Intravenous immunoglobulin for people with chronic inflammatory demyelinating polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an illness caused by inflammation of nerves leading to paralysis. It is probably an autoimmune disease and it usually requires a long-term treatment to prevent further disability. There is much debate about the first choice of treatment. Immunoglobulin, antibodies purified from the blood, are given intravenously to treat autoimmune diseases. A beneficial effect of corticosteroids and plasma exchange has already been demonstrated.
Seven randomised controlled trials including 287 participants were eligible for this review. We found five randomised trials which together prove that intravenous immunoglobulin improves disability more than placebo. Two other small trials showed no significant difference between intravenous immunoglobulin and plasma exchange in one and corticosteroids in the other. No new trials were found for this 2011 update. In this review, mild and transient side effects were reported in approximately half of treated participants; serious side effects were reported in six per cent of the treated participants. This did not differ significantly from plasma exchange or corticosteroids treated participants.
Whether the improvements are equally clinically relevant cannot be deduced from this analysis because each trial used a different disability scale with a unique definition of a significant improvement. Only one study included in this review had a long-term follow-up. These results suggest that intravenous immunoglobulin improves disability more than placebo over 24 and 48 weeks. Further research is needed to compare the long-term benefits as well as side effects of intravenous immunoglobulin with other treatments.