Fludarabine in the Treatment of Refractory Chronic Inflammatory Demyelinating Neuropathies

Inflammatory demyelinating neuropathies have variable responses to immunomodulating therapy. Eight patients with chronic inflammatory neuropathies who were refractory to standard therapy were treated with fludarabine, a combination of fludarabine and cyclophosphamide, and in 1 case with fludarabine and rituximab. Five patients with immunoglobulin M anti-myelin-associated glycoprotein neuropathies received fludarabine. Three patients with chronic inflammatory demyelinating polyneuropathy received a combination of fludarabine and cyclophosphamide. All 8 patients improved in either functional status or strength with minimal toxicities. Most patients experienced sustained remission after the use of fludarabine or fludarabine and cyclophosphamide. Fludarabine alone or in combination with cyclophosphamide should be considered for patients with inflammatory demyelinating neuropathies, refractory to other treatments.