Intravenous immunoglobulin (
IVIG),
corticosteroids and therapeutic
plasma exchange (TPE) are evidence-based conventional treatments for chronic inflammatory demyelinating
polyneuropathy (
CIDP). In many centres, unconventional treatments are frequently used as alternatives. We evaluated the outcome of conventional and unconventional
therapies in 31
CIDP patients. Overall response rate with conventional first-line
immunotherapies was 77% (20/26), comparable between
IVIG and
corticosteroids (80% vs 70%). Use of TPE was limited. Treatment response among typical and atypical
CIDP were comparable (76 vs 80%). Non-responders were patients with progressive form of typical
CIDP and DADS. Majority (21/26, 81%) of patients with persistent neurological deficits received maintenance
therapy. Two subgroups of patients frequently treated with maintenance
immunosuppressants were those with improving or stable disease following first-line treatment (12, 57%) and those with progressive form of
CIDP (2, 10%). Primary indications for
immunosuppressant use were
corticosteroids-sparing and additional immunosuppression effects. Nine (64%) patients with improving or stable disease given
azathioprine were taken off
corticosteroids after a median duration of 14 months (range 12-108). Two (14%) eventually achieved cure or clinical remission without treatment. Maintenance
IVIg was given to 6 (29%) relapsing
CIDP patients; none of achieved cure or remission after similar median
duration of treatment. Less potent
immunosuppressant drugs (
azathioprine,
mycophenolate mofetil, and
methotrexate) were frequently used, with moderate adverse effect profiles. In resource limited setting, unconventional treatments were commonly used among
CIDP patients with different
clinical course of progression. In most cases, careful risk-benefit re-assessment is required to justify its further use.