Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy

Area of Science:

• Neurology
• Immunology
• Clinical Trials

Background:

• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare, progressive, or relapsing paralytic disease caused by peripheral nerve inflammation.
• Autoimmunity is a suspected cause, suggesting autoantibody removal via plasma exchange may be therapeutic.

Purpose of the Study:

• To evaluate the efficacy and safety of plasma exchange as a treatment for CIDP.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and quasi-RCTs comparing plasma exchange with sham or no treatment.
• Searches conducted across multiple databases (Cochrane, MEDLINE, EMBASE, etc.) up to June 2015.
• Independent data extraction and risk of bias assessment by two reviewers.

Main Results:

• Two small trials (18 and 29 participants) demonstrated significant short-term improvements in disability and impairment scales with plasma exchange.
• Electrophysiological measures showed significant improvements in motor nerve conduction after 3-4 weeks.
• Adverse events occurred in 3-17% of procedures, some serious; rapid deterioration was noted in some patients post-treatment.

Conclusions:

• Plasma exchange provides significant short-term benefits for CIDP patients, improving clinical and electrophysiological outcomes.
• Potential for rapid deterioration and adverse events necessitate caution and further research.
• More studies are needed to identify strategies for prolonging the therapeutic effects of plasma exchange.