Page 20 - Read Online

Orsucci. Neuroimmunol Neuroinflammation 2019;6:3 Neuroimmunology and
DOI: 10.20517/2347-8659.2019.05 Neuroinflammation

Editorial Open Access

Pulsed intravenous corticosteroids in chronic
inflammatory demyelinating polyneuropathy: why
not?

Daniele Orsucci

Unit of Neurology, San Luca Hospital, Via Lippi-Francesconi, Lucca 55100, Italy.

Correspondence to: Dr. Daniele Orsucci, Unit of Neurology, San Luca Hospital, Via Lippi-Francesconi, Lucca 55100, Italy.
E-mail: orsuccid@gmail.com
How to cite this article: Orsucci D. Pulsed intravenous corticosteroids in chronic inflammatory demyelinating polyneuropathy: why
not? Neuroimmunol Neuroinflammation 2019;6:3. http://dx.doi.org/10.20517/2347-8659.2019.05
Received: 11 Feb 2019 Accepted: 12 Feb 2019 Published: 24 Feb 2019

Science Editor: Athanassios P. Kyritsis Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a remitting/relapsing and/or chronic
autoimmune disorder, characterized by symmetrical, sensorimotor neuropathic involvement and a slowly
progressive onset. There are many clinical variants, suggesting that this disorder may not be an unique
[1]
entity but rather a spectrum . CIDP diagnostic criteria combine clinical and electrophysiological features.
[1]
Supportive data include increased cerebrospinal fluid (CSF) protein levels .
Many, but not all, patients may be successfully treated with therapies aimed at arresting immunological
[3]
[2]
mechanisms, such as corticosteroids and intravenous immunoglobulins (IVIg) . A systematic review
concluded that there was no clear short-term difference with IVIg when compared with intravenous
methylprednisolone and likely no improvement when compared with either oral prednisolone or plasma
[4]
[4]
exchange . More randomised trials are strongly needed .
Recently, a multicentre retrospective study compared safety and efficacy of daily prednisolone, pulsed
dexamethasone, and pulsed intravenous methylprednisolone. Interestingly, corticosteroids led to
[2]
improvement in 60% of subjects and to clinical remission in 61% of responders . There were no significant
[2]
differences in terms of safety and efficacy . A therapeutic protocol with corticosteroids, with IVIg as an
adjunctive treatment in case corticosteroid treatment was insufficient, could lead to improvement in 90% of
[2]
CIDP patients .

Some patients may not respond to IVIg. For instance, we follow a 37-year-old male patient diagnosed
with CIDP at age 7, based on a sensory ataxic phenotype. The diagnosis was supported by typical

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.nnjournal.net