Efficacy of azathioprine and methotrexate in patients with chronic inflammatory demyelinating polyneuropathy (CIDP)

The study examined the efficacy of various immunosuppressants in patients with chronic inflammatory demyelinating polyneuropathy. We compared the efficacy of Azathioprine and Methotrexate in the treatment of CIDP. Patients of either gender aged ≥18 years having chronic polyneuropathy progressive for at least 8 weeks having no serum para protein or any genetic abnormality and fulfilling the Koski criteria. To measure the efficacy, Overall Neuropathy Limitation Scale (ONLS) was used. Group 1 was treated with a combination of oral steroids i.e., Prednisolone and Azathioprine while group 2 was treated with a combination of Prednisolone and Methotrexate. ONLS was statistically insignificant in the patient groups (AZA versus MTX) at the beginning of the therapy (from 1-3 months) in both groups. However, in the 4th month, the AZA group performed better than the MTX group. At the 12^th month, the mean ONLS score of the patients in the AZA group was 3.69, while the mean ONLS score of the patients in the MTX group was 5.30 (p-value=0.001). We concluded that Azathioprine was more efficacious as compared to Methotrexate in the treatment of CIDP based on ONLS and should be considered as a first-line immunosuppressant in the treatment of CIDP in low-income countries like Pakistan.