; Peripheral nerve disorder.

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Screening of treatment naïve CIDP patients and treatment response in patients initially treated with corticosteroids. CS corticosteroids, PE plasma exchange
Fig. 2
Fig. 2
Probability of remission after corticosteroid discontinuation in treatment responders. Data were censored for shorter follow-up duration than 60 months. The MPS group was analysed but removed from figure as the curve was misleading due to the small proportion of responders and large effect of censoring due to short follow-up in most patients

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