title: Immunosuppressive treatment in refractory chronic inflammatory demyelinating polyradiculoneuropathy. A nationwide retrospective analysis.
abstract: OBJECTIVE
  There are other options open to patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who are non-responders to conventional treatment, including immunosuppressive and immunomodulatory agents (IA). The aim of this study was to assess whether the use of IA is able to increase the number of responders.
  
  
  METHODS
  Clinical and electrophysiological data of patients with refractory CIDP, followed at 10 Italian centres, were collected, and the clinical outcome (Rankin Scale) and drug side effects (SE) for the different therapies were analysed.
  
  
  RESULTS
  A total of 110 patients were included. These patients underwent 158 different therapeutic procedures with IA. Seventy-seven patients were treated with azathioprine, 18 rituximab, 13 cyclophosphamide, 12 mycophenolate mofetil, 12 cyclosporine, 12 methotrexate, 11 interferon-alpha and three interferon beta-1a. The percentage of patients who responded to azathioprine (27%) was comparable to the percentage of responders to other therapies, after the exclusion of interferon beta-1a that was not effective in any of the three patients treated. The percentage of SE ranges from 8% (methotrexate) to 50% (cyclosporine).
  
  
  CONCLUSIONS
  One-fourth of patients, refractory to conventional treatment, showed an improvement in their disability with IA. Methotrexate had the lowest SE; cyclosporine was associated with severe SE and often led to drug discontinuation.
authors.affiliation: Dipartimento di Neuroscienze, AOU San Giovanni Battista, Torino, Italy. dariococito@yahoo.it
authors.forename: D
authors.initials: D
authors.lastname: Cocito
authors.forename: S
authors.initials: S
authors.lastname: Grimaldi
authors.forename: I
authors.initials: I
authors.lastname: Paolasso
authors.forename: Y
authors.initials: Y
authors.lastname: Falcone
authors.forename: G
authors.initials: G
authors.lastname: Antonini
authors.forename: L
authors.initials: L
authors.lastname: Benedetti
authors.forename: C
authors.initials: C
authors.lastname: Briani
authors.forename: R
authors.initials: R
authors.lastname: Fazio
authors.forename: S
authors.initials: S
authors.lastname: Jann
authors.forename: S
authors.initials: S
authors.lastname: Matà
authors.forename: M
authors.initials: M
authors.lastname: Sabatelli
authors.forename: E
authors.initials: E
authors.lastname: Nobile-Orazio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001369:Axons / Q000473:pathology; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000068556:Interferon beta-1a; D016898:Interferon-alpha / Q000627:therapeutic use; D016899:Interferon-beta / Q000627:therapeutic use; D007558:Italy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010956:Plasmapheresis; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000188:drug therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D000069283:Rituximab; D016899:Interferon-beta; D016572:Cyclosporine; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine; D000068556:Interferon beta-1a; D008727:Methotrexate