Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy

Mehndiratta MM, Hughes RAC

Published Online:

July 16, 2008

Chronic inflammatory demyelinating polyradiculoneuropathy is an uncommon progressive or relapsing paralysing disease caused by inflammation of the peripheral nerves. It is characterised by slowly evolving weakness and numbness of the limbs. It is thought to be caused by immune factors in the blood. One small randomised controlled trial involving 35 participants supports the opinion from non-randomised studies that corticosteroids are often beneficial in treating chronic inflammatory demyelinating polyradiculoneuropathy. Corticosteroids are known to have serious long-term side effects. The long-term risks and benefits of corticosteroids should be measured and compared with alternative treatments.

Abstract (click to read)

Background:

Chronic inflammatory demyelinating polyradiculoneuropathy is a peripheral neuropathy caused by peripheral nerve inflammation probably due to autoimmunity and would be expected to benefit from corticosteroids. Non-randomised studies suggest that corticosteroids are often beneficial.

Objectives:

To evaluate the efficacy of corticosteroids for treating chronic inflammatory demyelinating polyradiculoneuropathy.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Register (October 2007), MEDLINE (January 1966 to October 2007) and EMBASE (January 1980 to October 2007) for randomised trials of corticosteroids treatment for chronic inflammatory demyelinating polyradiculoneuropathy and made enquires of subject experts.

Selection criteria:

Types of studies: All randomised or quasi-randomised trials

Types of Participants: All patients with chronic inflammatory demyelinating polyradiculoneuropathy who were diagnosed by an internationally accepted definition.

Types of interventions: Treatment with any form of corticosteroids or adrenocorticotropic hormone.

Types of outcome measures:

Primary outcome measure: Change in disability 12 weeks after randomisation.

Secondary outcome measures:

(1) Change in impairment 12 weeks after randomisation.

(2) Change in maximum motor nerve conduction velocity or compound muscle action potential amplitude after 12 weeks.

(3) Side effects of corticosteroids.

Data collection and analysis:

One author extracted the data and the other checked them.

Main results:

In the first version of this review, we identified one randomised controlled trial, an open study in which 19 corticosteroids treated patients showed more improvement in impairment than 16 untreated controls after 12 weeks. In subsequent updates, including that in March 2008, we have not found any other randomised controlled trials. Experience from large non-randomised studies suggests that steroids are beneficial.

Authors' conclusions:

A single randomised controlled trial with 35 participants provided weak evidence to support the conclusion from non-randomised studies that oral corticosteroids reduce impairment in chronic inflammatory demyelinating polyradiculoneuropathy. Corticosteroids are known to have serious long-term side effects. The long-term risk and benefits have not been adequately studied.

This record should be cited as:

Mehndiratta MM, Hughes RAC. Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002062. DOI: 10.1002/14651858.CD002062

Assessed as up to date:

March 26, 2008

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Primary Review Group:

Neuromuscular Disease Group

Health topics:

Neurology > Peripheral neuropathy > Chronic inflammatory demyelinating polyradiculopathy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy

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