Expert Clinical Perspectives: Treatment of chronic inflammatory demyelinating polyneuropathy-Article

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Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic peripheral polyneuropathy that results in immune-mediated nerve injury, leading to disability. The treatment of CIDP involves addressing both the abnormal immune activity that causes ongoing deficits and managing residual symptoms through supportive interventions. Immune-based treatments are guided by evidence-based therapies and are tailored to each individual patient. Early treatment is important, and therapies are escalated depending on the response. Personalization of treatment is needed to determine the ideal dose and duration of treatment. Immunosuppressive agents may be used in nonresponding patients or when corticosteroid-sparing interventions are desired, but their effectiveness is unproven and must be weighed against the risk and cost. Serial clinical assessments are necessary to monitor disease activity and determine the need for ongoing treatment. Supportive interventions such as physical therapy, adaptive equipment, pain management, and emotional support are also important for addressing residual deficits. The decision to initiate treatment with intravenous immunoglobulin (IVIg) or corticosteroids depends on individual factors and contraindications. If first-line therapies are not effective, plasma exchange may be considered, followed by other immunosuppressive agents if necessary. Monitoring treatment response through objective outcomes measures is critical to guide treatment decisions. For patients who have a complete response, treatment weaning can be considered to determine the need for ongoing therapy. For patients with a partial response, an escalation of immunotherapy may be necessary. Non-immune-based interventions are important for managing residual deficits, addressing pain and fatigue, and improving quality of life. CIDP treatment requires an individualized approach that encompasses both immune-based and supportive interventions to optimize outcomes for patients with this chronic neurologic condition.

Keywords

Chronic inflammatory demyelinating polyneuropathy

CIDP

immune-mediated nerve injury

disability

immune-based treatments

evidence-based therapies

personalization of treatment

immunosuppressive agents

supportive interventions

plasma exchange

cidp

Chronic Inflammatory Demyelinating Polyneuropathy