Immunomodulation in inflammatory neuropathies: rationale and safety

Inflammatory neuropathies are treatable immune-mediated disorders of the peripheral nerves, the prevalence of which is higher than previously believed. Although there are now established treatments of proven benefit for acute and chronic inflammatory neuropathies consisting of intravenous immunoglobulins, corticosteroids and plasma exchanges, there are patients who fail to respond to these therapies. Immunosuppressants have been used in these refractory patients and also to lower the requirements of therapies of established efficacy due to their cost (e.g. immunoglobulins) or sideeffects (e.g., corticosteroids). These drugs include "conventional" immunosuppressants like azathioprine, cyclophosphamide etc. and also newer drugs like Rituximab. Other immunomodulatory drugs like interferon beta have also been trialled in some patients. Currently the role of newer drugs like Fingolimod in inflammatory neuropathies is being studied. In this article, the issue of treating inflammatory neuropathies with immunomodulatory and immunosuppressive agents in the context of their potential adverse effects, is reviewed and discussed. The published evidence on these drugs is reviewed, rationale behind the use of such drugs is analyzed and benefit to risk ratio highlighted.