neurologic disorders
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Treatment of CIDP
IV immune globulin (IVIG) Corticosteroids Plasma exchange IVIG, although more expensive, is often offered first to patients with chronic inflammatory demyelinating polyneuropathy because of the following: It does not have the many adverse effects of long-term corticosteroid use. It is easier to administer than plasma exchange. However, recent evidence suggests that pulsed corticosteroids may result in longer remissions and have a lower rate of serious adverse effects than IVIG. Pulsed corticosteroids may be given as follows: Dexamethasone40 mg orally a day for 4 consecutive days each month for 6 cycles Dexamethasoneorally once a week for 3 months with monthly dose adjustments based on the patient's clinical status IVmethylprednisolone500 mg once a day for 4 consecutive days each month for 6 months Some patients may benefit from a combination of IVIG and corticosteroids. Plasma exchange also does not have the long-term adverse effects of corticosteroids, but it often requires an indwelling port and, because of the large fluid shifts, may cause hypotension. Patients who do not respond to IVIG or who have severe disease may be offered plasma exchange, but because plasma exchange is invasive and has risks, it is best used as a way to de-escalate severe deterioration rather than as long-term maintenance treatment. Subcutaneous immunoglobulin (SCIG) may be as effective as IVIG. Immunosuppressants (eg,azathioprine) may be helpful and can reduce corticosteroid dependence. Treatment may be needed for a long time. 