[Review of the recent literature on peripheral neuropathies: therapeutic advances].

Abstract

Improvement of therapeutic strategies for peripheral neuropathies requires multicentric clinical trials. For chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), a randomized controlled multicentric study compared IgIV to pulses of methylprednisolone (MP) given for 6 months. The primary endpoint was treatment discontinuation due to inefficacy or intolerance; 45 patients were enrolled: more patients had interrupted MP than IVIg, usually because of inefficacy. A multicentric randomized clinical trial (PREDICT) evaluated long-term remission of CIDP after short-term corticosteroid therapy (pulses of dexamethasone or prednisolone); 39 patients were enrolled: 26% achieved cure or remission, a relapse occurred in 50% after a delay of 11 to 17 months. Differential diagnosis was identified in 58% of patients who had not responded to any therapy. For refractory CIDP, a retrospective study showed the possibility of functional improvement in 24% of cases after adjunction of an immunomodulatory agent; cyclosporine was associated with the highest rate of adverse events or side effects. In familial amyloidotic polyneuropathy, a multicentric controlled study against placebo with tafamidis, an akinetic stabilizer of transthyretin (TTR) 20mg/d, in early stage of Val30MetTTR showed efficiency in the evaluable group and led to marketing authorization by the EMA in stage 1 to slow the progression of the neuropathy. A Cochrane database system review showed that there are no randomized or quasi-randomized controlled clinical trials of treatment for POEMS syndrome, for neuropathies with anti-MAG antibodies, or multifocal motor neuropathy on which to base practice. This review underlines the usefulness of multicentric randomized trials to assess treatments in peripheral neuropathies.

• Authors: D Adams
• Journal: Revue neurologique (Rev Neurol (Paris)) Vol. 169 Issue 12 Pg. 1004-9 (Dec 2013) ISSN: 0035-3787 [Print] France
• Vernacular Title: Revue de la littérature récente sur les neuropathies périphériques: actualités thérapeutiques.
• PMID: 24262610 (Publication Type: English Abstract, Journal Article, Review)
• Copyright: Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Topics

• Humans
• Immunotherapy
• POEMS Syndrome (drug therapy)
• Peripheral Nervous System Diseases (drug therapy, therapy)
• Polyradiculoneuropathy, Chronic Inflammatory Demyelinating (drug therapy)