Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy

Abstract

Background: Chronic inflammatory demyelinating polyradiculoneuropathy is a peripheral neuropathy caused by peripheral nerve inflammation probably due to autoimmunity and would be expected to benefit from corticosteroids. Non-randomised studies suggest that corticosteroids are often beneficial.

Objectives: To evaluate the efficacy of corticosteroids for treating chronic inflammatory demyelinating polyradiculoneuropathy.

Search strategy: Search of the Cochrane Neuromuscular Disease Group register for randomised trials of corticosteroids treatment for chronic inflammatory demyelinating polyradiculoneuropathy and enquiry from subject experts.

Selection criteria: Types of studies: All randomised or quasi-randomised trials Types of Participants: All patients with chronic inflammatory demyelinating polyradiculoneuropathy who were diagnosed by an internationally accepted definition. Types of interventions: Treatment with any form of corticosteroids or adrenocorticotropic hormone. Types of outcome measures:

Primary outcome measure: Change in disability 12 weeks after randomisation.

Secondary outcome measures: 1. Change in impairment 12 weeks after randomisation. 2. Change in maximum motor nerve conduction velocity or compound muscle action potential amplitude after 12 weeks. 3. Side effects of corticosteroids.

Data collection and analysis: One author extracted the data and the other checked them.

Main results: We identified one randomised controlled trial, an open study in which 19 corticosteroids treated patients showed more improvement in impairment than 16 untreated controls after 12 weeks. Experience from large non-randomised studies suggests that steroids are beneficial.

Reviewer's conclusions: A single randomised controlled trial with 35 participants provided weak evidence to support the conclusion from non-randomised studies that oral corticosteroids reduce impairment in chronic inflammatory demyelinating polyradiculoneuropathy. Corticosteroids are known to have serious long term side effects. The long term risk and benefits have not been adequately studied.