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. 2024 Mar 8;14(3):e083669.
doi: 10.1136/bmjopen-2023-083669.

Physician awareness and understanding of chronic inflammatory demyelinating polyradiculoneuropathy in Japan: a web-based study

Yukio Takeshita  1   2 , Yasuaki Imajo  3 , Akinori Oh  4 , Masayoshi Kikutani  5 , Nobuaki Okamatsu  5
Affiliations

Physician awareness and understanding of chronic inflammatory demyelinating polyradiculoneuropathy in Japan: a web-based study

Yukio Takeshita et al. BMJ Open. .

Abstract

Objectives: To investigate potential knowledge gaps between neurologists and non-specialists and identify challenges in the current management of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), with a focus on 'early diagnosis' and 'appropriate treatment' for CIDP.

Design: A non-interventional, cross-sectional, web-based quantitative survey of physicians working in healthcare clinics or hospitals in Japan.

Setting: Participants were recruited from the Nikkei Business Publications panel from 18 August to 14 September 2022.

Participants: Responses from 360 physicians (120 each of internists, orthopaedists and neurologists) were collected.

Outcome measures: Responses relating to a CIDP hypothetical case and current understanding were assessed to determine awareness, collaboration preferences and diagnosis and treatment decisions.

Results: Understanding of CIDP was 90.8% among neurologists, 10.8% among orthopaedists and 13.3% among internists; >80% of orthopaedists and internists answered that neurologists are preferable for treatment. Diagnostic assessment using a hypothetical case showed 95.0% of neurologists, 74.2% of orthopaedists and 72.5% of internists suspected CIDP. Among orthopaedists and internists suspecting CIDP, >70% considered referring to neurology, while ~10% considered continuing treatment without a referral. Among neurologists, 69.4% chose intravenous immunoglobulin (IVIg) as first-line treatment and determined effectiveness to be ≤3 months.

Conclusions: Orthopaedists and internists had lower CIDP awareness compared with neurologists, which may lead to inadequate referrals to neurology. Evaluation of IVIg effectiveness for maintenance therapy occurred earlier than the guideline recommendations (6-12 months), risking premature discontinuation. Improving CIDP knowledge among orthopaedists and internists is critical for better diagnosis and collaboration with neurologists. Neurologists should consider slow and careful evaluation of IVIg maintenance therapy.

Trial registration number: UMIN000048516.

Keywords: Awareness; Clinical Competence; Cross-Sectional Studies; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating.

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Conflict of interest statement

Competing interests: YT and YI have received support and consulting fees from Takeda Pharmaceutical Company Limited. AO, MK and NO are employees of Takeda Pharmaceutical Company Limited.

Figures

Figure 1
Figure 1
Awareness (knowledge level) of CIDP among participants. CIDP, chronic inflammatory demyelinating polyradiculoneuropathy.
Figure 2
Figure 2
Distribution and percentages of CIDP suspicion in each stage among participants (results of responses to hypothetical case questions). CIDP, chronic inflammatory demyelinating polyradiculoneuropathy.
Figure 3
Figure 3
First-line drug treatment choice for CIDP. (A) Distribution and percentage of CIDP treatments typically administered during clinical practice among neurologists. (B) Regional differences in treatment choice for CIDP. CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; IVIg, intravenous immunoglobulin; PE, plasma exchange.
Figure 4
Figure 4
Distribution and percentage of CIDP maintenance treatment preferences among neurologists. (A) Timing of patient treatment response to immunoglobulin maintenance treatment. (B) CIDP maintenance dosage of steroids. CIDP, chronic inflammatory demyelinating polyradiculoneuropathy.
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