Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy

Mehndiratta MM, Hughes RAC, Agarwal P

Published Online:

October 6, 2010

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. Plasma exchange removes such factors from the blood stream. It involves connecting a person's blood circulation to a machine which exchanges the plasma part of the blood for an artificial substitute solution. Two small trials involving 44 people both showed that plasma exchange induces short-term improvement in nerve function but in one trial this was followed by relapse in two-thirds of cases. Plasma exchange causes side-effects in about 10% of people and these are sometimes serious.

Abstract (click to read)

Background:

Chronic inflammatory demyelinating polyradiculoneuropathy is an uncommon progressive or relapsing paralysing disease caused by inflammation of the peripheral nerves. If the hypothesis that it is due to autoimmunity is correct, removal of autoantibodies in the blood by plasma exchange should be beneficial.

Objectives:

To evaluate the efficacy of plasma exchange in chronic inflammatory demyelinating polyradiculoneuropathy.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (26 January 2010), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010), MEDLINE (January 1950 to January 2010), EMBASE (January 1980 to January 2010), CINAHL Plus (January 1937 to January 2010) and LILACS (January 1982 to January 2010). We also scrutinised the bibliographies of the trials, and contacted the trial authors and other disease experts.

Selection criteria:

Randomised or quasi-randomised controlled trials in participants of any age comparing plasma exchange with sham treatment or no treatment.

Data collection and analysis:

Two authors selected the trials, extracted the data and assessed methodological quality independently. Where possible data was combined according to the methods of the Cochrane Neuromuscular Disease Review Group.

Main results:

Primary outcome measure: one crossover trial including 18 participants showed two (95% confidence interval (CI) 0.8 to 3.0) points more improvement after four weeks on an 11-point disability scale with plasma exchange (10 exchanges over four weeks) than with sham exchange. Rapid deterioration after plasma exchange occurred in eight of 12 who had improved.
Secondary outcome measures: when the results of this trial and another with 29 participants treated in a parallel group design trial were combined, there were 31 points (95% CI 16 to 45) more improvement in an impairment scale after plasma exchange (six exchanges over three weeks) than after sham exchange. There were significant improvements in both trials in an electrophysiological measure, the proximally evoked compound muscle action potential, after three or four weeks. Non-randomised evidence indicates that plasma exchange induces adverse events in 3% to 17% of procedures. These are sometimes serious. A trial showing no significant difference in the benefit between plasma exchange and intravenous immunoglobulin has been included in the Cochrane review of intravenous immunoglobulin for this condition.

Authors' conclusions:

Moderate to high quality evidence from two small trials showed that plasma exchange provides significant short-term improvement in disability, clinical impairment and motor nerve conduction velocity in chronic inflammatory demyelinating polyradiculoneuropathy but rapid deterioration may occur afterwards. Adverse events related to difficulty with venous access, use of citrate and haemodynamic changes are not uncommon. More research is needed to identify agents which will prolong the beneficial action of plasma exchange.

This record should be cited as:

Mehndiratta MM, Hughes RAC, Agarwal P. Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003906. DOI: 10.1002/14651858.CD003906.pub2

Assessed as up to date:

January 26, 2010

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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

Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy

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